The statistics on antibiotic use are jarring. Five prescriptions written each year for every six people in the United States. One-third of those antibiotics not needed at all.
C. diff is the overgrowth of this bacteria that most of us have in our gastrointestinal (GI) tracts but can get thrown out of balance after taking antibiotics. The infection is particularly deadly to seniors and those with compromised immune systems.
Antibiotics Aren’t Risk-FreeRachel Zetts, senior officer for Pew’s antibiotic resistance project, told The Epoch Times the nonprofit is shifting its antibiotic stewardship efforts to outpatient and community settings and encouraging patients to use their voice to protect their own health. Pew has been working to lower antibiotic overprescribing in hospitals since 2015.
“A lot of times there is a perception antibiotics are safe, and they are largely a safe and efficacious drug. There’s always a risk anytime a medication is prescribed,” Ms. Zetts said. “It’s really critical from our perspective that these antibiotics are used appropriately and when needed, both from a resistant perspective and a patient quality care perspective.”
The Evolution of BacteriaAntibiotics only treat infections caused by bacteria, and many unnecessary prescriptions are written for similar symptoms that have different root causes. Antibiotics don’t cure viral infections—like the common cold, influenza, COVID-19, coughs, stomach bugs, and even some ear and sinus infections.
“It’s tough because when you’re suffering, you want something to ease that suffering,” Romney Humphries, division director of the laboratory at Vanderbilt University Medical Center, told The Epoch Times.
“Sometimes antibiotics make you feel a little bit better...some of them have a little anti-inflammatory response. But all you're really doing is training your own bacteria to become resistant to that antibiotic,” she said.
One way bacteria resist the antibiotic is by developing a thick outer membrane the antibiotic can't penetrate. They can also evolve to remove a component of their own makeup that is targeted by the antibiotic, among other mutations.
“Bacteria are very wily creatures, and they are able to evolve in lots of ways in response to antibiotics,” Ms. Humphries said. “Sometimes that can be very regional, so you can have one area of the world where they evolve in one way to become resistant to an antibiotic, and in another area, they can evolve in another way.”
What Are Doctors Doing?Antibiotic resistance is an important issue but not as pressing as obesity and opioids, according to doctors interviewed in eight focus groups for a 2020 study published in BMJ Open. They believed key drivers on antibiotic resistance were non-primary care settings, such as urgent care clinics, as well as patients who demand prescriptions.
Right or wrong, physicians tend to have the perception that patients want an antibiotic, Ms. Zetts said.
Using state Medicaid data, OASIS identified all Kentucky physicians prescribing 12 or more antibiotic prescriptions per year. They received letters with their prescribing data and an antibiotic “report card” showing how they compare to their peers.
Another novel idea is unofficial prescription pads for non-pharmaceutical interventions, Ms. Zetts said. That way, patients feel supported when they visit their doctors, leaving with over-the-counter suggestions for alleviating their symptoms.
‘Best Guess’ TherapyAnother reason doctors say overprescription is a problem is diagnostic uncertainties. Samples taken from patients are cultured on petri dishes in labs—a practice that is time-consuming and not foolproof, Ms. Humphries noted.
“Today we are still very reliant on the tools we used 100 years ago,” she said. “We are always beholden to the amount of time it takes the bacteria to grow in the culture.”
That could be days in some cases, and severe infections necessitate more immediate action. That’s led to empiric therapy—the “best guess” based on data as to which antibiotic will work—which is right oftentimes, Ms. Humphries said. However, premature prescribing is what leads to patients being treated too narrowly or too broadly, and both scenarios can cause antibiotic resistance.
What Is the Government Doing?Beyond better, faster testing, new antibiotics could help—and there’s been legislation introduced for several years aimed at funding them. That’s because most pharmaceutical companies simply are not interested in developing a product that won’t be a money-maker.
“If you think of an antibiotic, you only want to take it once, and if it does its job you never have to take it again,” Ms. Humphries said. “If you compare it to an antidepressant or birth control, which you’re going to be taking for a long period of time, the return on investment is very different.”
What Can Patients Do?Because the gut is home to at least 70 percent of the body’s immune cells, it makes sense that nurturing good gut health can be protective against infections.
It’s in our gut microbiome—home to the largest community of bacteria, viruses, and fungi in the human body—where cross talk between microbes forms the intestinal epithelial layer and mucosal immune system that protect the body from pathogenic invasions.
- Not pressuring doctors to prescribe an antibiotic unless they feel your infection is caused by bacteria.
- Refusing “just in case” prescriptions and asking for testing.
- Telling your doctor you are concerned about antibiotic resistance and ask:
- Can you prescribe a “narrow spectrum” antibiotic for this infection? A “broad spectrum” antibiotic kills a wider variety of bacteria and can kill good bacteria in your body leading to side effects such as diarrhea or yeast infections.
- Can this infection be treated with fewer doses?