Antibiotics and Antibiotic Resistance: A Q&A With Steven Q. Simpson, MD
November 28, 2019
Antibiotics are one of the most readily available prescription medications. According to the Centers for Disease Control and Prevention (CDC), almost 270 million antibiotic prescriptions were filled by consumer pharmacies in the United States in 2015 alone. This comes out to 5 out of every 6 people in the U.S. getting at least one antibiotic prescription in that one year alone. And the CDC reported that at least 30% of the prescriptions were not called for, often prescribed for an illness that wasn’t bacterial. There are also over-the-counter products that contain antibiotics. They come in eye drops, ear drops, ointments, and more. These are often used without a doctor’s supervision.
There is no argument that since antibiotics were discovered, they have saved millions of lives. Untreated or delayed treatment for infections can cause sepsis, which can lead to serious complications, even death. But overuse and misuse of antibiotics has resulted in another problem, one predicted by the scientist who discovered penicillin, Sir Alexander Fleming. He warned in 1945 that bacteria could become resistant to antibiotics. And he was right. Signs of antibiotic resistance started as early as 10 years after penicillin became widely available. Now, the CDC estimates that at least 2 million people each year in the U.S. contract an antibiotic-resistant bacterial infection. At least 23,000 of these people die.
U.S. Antibiotic Awareness Week ran from November 18 to 24, and Sepsis Alliance asked Steven Q. Simpson, MD, to answer some common questions regarding antibiotics and antibiotic resistance. Dr. Simpson is the Chief Medical Officer for Sepsis Alliance. He is also a Professor of Medicine and Acting Director of the Division of Pulmonary and Critical Care Medicine at the University of Kansas, as well as Chair of Interdisciplinary Critical Care at the University of Kansas Hospital and Medical Director of three intensive care units.
We keep hearing about antibiotic resistant bacteria – are there bacteria that are resistant to all antibiotics or is it just some?
Yes. There are most assuredly bacteria that are resistant to all known antibiotics. For patients who become septic with these bacteria, our therapies are not much different from what they were 100 years ago. We give supportive care, in hopes that the patient’s own immune system can eradicate the bacterial load. At present, we have nothing further to offer. Fortunately, however, most resistant bacteria do have some sensitivities to some of our available antibiotics. For now.
If an antibiotic can kill bacteria, how does it happen that bacteria can become resistant?
Not all of our antibiotics kill bacteria. The word for killing bacteria is bactericidal. The word for antibiotics that don’t kill bacteria is bacteriostatic. The “static” part means that the antibiotic doesn’t kill the bacteria but keeps it from growing.
Often the antibiotic interferes with the machinery that bacteria use to make the protein. Proteins are vital for bacteria to survive, just like they are for us. We can eat proteins, but bacteria can’t. They have to make their own from the ingredients they find in their surroundings. So, if we interfere with their ability to do that, they don’t die right away, but they still can’t grow or reproduce.
Other bacteria have learned to produce enzymes that chew up our antibiotics, and this is another way for them to be resistant. In some cases, one type of antibiotic induces enzymes from the bacteria that not only chew up themselves, but leave the bacteria ready to chew up other antibiotics, too. This is a second way that bacteria become resistant to our antibiotics.
Why is antibiotic resistance a concern? Can’t we just do more research and get more antibiotics?
Wouldn’t it be great if it were that easy? Research in this area takes many years and is very, very expensive. Further, the targets on known bacterial pathogens have been pretty well mined, so that it is difficult to find new ones. Many of our antibiotics are either naturally occurring or are off-shoots of naturally occurring chemicals, meaning that the originals were found in nature and adapted for use in humans. Actually, penicillin, the first antibiotic, was discovered this way, and it is purified from a mold that Alexander Fleming found growing in a petri dish. Unfortunately, almost all bacteria are now resistant to penicillin. New research ideas don’t just grow on trees; they are hard to come by.
If there are warnings about not using antibiotics too much, how does this reconcile with the treatment of suspected sepsis with antibiotics right off the bat, even if you don’t know exactly what is causing the infection at first?
When we talk about preserving our antibiotics, we are talking about saving them for people with life threatening infections and not using them in people who have either viral infections or trivial infections (think about an ingrown hair or a pimple). Sepsis is a condition marked by organs that are failing and threatening a person’s life. We know that the faster a patient with sepsis gets the correct antibiotic, the more likely they are to survive. When we see an infection that has resulted in life-threatening organ damage, we owe it to our patient to use what we call broad-spectrum antibiotics, which means antibiotics that will be good for almost any bacteria. We do that so that we don’t accidentally give them an antibiotic that their bug is resistant to and that won’t help our patient, at all.
There is definitely a down side to giving a broad-spectrum antibiotic to a patient, and that is that we might induce antibiotic resistance in some of their own natural bacteria, like those that live in their intestines. Because of this real possibility, as soon as the cultures tell us which bacteria are causing the patient’s infection, we should reduce the antibiotics we give, so that we are killing the bacteria causing the patient’s infection but not many more. Another thing that can happen is that antibiotics can allow the growth of a particular type of bacteria called Clostridium difficile in a patient’s intestine. Just like the name looks, that is a bacterium that is difficult to treat and that can cause a diarrhea that is life threatening, itself.
The truth is that antibiotics, like every drug are not natural parts of us and like every other drug, they all have unwanted side effects. We should use antibiotics appropriately when circumstances are dire, and we should avoid antibiotics appropriately when they are not. We have often said that all drugs are poisons in one way or another, and if God wanted them in us, he would have put them in us to begin with. We should only use any drug when we truly need it, and when we don’t need it, we should not use it. Antibiotics are no exception to this rule.
What can we do, as members of the public, to slow down the development of antibiotic resistant bacteria?
Do not request and do not accept antibiotics for a cold or the flu. And follow the same rule for your children. They WILL NOT help you or your child and they will help some of your own body’s bacteria to become resistant. When you visit loved ones in the hospital, wash your hands before and after you see them. Ask questions about any antibiotic your doctor gives you, even if you are in the hospital. And tell your doctor that you want any antibiotic stopped as soon as it is safe.
To learn more about different types of infections that can cause sepsis and conditions that can increase your risk of infection and sepsis, please visit our Sepsis and… library, where you will find topics ranging from Sepsis and Diabetes to Sepsis and Pregnancy & Childbirth, and more.