Dr. Jeff Hersh: Antibiotic overuse on the rise

Dr. Jeff Hersh

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:

Myth: If a cold persists for more than three days, antibiotics are needed.

Fact: Colds commonly last five to seven days, and sometimes 10 days or more.

Myth: If a child gets a high fever, they need antibiotics.

Fact: Most childhood infections, even those that cause high fevers, are from viral infections that do not require antibiotics.

Myth: If the nasal discharge is yellow or green it requires antibiotics.

Fact: There is no correlation with mucus color and the need for antibiotics.

With the colder weather coming, many of us will get URIs. Instead of pressuring your health-care provider to prescribing inappropriate antibiotics, there are beneficial things you can do for you and your community:

- Wash your hands frequently. This will decrease the chance you will get ill, and if you do it will decrease the chance that you will pass it on to someone else.

- Drink plenty of fluids and get plenty of rest. Chicken soup is a more effective treatment for an RI than inappropriate antibiotics.

- Get a flu shot.

- See your health-care provider if you are not sure it is just an URI, but if they tell you antibiotics are not required, be patient; time is often a great healer.

Jeff Hersh, Ph.D., M.D., F.A.A.P., F.A.C.P., F.A.A.E.P., can be reached at