15 May Sometimes You Should Give Antibiotics A Rest
The Uses And Abuses Of Antibiotics
"Doctor I think I have a spider bite!"
To your health care provider, that means MRSA until proven otherwise. Many people who believe they were bitten by spiders actually have Staphylococcus abscesses. MRSA, or Methicillin-resistant Staph aureus, is a strain of bacteria on the march.
MRSA has garnered its share of headlines over the past decade for good reason. It has been labeled the "Modern Day Plague" and "Flesh Eating Bacteria." It is a modern and continually evolving disease; a disease of our making. It is Frankenstein spawned from the soups of antibiotics we have poured into our bodies and food supply for 70 years. It is a disease that proves the dominion humans believe they hold over the earth is an illusion.
Staphylococcus aureus is a bacterium found on all normal human skin and has likely coexisted with us since the beginning. Through poorly understood reasons, it sometimes causes abscesses, boils and other nasty rashes. It can get into the blood and colonize about every organ even in otherwise healthy individuals. The term "methicillin-resistant" means that most penicillin-derived antibiotics have lost their ability to kill the bacteria. So while we all carry Staph bacteria on our skin, more and more of us are harboring the MRSA strains. Now it is not unusual to encounter strains resistant to three or four entire classes of antibiotics. And in case you haven’t heard, there aren’t that many choices left. Due to onerous FDA approval processes, the pharmaceutical industry is shying away from developing new drugs. Up until 1999, we went 30 years without a new class of antibiotics brought to market. What is the FDA doing about it? Not much.
In 1969, the U.S. Surgeon General, William Stewart, bragged to Congress it was time to "…close the books on infectious diseases." Such naive confidence! We underestimated the enemy. MRSA has evolved ingeniously clever devices to survive our antibiotics. They have molecular cloaking mechanisms that render them invisible to our treatments. Some even have developed a pump that spits the antibiotics right back out. This bag of tricks is not MRSA’s alone; many bacteria are now pulling off the same stunts. Some strains of Medieval "Black Plague," aka "Bubonic Plague," are now resistant to eight different antibiotics. This is the same plague that wiped out a third of Europe in the 1300s. And it is still alive and well in the world.
About 80 percent of antibiotics sold in America are not used for medical reasons. They are fed to healthy animals for the purpose of fattening them up, not to treat disease. The FDA warned us back in the ’70s that indiscriminate use of antibiotics to promote livestock growth would contribute to resistant strains.
In 1977 they even passed a law against the practice. The agriculture lobby pushed back and it was never enforced. Last month a federal judge ruled the agency has to enforce its own 35-year-old rule after several public safety groups filed suit. Now antibiotics are only to be utilized when an animal actually has an active infection and they are to be prescribed by a veterinarian.
The FDA has kindly requested a "voluntary" compliance and their recommendations are not binding. The agriculture industry is not happy about the decision and opposed the legislation vehemently, warning of higher food prices. Health care officials are worried the FDA’s ruling is symbolic only and lacks any real enforcement power. It is not difficult to imagine large agribusiness ignoring the ruling completely.
It would be easy to lay all the blame at the feet of agribusiness. But health care professionals have thrown plenty of kerosene on this fire themselves. The over-prescribing of antibiotics and poor sanitary conditions of hospitals has turned our hospitals into unintentional biological warfare laboratories. But the difference between the agriculture industry and health care industry here is that we have admitted ownership of the issue. Whereas big agribusiness has spent millions denying they even contribute to the problem, the health care industry worldwide has adopted numerous measures to combat this problem.
So are we learning our lesson? What keeps us from abusing any new antibiotics that may come to market?
I try to limit the prescribing of antibiotics in my practice, and the third-party payers thwart me at almost every turn. For example, when I conscientiously prescribe an antibiotic-sparing medication for acne, that medicine is routinely denied. I receive the message, "Patient must fail two antibiotics before approval of your requested medication."
People also call every day asking for an antibiotic to be phoned into their pharmacy without an examination, with no more concern than they would show when ordering out for a pizza.
The emergence of MRSA is a reflection of who we have become as a society. Take a pill for your problem. There is no problem science cannot absolve us from. If the MRSA story could be summoned up in a fable, it would read as a Greek tragedy. The Gods grant humankind a most precious gift (antibiotics), that through our hubris and poor stewardship ends up turning upon us.
When it comes to preventing MRSA infections, advice ranges from simple hand-washing to fumigating your house and impounding your dog. I usually reiterate hand-washing with patients.
I recently was in the bathroom of a movie theater and noted the majority of grown men didn’t wash their hands. Most of the children and teenagers went right to the sink after doing their business. The men just zipped up and out the door they went. Hopefully this is a sign that the social dinosaurs who don’t wash their hands will be extinct in a few years. Visit the CDC.gov website for more practical tips to prevent the spread of infections.
When Do You Need Antibiotics
If you are diagnosed with an infectious disease, ask your doctor if antibiotics are really the best choice for you. Many doctors will be relieved to hear that you don’t expect them. The Centers for Disease Control and Prevention recommend against using antibiotics for uncomplicated skin infections. Most cases can be simply drained or lanced and will result in total cure. The continued piling on of more and more antibiotics only compounds the problem in the long run.
It will probably be in our lifetime when we wake up one day and realize we’ve squandered away the greatest medical breakthrough in history. Do your small part in delaying that day a little longer.
And stop blaming the spiders; they can’t argue back.