Superbugs: antibiotic resistance

The idea that your child’s ear infection or a simple throat infection could develop into a life-threatening illness seems ludicrous, but it could happen in the near future.

The nightmare scenario whereby our most potent antibiotics don’t work may soon be a reality unless we stop the overuse and misuse of antibiotics. Ironically it is our great fear of the development of killer infections that may be triggering the development of these superbugs.

In the past, antibiotics seemed to be an invincible weapon in our fight against illnesses caused by bacterial infections. But the superbugs are fighting back against our best antibiotic drugs and drug resistant strains are on the increase worldwide. The most vulnerable members of society, the very young and the elderly and those who are really ill in hospital, are most at risk.

So why do we seem to be losing our fight against this new generation of bacteria dubbed superbugs?

The major reason is that bacteria are so plentiful and omnipresent. They grow everywhere and they are constantly trying to gain an advantage by mutating or changing themselves. So when we kill them with antibiotics or other chemicals they will change to try and avoid being killed. This includes the harmless bacteria and the ones that are most deadly.

It is not just these new mutant disease causing organisms that are dangerous to vulnerable individuals, but also new drug resistant strains of old bacterial diseases such as tuberculosis.

The more mutations or changes that we induce in bacteria the greater the future risk. The challenge of having antibiotics about is a great inducer of change in bugs as they reproduce.

So there is an increasing importance to limiting the use of antibiotics and using them correctly. About half of all antibiotic use is inappropriate and GPs prescribe about 80% of the human antibiotics given to patients in Ireland. So targeting bad antibiotic prescribing practices in the community is a priority.

Antibiotics are not cure alls and there are many misconceptions about them.

Giving antibiotics for childhood ear infection is a good example as nearly all children will have at least one at some time, and it is the most reason for antibiotic prescribing in children.

In many cases, antibiotics are prescribed immediately and this may not be the best approach as they may not always work. Antibiotics probably are the best option in those with pain in both ears and who are under 2 years of age. But in the case of mild infection in an older child, it might be better to watch and wait as there may be reduction of pain anyhow after 48 hours as the infection runs its course. If things have not improved in 2 or 3 days then it is generally advised that the GP prescribe antibiotics. However, in 85% of children, their symptoms will nearly be gone by that time without any antibiotic treatment being needed. Also there are some downsides to giving antibiotics apart from encouraging resistance, such as secondary infections or fungal infections.

Antibiotics are also ineffective against most throat infections. Viruses cause 80-90% of sore throats; so taking antibiotics to treat them is a complete waste of time as antibiotics do not kill viruses.

Viral sore throats can usually be distinguished from a strep throat, requiring antibiotics, usually by the presence of swollen or tender lymph nodes, but a throat swab sent to the lab will provide a definitive diagnosis. A return visit to the surgery will be required. This is inconvenient for most of us patients who expect a fast cure, so there is often pressure on the GP to prescribe an antibiotic. One important point is the time when the patient visits the GP and ask for an antibiotic for a sore throat. Most usually go about 24 to 48 hours before their condition improves anyhow. So then they will attribute the improvement in their condition to the antibiotic and not realize they will have recovered by that time anyhow. This of course reinforce the idea that the antibiotic was the cure.

Most people who get these nasty superbug infections are in hospital with serious illness. Their immune system is already compromised and weak. They may have had major surgery, serious trauma after a car accident or burns, or have some underlying illness such as cancer. They are likely to have been in hospital for some time and be on long-term antibiotics.

The last line of defence antibiotics  are usually given to these patients but even they are beginning to fail. Currently, these kind of serious bacterial infections are confined to the hospital setting, but that does not mean they will not spread into the community.

Reducing inappropriate antibiotic prescribing in the best preventative approach to infections with the superbugs. This includes the reduction of antibiotic prescribing for viral and fungal conditions. Overuse and inappropriate use of antibiotics in agriculture could impact on human health in the future and should be reduced.

All of those prescribed antibiotics should finish their course to prevent resistance developing. The best antibiotics should be reserved for those who really need them.

So next time you visit your GP with a cold or flu, and are worried about your relatively mild illness breaking into your hectic lifestyle, think twice before you before you lose your cool when he doesn’t prescribe you an instant fix antibiotic cure.

Conor Caffrey is a medical and science writer.


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