The Risks of Antibiotic Resistance

When they were discovered in 1928, antibiotics saved many lives. Over the years, they became almost like candy, used for nearly every part of the body that has gone awry. Antibiotics became a "necessity" - even when not needed. Some even became a placebo, making people think they got them better when, in fact, it was their immune system and time that helped them improve. Now, many antibiotics no longer work very well when people need them. When antibiotics don't work,  what will we do when we get really sick and need them?

Antibiotics for Bacterial Infections

"It's okay if I get an antibiotic this one time. I never take antibiotics so, I won't get resistant". Misconception. Why?

Its not always just about the one person getting an antibiotic. There are actually two major types of resistance: personal and community. While weak and susceptible bacteria die off every time a person takes an antibiotic, a few resistant ones—which have developed an "armor" against the antibiotics—remain behind to multiply and produce more resistant "offspring" like themselves.

The primary ways you can develop resistance to an antibiotic:

1. By taking too many antibiotics, each of which creates more and more resistant organisms.

2. By contracting an illness from someone with resistant organisms (this occurs frequently in hospitals through cross-contamination).

3. Antibiotics are used to decrease the bacterial load to a manageable level for the person using them. People working with antibiotics have been saying for years that if you do not finish your full course of antibiotics as directed, some organisms will initially die off, but the more resistant organisms may remain and multiply. This, in fact, may NOT be the case. Several studies are being done in the UK, one of which was conducted by Peter Openshaw, a member of the British Society for Immunology at the Imperial College, suggest:

“It could be that antibiotics should be used only to reduce the bacterial burden to a level that can be coped with by the person’s own immune system. In many previously healthy patients with acute infections, letting them stop the antibiotics once they feel better has considerable appeal. However, there are clearly circumstances where antibiotics should be given for extended periods..." (1)

In the past, sources argued that if you did not take a standard ten-day course of antibiotics, you would develop more resistant organisms in your body. Sources now suggest that this is no longer true and that an entire ten-day course may not be necessary. There are several arguments for shortening the course of antibiotics:

• Shortening the course of antibiotics will allow your body to develop greater immunity,

• If the course is shorter, patients are more likely to complete it.

• It will be less expensive.

• The longer an antibiotic is taken, the greater the likelihood of developing side effects.

• Resistant diseases cost the US 4.6 billion dollars annually in healthcare costs (2021 study)

Patients frequently tell us, "I took the medicine I had left over from the last time I was sick" (meaning they did not take it all when they initially got it for an illness). Or, the patient tells us they stopped taking antibiotics when they felt better (they never finished the entire course), and while it does happen, most did not relapse. Either the patient's immune system took part in the fight along with the antibiotic, or, perhaps, the short-course antibiotic worked well. Or...maybe they did not need an antibiotic: It was a "green mucous virus." Whatever the reason, the shorter course of antibiotics worked.

The information is scant but apparently, the idea of giving people antibiotics for ten days was developed arbitrarily on the premise of "not too much and not too little."

So, should we prescribe an antibiotic course tailored to the severity of the patient's illness? Giving a person an arbitrary ten-day course of antibiotics should be worthy of some medical conversation among medical specialists and microbiologists. Is it time to take a closer look at our current practices?

Important Note: The NIH does warn that further studies must be done before providers and patients change their current practices. Patients should take the antibiotics according to their healthcare provider's instructions.

4. A fourth mode of resistance: We eat meat and poultry that have been given antibiotics to fatten them up (yes, they gain weight!) and treat things like animal salmonella and E. coli. The resistant organisms then get passed on to us. (Cook your meat adequately!).

5. According to various sources (2), antibiotics (and other medicines) are dumped (and flushed) into our waters by individuals, farms, pharmaceutical industries, hospitals, and nursing homes, among others. This creates resistant organisms in the water we sometimes drink or irrigate with, creating even more of a risk of antibiotic resistance.

So, antibiotic resistance is NOT just from personal use of antibiotics. Resistant bacteria pass from animals to people, from water to people; we spread resistant bacteria from people who sneeze in stores, from friends to family to coworkers. Antibiotic resistance can eventually affect an entire community.

The key is, in great part, NOT GETTING SICK TO THE POINT OF NEEDING AN ANTIBIOTIC - practicing prevention through a 20-second hand washing with regular soap (antibacterial soaps are thought to foster resistance as well!); sneezing into your sleeve; and getting enough rest, hydration and nutrition. Preventive products and symptom remedies are available over-the-counter or from reputable herbal/alternative medicine companies. Many of the latter have been used for thousands of years and, while not FDA-approved, may help. Be smart: Know what symptoms antibiotics do and do not work for - ask a healthcare provider or pharmacist (the latter may have great ideas at no charge!).

Unless you have a good reason to avoid them, consider getting the flu, COVID-19, and pneumonia vaccines before cold and flu season begins.

Facts about Antibiotic Resistance and Its Risks

• According to a CDC quote in 2017, antibiotic-resistant bacteria sickened more than two million Americans each year and accounted for at least 23,000 deaths. The main cause? Overuse of antibiotics. While this occurs in some clinic patients we see, the incidence is even higher in hospitals.

• It is estimated that, worldwide, over ten million deaths occur annually due to antibiotic resistance. These numbers might not mean too you right now - until you actually start hearing about it and seeing it, when it may be too late to change our antibiotic habits.

• A growing number of infections—such as UTIs, pneumonia, tuberculosis, gonorrhea, salmonellosis, staph, chlamydia, and syphilis—are becoming harder to treat as the antibiotics used to treat them become less effective. Unfortunately, some antibiotics that used to work for strep and ear infections no longer work for these things.

The Soapbox

At one point, I worked at an urgent care clinic. The most common complaints to the administration were from patients who had not received an antibiotic from the provider. 

Given what you have read, please understand that the healthcare provider is trying to maintain the integrity of your health. They are trying to spare your immune system, your money, your gut, and the embarrassment of taking a placebo (even if they do not call it that). They are not being negligent. Please listen to what they are saying.

Sometimes, to avoid another visit or charge, you can ask them to place the antibiotic on "hold" at the pharmacy in case it gets worse later. But do try other measures first if you can and if they are appropriate.

THERE ARE CASES WHEN A PATIENT REALLY SHOULD HAVE AN ANTIBIOTIC. WHEN IN DOUBT, SPEAK TO A HEALTHCARE PROVIDER OR PHARMACIST WHO CAN POINT YOU IN THE RIGHT DIRECTION.

Is the "Good Life" gone? Remember when you went to the doctor and said you were sick, and they gave you an antibiotic ..no questions asked? You may get "lucky" but, in general, those days are gone.

Our culture is an “antibiotic cures all” culture. Over the past several decades, this is what people have learned: "Go to your healthcare provider - he or she will give you an antibiotic, and you will be cured." After several days, you get better (most of the time, you would have gotten better with time alone, without the antibiotic). Many ailments are self-limiting, including otitis media (ear infection), conjunctivitis (pink eye), and even bronchitis! If the healthcare provider refuses the antibiotic, the patient gets angry, “But I have always gotten antibiotics for this!” 

The problem today, as I see it, is that we live “life in the fast lane.”  How often do patients tell us,  “I don’t have time to be sick??” "My kid has a birthday party next weekend;" "I have to travel for work and speak at an important conference;" "I am a valedictorian speaking at a high school graduation in two days;" "My child is sick, and I can't take that time off." It is the child who can’t miss school, the star athlete who has a big out-of-town baseball tournament on the weekend,  the Disney trip where parents can't get a refund for illness, the waitstaff whose boss won’t let him off, the accountant during tax season, the hourly wage workers who can't afford take time off work to nurse themself back to health…the person who does not want to pay another high copay for a repeat visit in this day and age of increasing copays and high deductibles.

How do we “fix” this? It will take a lot of education: A change in beliefs in everyone from patient to practitioner, employer to employee, student to school administrator. We need to teach about resistance:” I don’t take a lot of antibiotics, so I am not worried about becoming resistant”…and community resistance.  We need a cheaper safety net for our patients so they don’t need to pay as much to be reevaluated if their illness worsens. We need easy and inexpensive tests to determine viral versus bacterial issues (I understand that these are being developed). We also need an armament of consistently GREAT non-antibiotic prescriptions and over-the-counter treatments/ protocols that work wonders.

No. This is not just saying, “No, you can’t have an antibiotic.” It is much more than that—it is developing protocols, better tests, and education. It is about "allowing " people time to rest and get better. To providers: It is important to take the time to teach and plant a seed… provided you have the time in your practice.