Antibiotic Resistance Essay, Research Paper

Horror movies graphically reveal the ravages of killer plagues and flesh-eating bacteria, but behind this Hollywood hype is a story of real immanent danger. Antibiotic resistant strains of staph and strep are putting the lives and health of people at risk. When first discovered, about 75 years ago, antibiotics were touted as a miracle cure, which they literally were. Infections that were fatal before the turn of the century were turned into mere inconveniences over the last 75 or so years.

But we ve come almost full circle, the misuse, over prescriptions, and abuse of antibiotics has allowed resistant strains of bacteria to develop and once again threaten health and life. Diseases that were virtually eliminated with the introduction of antibiotics are mutating, gaining strength, and resisting treatment. The global increase in resistance to antimicrobial drugs, including the emergence of bacterial strains that are resistant to all available antibacterial agents, has created a public health problem of potentially crisis proportions.

How does antibiotic resistance happen? Any time bacteria are exposed to an antibiotic, they are under selective pressure that allows only resistant forms to survive and reproduce. Under an antibiotic blitz, a tiny fraction of any population of otherwise-susceptible bacteria can survive, because they possess mutations- -acquired randomly or from other bacteria that slip them rings of DNA called plasmids- -that counter an antibiotic s effect (Ferber 792). So the basic rule in slowing the evolution of resistance is reducing the unnecessary use of antibiotics because once antibiotics that have lost their effectiveness won t become powerful weapons again (Morell 576).

Antibiotic use in the United States has soared since the 1950s, when the total American production of antibiotics was about two million pounds per year. Today the figures exceed 50 million pounds. More than 40 percent of that amount is used in agriculture. Antibiotics are

given to animals to treat infections and some are mixed into feed. The amounts consumed in feed are too little to eradicate infection, but are enough to select for resistant bacteria that could pass on to people who consume undercooked meat or raw eggs. Antibiotics mixed into aerosols sprayed on fruit trees get rid of some bacteria, but also contribute to the selection of resistant ones. Antibiotic residues left on unwashed fruits may attack the good bacteria in our intestinal tracts instead of selecting for more virulent strains. The remainder of the antibiotics produced becomes medications for human use. While necessary and often life saving, these drugs are being taken inappropriately.

Is an antibiotic necessary at all? There are many people who believe that when they get sick, antibiotics are the solution. The more times you uses a drug, the more it will decrease the effect it has on you. Viruses, not bacteria, cause colds and flu, thus antibiotic treatment is useless and breed resistance. Treatment for eye infections is another major cause of resistance. Doctors write out more outpatient antibiotic prescriptions for these infections often wrongly than for any other condition except sinusitis (Super-germ 60). In a review of 1,500 physicians with more than 28,000 patients encounters in the National Ambulatory Medical Care Survey, over 50% of patients with the diagnosis of colds or upper-respiratory infections (conditions usually caused by viruses) were given antibiotics (Gonzales 903).

It is difficult in many cases to differentiate between the symptoms of viral and bacterial infections. Since in many cases the symptoms can be very similar, it might take several days to make an accurate diagnosis. Because of this difficulty patients request antibiotics immediately even though they might have a viral infection and not one of bacterial nature. About 12 million

antibiotic prescriptions were written for respiratory infections in 1992, even though the cause of more than 90 percent of such infections tends to be viral (Science 257).

The fault of antibiotic resistance is not with the developers but rather on the doctors and patients. Excessive and inappropriate antibiotic prescribing is believed to be an important factor in increasing bacterial resistance (Resistance Movement 12). An influence to the doctors prescribing inappropriate antibiotics is partly due to the patients persistency is demanding antibiotics. A survey showed last year that 25% of people were persistent in demanding antibiotics for colds and flu, which are viral and cannot be cured by antibiotics. This falls into the common misconception that people have when they walk into a doctor s office; they expect to walk out with antibiotics to cure their upper respiratory infection, earaches, sore throats, colds, and flu.

Pharmaceutical companies have taken to television and print advertising to promote their antibiotics direct to the consumers. The consumers see and hear about all the aspects and how well the antibiotics are supposed work. The advertising is so effective; it causes the viewer to demand certain types of antibiotics and in some cases by specific brands when they go to the doctor. This is a double edge sword; pharmaceutical companies are educating the consumers about illnesses and medication but at the same time the viewer cannot make the correct diagnoses. When they get to see the doctor, their mindset is only on the drug they have heard about and therefore request inappropriate medication for the treatment of their illness only because they have seen wonderful medical outcomes on television or in print.

For the past 20 years, pharmaceutical companies have distributed samples of medicine direct to physician offices. These include all types of antibiotic therapies as well as other types

of medications. The original method of distributing samples was to give physicians the ability to see the effectiveness of new medications. However, both the physician and the patient have misused the samples. Many physicians will give sample antibiotics to persistent patients who demand antibiotic therapies for aliments that may or may not be bacterial. This is another reason why antibiotics have such widespread use in cases that are not appropriate. The pharmaceutical industry must develop methods to monitor and govern their products so that misuse of antibiotics can be controlled.

Years ago physicians prescribed antibiotics for patients by selecting brands that they were most familiar with and outcomes that could be expected. With the new dynamics of consumer education by pharmaceutical companies physicians are now prescribing some brands of antibiotic therapy that they might not be totally familiar with. With these factors added together it is quite possible the patient is not being treated with the most effective treatment available. Our society and our methods of advertising are partially the cause the misuse of antibiotic therapy, which in turn we now know leads to antibiotic resistance.

Why do doctors prescribe antibiotics unnecessarily? Doctors feel pressure because they are afraid they ll lose their patients. Pediatricians say, Parents will think I m a lousy doctor because they took off time from work, they pulled their child out of day care, and I looked at the kid and said, Yup, he s got a cold. Bye. And patients feel like, Why did I spend all this time going to the doctor when I didn t get anything (Liebman 6). At a seminar I [Stuart B. Levy] conducted, more than 80 percent of physicians present admitted to having written antibiotic prescriptions on demand against their better judgment (5). This is widely part to the change in health care, unlike years ago when doctors could sit down and talk to the patients and explain

everything to them and still earn large quantities of money, doctors now must see large quantity of patients in order to see large amounts of money. Unrealistic patient expectations, coupled with insufficient time to discuss with patients why an antibiotic is not needed (Science 257). All of this subsequently leads to doctors inappropriately prescribing antibiotics unnecessarily because they just don t have the time to spend talking to there patients and explaining everything. As noted, increasing antibiotic resistance is a worldwide problem, and is likely to continue into the future.

Obviously, if a bacterial pathogen is able to develop or acquire resistance to an antibiotic, then that substance becomes useless in the treatment of infectious disease caused by that pathogen. So as pathogens develop resistance, we must find new, different, antibiotics to fill the niche of the old ones in treatment regimes. Not only is there a problem in finding new antibiotics to fight old diseases because resistant strains of bacteria have emerged, there is a parallel problem to find new antibiotics to fight new diseases. This has driven the pharmaceutical industry to produce new agents and has contributed to dilemmas in treating outpatient respiratory infections (Singh 47).

It is said that the discovery and use of antibiotics and immunizations procedures against infectious diseases are two developments in the field of microbiology that have contributed about twenty years to the average life span of humans in developed countries where these practices are employed. While the greater part of this span in time is probable due to vaccination, most of us are either still alive or have family members who are still alive because an antibiotic conquered an infectious disease that otherwise would have killed the individual. If we want to retain this medical luxury in our society we must be vigilant and proactive: we must fully understand how

and why antimicrobial agents work and why they don t work and realize that we must maintain a stride ahead of microbial pathogens that can only be contained by antibiotic chemotherapy.