Antibiotic overuse on the rise

Dr. Jeff Hersh: Antibiotic overuse on the rise.
http://www.tauntongazette.com/health/x635404220/Dr-Jeff-Hersh-Antibiotic-overuse-on-the-ri
se?view=print
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By Dr. Jeff Hersh
GateHouse News Service
Posted Oct 20, 2008 @ 08:38 PM

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.Q: I read an article about antibiotic-resistant bacteria. Why is this
a big deal? Can't you just use a different antibiotic? It said using
antibiotics is a cause of bacteria becoming resistant to antibiotics.
Isn't this circular reasoning?

A: Antibiotic-resistant bacterium are a major worldwide public health
threat. This has become such an important issue that the Centers for
Disease Control launched the "Get Smart About Antibiotics" campaign
Oct. 6.

We are all colonized by bacteria, called our "normal flora." These
"normal" bacteria live on or in us without causing disease and can
even help us. For example, some bacteria in our intestines make
vitamins.

Whenever we take antibiotics, we risk disturbing the balance we have
with these colonizing bacteria. Although uncommon, offsetting this
balance can allow a strain of our normal flora to develop antibiotic
resistance, becoming "stronger" and more difficult to kill. There may
not be other effective antibiotics, or these alternate treatments may
cause more side effects or other problems, so the strategy of using
some other antibiotic may be limited.

For example, a resistant strain of Staphylococcus aureus (a bacteria
that lives on most people's skin) called MRSA has become much more
prevalent. Rates of MRSA for intensive care unit infections have
increased from 34 percent in 1996 to more than 60 percent in 2004.
Unfortunately, infections from MRSA are more virulent (cause worse
disease) and are harder to treat.

Furthermore, altering the balance we have with our normal flora can
occasionally cause some of these otherwise benign colonizing bacteria
to cause illness. About 5 percent of the population is colonized by
Clostridium difficile (C. diff) at any given time. The rate of illness
from C. diff has increased by about 10 percent per year for the last
several years, with mortality quadrupling from 6 per million people in
1999 to 24 per million in 2004.

When antibiotics are used for appropriate reasons, such as to treat a
bacterial pneumonia, they can be life-saving. For these appropriate
uses, the benefits of treatment far outweigh any risks of altering our
normal flora, and so antibiotic treatment is indicated.

However, these risks are huge when compared to no possible benefit
when antibiotics are used for inappropriate reasons. Furthermore,
these risks have become a public health problem since antibiotic-
resistant bacteria can be spread from person to person.

The CDC's campaign is specifically trying to address the tens of
millions of antibiotic prescriptions written to treat upper
respiratory infections of viral origin that are not responsive to
antibiotics. These include:

- Colds, such as with typical winter runny noses and coughs

- Most sore throats (excluding those caused by strep which do require
antibiotics)

- Most cases of sinusitis

- Most cases of bronchitis

- Most middle ear infections with effusions in kids

The reasons so many of these infections are inappropriately treated
with antibiotics are many, but include patient's expectations of
getting a prescription from their health-care provider. There are many
myths that make people think they need antibiotics:

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