In 1900 the three leading causes of death were: pneumonia (viral or bacterial), tuberculosis (bacterial), and diarrhea and enteritis (bacteria or viral). Children under 5 years of age accounted for 40% of the total deaths caused by the aforementioned illnesses. By this time bacterial infections had already wiped out millions of people. Simple cuts could cause blood poisoning and there was nothing doctors could do about it. It was a scary time to be living indeed!
Then in 1943 a miracle drug was developed. Penicillin! This drug was the first of its kind (antibiotic) and saved countless lives. Soon more and more classes of antibiotics were being developed. To this day the discovery of penicillin is considered one of the most significant medical advances in history having saved millions of lives. No longer did man have to fear death from simple bacterial infections. It was a great time for all.
Soon enough, however, bacteria became wise to our drugs. By 1947, just four years after the discovery of penicillin, there was already a bacterium that had developed resistance to penicillin, most likely because penicillin was so widely prescribed-it was available without prescriptions. Even Alexander Fleming, discoverer of penicillin, warned that overuse would create “mutant forms” of bacteria that could cause more serious infections (1).
Amount of antibiotics prescribed per year
Between 2000-2010 about 1.4 billion outpatient antibiotics were prescribed in the US (2). This came out to be about 104 million antibiotics prescribed per year (2). This does not take into account the large amounts of antibiotics given in hospitals every day. The CDC reported that 4 out of 5 Americans are prescribed antibiotics each year.
Why we need bacteria
Antibiotics are indiscriminate killers of bacteria. We have trillions of bacteria in our body.They inhabit nearly all areas of our body including our mouth, skin and gut (3). Most of them are good. They help us digest plant starch, they help renew the walls of our digestive tract, supply essential nutrients, and help protect against the development of harmful bacteria (3). They also have roles in maintaining our immune system.
Some of the bacteria promote inflammation and some reduce inflammation. It depends upon our bacterial makeup. Some bacteria in us are opportunistic and when our immune system is compromised (as in AIDS) these normally harmless bacteria turn deadly. The point is that we NEED good bacteria in our body. Killing off good bacteria leaves our body open to the colonization from harmful bacteria.
What causes resistance?
The amount of antibiotics used and how they are used influence development of antibiotic resistant bacteria (4). Antibiotics which target a broad range of bacteria (compared to antibiotics targeting specific non general bacteria) increase the chance of creating resistant bacteria (4). Often doctors prescribe antibiotics for viral infections- to which they are useless (4). Sometimes doctors prescribe wrong doses of antibiotics for bacterial infections or prescribe antibiotics for incorrect periods of time- both contributing to antibiotic resistance (4).
Many times antibiotics are prescribed for colds, sore throats and other viral infections to which antibiotics do not work. 50 million courses prescribed for viral respiratory infections and 18 million courses prescribed for colds each year according to the CDC. A majority of the antibiotics prescribed per year are for children. Although decreasing, 229 antibiotic courses per 1,000 doctor office visits were prescribed in children less than 14 years old in 2007-2008 (5).
It seems that long term incorrect dosages of antibiotics produces more resistant bacteria than short term high doses of antibiotics (4). Human use of antibiotics makes up 50% of total antibiotic consumption in the US and the European Union (farm animals use very high amounts too) (4). Until about 10-20 years ago most antibiotic resistant bacteria were seen in hospitals due to the heavy use of antibiotics administered (4). There is much resistance outside of hospitals today as community doctors prescribe antibiotics very often in outpatient settings (4).
As many antibiotics are structurally similar, taking one antibiotic may cause development of bacteria that is resistant to multiple antibiotics. So even if one antibiotic is stopped and another began if they are similar enough bacteria will become resistant to both antibiotics. One of the most worrisome resistant bacteria is E. faecium. This bacteria is resistant too so many antibiotics (even new ones) that there is no antibiotic drug approved by the FDA for use against this bacteria (6).
Examples of resistance
A few examples of antibiotic use which may have spawned antibiotic resistant bacteria are as follows. In Finland there was a strong link between the increased use of erythromycin (an antibiotic) and an increase in erythromycin resistant bacteria seen in groups in the early 1990’s (4). In Iceland antimicrobial use was strongly associated with penicillin resistant bacteria in children (4).
An example of how quickly bacteria can develop resistance can be seen from the use of erythromycin (antibiotic alternative to penicillin) which was used in a Boston hospital and completely discontinued less than a year later because 70% of the bacteria it was used against became resistant to it (7). Bacteria are able to transfer their drug resistance to other bacteria in our colon.
Dangers of antibiotic resistance (what can happen)
Every year in the United States there are at least 2 million cases where people have resistant bacteria and at least 23,000 people die each year because of our inability to deal with these antibiotic resistant bacteria (8). Many of the medical marvels of today such as organ transplants, joint replacements, and cancer therapy rely on the ability of antibiotics to kill any bacterial infection resulting from these operations (9).
If we are unable to combat infections resulting from these types of operations the risk of death following operation will outweigh any benefit the operation offers. Many surgeries such as open heart surgery put the patient at an increased risk for surgical site infection which may rely on antibiotics to cure. People with cancer who receive chemotherapy have a lowered white blood cell count (these fight infections) so any infection can be potentially life threatening and quick use of antibiotics is paramount.
Since antibiotics kill ALL bacteria indiscriminately (even healthy bacteria we need) giving children needless antibiotics can destroy the normal healthy bacteria in their digestive system that they need for proper immune function. A study found that children who took antibiotics often when they were young were at an increased risk of developing asthma later on (10).
A theory from scientists that has not panned out was that over time bacteria that develop resistance to a drug once the drug is stopped for a long period the resistant bacteria will disappear as there is no longer selective pressure on the resistant bacteria (since the drug is not being used). Unfortunately, this does not appear true (4). High levels of antibiotic resistant bacteria in humans and animals have been found even when antibiotic use was stopped for a long period of time (4).
How to reverse the spread of resistant bacteria
It may be hard to reverse antibiotic resistance simply by reducing the amounts prescribed. Bacteria have developed a way to stabilize their resistant genes (4). Bacteria have developed resistance hand in hand with the increased number, volume and diversity of antibiotic classes prescribed in humans over the past few decades (4). As we developed and administered new antibiotics soon after we found bacteria in humans that were resistant to the new antibiotics (4).
One step that would help reverse resistance is the administration of antibiotics which target a narrow spectrum of bacteria and less administration of broad spectrum antibiotics which have been shown to produce more resistant bacteria than their narrow spectrum counterparts. It appears that reversal of antibiotic resistant bacteria is much slower than the development of antibiotic resistant bacteria and even after control and decreased use of antibiotics the levels of resistant bacteria decrease but do not reach the low levels seen before the use antibiotics.
Doctors must only be allowed to prescribe antibiotics for certain conditions. They must stop giving antibiotics for viruses just because the patient asks for some. Doctors must give the proper dosage so that all of the bacteria are killed and people must take the whole prescription and not stop when they feel better.
It is obvious that antibiotic resistant bacteria are potential health disasters if we keep using antibiotics incorrectly. Bacteria have been shown to have an amazing ability to adapt and evolve resistance to drugs. They evolve more rapidly than we can create new drugs. We do not have an endless supply of antibiotic drugs and the pace of discovering ones has slowed recently.
We do not want to return to the dark ages where people die from simple bacterial infections. Thousands of people already die each year because of resistant bacteria that we have no way to fight. When bacteria become resistant we are forced to try more and more different types of antibiotics which are very expensive and increase the risk of side effects from all the different drugs.
We should take steps to protect ourselves from developing antibiotic resistant bacteria. Parents should not let their children receive antibiotics for a cold or any other illness likely to be a virus. If you get sick try to let the illness go away on its own how it naturally would. If you must get antibiotics make sure you use the whole prescription. Stopping too soon can let the bacteria with resistance to the drug inhabit the colon and multiply.
- Alanis, A. J. (2005). Resistance to antibiotics: are we in the post-antibiotic era?. Archives of medical research, 36(6), 697-705.
- Lee, G. C., Reveles, K. R., Attridge, R. T., Lawson, K. A., Mansi, I. A., Lewis, J. S., & Frei, C. R. (2014). Outpatient antibiotic prescribing in the United States: 2000 to 2010. BMC medicine, 12(1), 96.
- Round, J. L., & Mazmanian, S. K. (2009). The gut microbiota shapes intestinal immune responses during health and disease. Nature Reviews Immunology, 9(5), 313-323.
- Barbosa, T. M., & Levy, S. B. (2000). The impact of antibiotic use on resistance development and persistence. Drug resistance updates, 3(5), 303-311.
- Arias, C. A., & Murray, B. E. (2009). Antibiotic-resistant bugs in the 21st century—a clinical super-challenge. New England Journal of Medicine, 360(5), 439-443.
- Davies, J., & Davies, D. (2010). Origins and evolution of antibiotic resistance. Microbiology and Molecular Biology Reviews, 74(3), 417-433.
- Kozyrskyj, A. L., Ernst, P., & Becker, A. B. (2007). Increased risk of childhood asthma from antibiotic use in early life. CHEST Journal, 131(6), 1753-1759.