Pending Consequences Overuse of Antibiotics Puts People’s Health at Risk

Most people don’t worry much about infections because they believe antibiotics can cure them. But overuse of these drugs has led bacteria to mutate and become resistant to many commonly prescribed medications.

In fact, the problem has become so severe that in March, World Health Organization Director-General Dr. Margaret Chan warned that, if the trend continues, a normal infection could become deadly.

“Things as common as strep throat or a child’s scratched knee could once again kill,” she said.

Jennifer Schimmel agrees. “There definitely could be unnecessary deaths that would have been treatable before antibiotic resistance developed,” said the infectious disease physician and co-director of Antimicrobial Stewardship at Baystate Medical Center in Springfield.

The Centers for Disease Control and Prevention cites the problem as one of the world’s most pressing public-health threats, while the Mayo Clinic says that antibiotic resistance can result in longer illnesses, more doctor visits and/or extended hospital stays, as well as a need to use more expensive and toxic medications, which in some cases have caused deaths.

No one denies the benefits of antibiotics, but the risks are often understated. Dr. Daniel Skiest, chief of infectious diseases at Baystate Medical Center and a professor of Medicine at Tufts University, says society has been much better off since antibiotics became available in the 1940s. “There are clearly many infectious diseases, such as pneumonia, meningitis, and urinary-tract infections, that are now treatable because of these drugs,” he said.

Dr. Colette Haag-Rickert, a principal with the practice Fitzpatrick, Moran, Costa and Haag-Rickert in Springfield, concurs. “Antibiotics are fantastic, and we don’t have nearly the number of deaths that occurred 100 years ago as a result,” she said. “Due to vaccines and antibiotics and clean water, the average life span has moved from age 40 to about age 80. But these drugs are very powerful and have risks, so people need to use them judiciously.”

Although danger exists — on a personal as well as societal level — when patients demand and take medication that is not needed, antibiotics are dispensed freely. A report published in the journal Nature says the average American child receives 10 to 20 antibiotic prescriptions by the time he or she is 18 years old, and between one-third and one-half of expectant women take them during pregnancy. However, these drugs can permanently change the beneficial bacteria people have in their bodies and make them susceptible to disease.

“When people are exposed to an antibiotic, the bacteria in their body may become resistant to it, so when they have another bacterial infection, that drug may no longer be useful,” Schimmel said.

Antibiotics do nothing to combat viruses, which include bronchitis, colds, the flu, most coughs, ear infections, sore throats, and stomach flu. And they kill good bacteria as well as the types that cause infection. “Since all organisms do whatever they can to survive, bacteria will mutate when exposed to these drugs,” Skiest explained. “And in some cases, if people are treated with multiple courses of antibiotics, they may develop resistant bacteria within their own bodies.”

In addition to immunity, side effects can be serious. They can range from an anaphylaxis reaction, which is life-threatening and can develop within minutes, to diarrheal infections to ruptures of the Achilles tendon. “Interactions with other medications can also lead to heart problems such as arrhythmia,” he said.

Serious Side Effects

When doctors believe their patient has a bacterial infection, Haag-Rickert said, they will often prescribe an antibiotic. However, there is a 15{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} to 20{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} chance it won’t work, because until lab tests reveal the actual type of bacterial strain and the best antibiotic to target it, it is impossible to predict with 100{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} accuracy what medication to use.

And side effects occur frequently. “The most common scenario occurs when a person takes antibiotics for a sinus infection and ends up with a yeast infection,” Haag-Rickert said, adding that this can present in the mouth as thrush, or in women’s vaginas and men’s groins, and can cause redness, itching, and burning. “It’s normal to have a small amount of yeast, but if you take antibiotics, that alters the normal balance in the mouth, on the skin, and in the colon.”

The problem can exacerbate when the balance in the colon is disturbed. Haag-Rickert said that, if the bacteria known as clostridium difficile (C. diff) begins to multiply, the person can experience severe episodes of diarrhea and pain and become dehydrated.

“It can be very difficult to eradicate and also difficult to restore the normal balance of flora,” she said, adding that C. diff typically exists in the colon, but only in small quantities. “Antibiotics kill off the good bacteria in the colon that help monitor balance and digestion. And when C. diff overgrows, it can lead to illnesses that range from mild to life-threatening.”

Schimmel says C. diff infections are increasing within the community. “In the past, we only saw them in the hospital,” she told HCN, explaining that broad-spectrum antibiotics carry a higher risk of changing the flora in the intestinal tract.

However, broad-spectrum drugs are called for in many instances, such as when someone is hospitalized and is very ill. But as soon as the lab results come back, “we streamline the therapy to target specific bacteria,” Skiest said.

Haag-Rickert cites nitrofurantin, often prescribed for bladder infections, as another antibiotic that can have serious side effects, since there is a slight risk of developing pulmonary fibrosis from taking it. “People can also have horrible reactions to sulfa drugs such as Bactrim or pencillin,” she said.

Schimmel said the New England Journal of Medicine reported that one of the risk factors for zithromax, commonly prescribed and referred to as a Z-Pak, is cardiovascular death, which is most pronounced in patients with cardiovascular disease.

Another drug that can have dangerous side effects is Levaquin, which is used to treat bronchitis, pneumonia, chlamydia, gonorrhea, and skin infections. “It’s a great drug for treating certain types of infections,” she noted. “But it’s strongly associated with C. diff, can lead to tendon rupture, and is also linked to retinal detachment,” which happens when the light-sensitive membrane in the back of the eye (the retina) separates from its supporting layers.

Even if side effects are not severe, antibiotics can cause a rash, nausea, vomiting, or problematic interactions with other medications.

“Antibiotics are important when people need them, and they can be life-saving,” Schimmel said. “But when they are used inappropriately, the risks outweigh the benefits.”

Indeed, some infections, such as gonorrhea and staph, have become resistant to common antibiotics. In addition, the incidence of the infection caused by methicillin-resistant staphylococcus aureus bacteria (referred to as MRSA), once only seen in the hospital, is increasing in the community.

“It can be serious, and if people are colonized with the bacteria, they can develop cellulitis, boils, and skin infections, which can be difficult to treat,” Skiest said. “Some hospital-associated bacteria has developed resistance to all antibiotics.”

Educational Initiatives

Many people visit their doctors when they have a cold, which is something antibiotics cannot help.

“Colds are viruses and won’t respond to antibiotics, but patients request them all the time,” said Haag-Rickert. “The vast majority of physicians try to educate people on whether their symptoms sound bacterial or viral, but there is a misperception on the part of the public, and many people confuse the two.”

Upper-respiratory-tract infections are one of the most common reasons people visit their doctors. “They want a quick fix, but there are more than 200 viruses implicated with the common cold, and it can take up to a week for someone to feel better,” said Skiest. “Occasionally, a cold can result in bacterial sinusitis, but that is quite rare, so the majority of time, people with a cold don’t need antibiotics. I tell my patients, ’there is no quick fix. You can get better in seven days with antibiotics or a week without them.’”

Rest and large amounts of fluids do make a difference, and Haag-Rickert says vitamin C and zinc can help the immune system. “If you are feverish, take Tylenol or ibuprofen, and if you have a sore throat, gargle with salt water. People should wait and see how they feel after a few days before calling their doctor.”

However, if they have drainage of yellow or green mucus from their nose after four or five days, it is time to consult with a physician.

Schimmel said the problem of antibiotics overuse also exists in facilities that cater to the elderly. In fact, there is a statewide effort to reach out to providers in nursing homes and long-term-care facilities to encourage more prudent use of the products. She has spoken frequently on the subject, and notes that antibiotics are frequently used to treat upper-respiratory infections and urinary-tract infections.

“It’s a complicated issue,” she told HCN. And, when it comes to office visits, “it takes a lot more time and effort for a physician not to give someone an antibiotic,” Schimmel said. “People think they are a magic bullet, and unfortunately many physicians don’t have the time to explain the downside of taking these drugs.”

Parents also play a role in the problem, as they often demand that pediatricians put their child on an antibiotic. “But children can develop resistance to antibiotics, and C. diff can also occur in them,” said Schimmel. “There are no benefits to treating anyone who has a virus with antibiotics.”

In the past, these drugs were prescribed on a routine basis for children with earaches. “But studies show there is no proof of an improved outcome if they take them,” Skiest said.

Still, people often associate feeling better with an antibiotic. “If someone takes them for a cold, there is not a cause-and-effect result, because they do not work against viruses,” Skiest said, repeating the message doctors hope the public will take to heart. “But people demand a quick fix for everything, which presents a significant problem, as bacteria are becoming resistant.”

Another significant factor is the failure of drug companies to develop new antibiotics. They aren’t spending money on research because there is no profit to be made, since these medications are only taken for a short period of time (compared to a drug that treats a chronic condition, such as cholesterol or high blood pressure), and they are unlikely to work in a few years because of overuse, said Skiest.

“In the past,” he noted, “there was always a rescue drug being developed, but that is no longer the case.”

New Findings

Researchers are learning that some infections can be eradicated with a shorter course of treatment than was used in the past. “An example is an uncomplicated urinary tract infection. We used to treat them for a week or longer, when all they need is three days of antibiotics,” said Skiest. “And some skin infections can be resolved in five days that used to be treated for seven to 10 days.”

There are other discoveries being made about these wonder drugs. But one thing is clear. Although they can save your life, their failure to work can make it more difficult to do so in a life-threatening situation. So, before you call your doctor, think about the long-term costs of taking these prescription drugs, and do what you can to alleviate your symptoms on your own.