Before World War II, when antibiotics came into practical use, humans lived in mortal fear of infections and diseases caused by “germs.” Though today’s generations may find it hard to believe, in those days, a simple infection often led to a rapid death. The invention of antibiotics revolutionized medical treatment and significantly reduced our fear of common infection and many serious bacterial diseases, such as tuberculosis.

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LHSFNA Management Co-Chairman Noel C. Borck

Unfortunately, today these “miracle drugs” are in danger of losing their effectiveness. “The overuse and misuse of antibiotics in recent decades have become a serious threat to health care as we know it,” says LHSFNA Management Co-Chairman Noel C. Borck. “It is important that LIUNA members and their families educate themselves on this issue and avoid being part of the problem.”

The Science

Antibiotics – penicillin is, perhaps, the best known – are drugs that kill bacteria, one of the two main kinds of “germs” that cause illness in humans and other animals. Antibiotics have no effect on viruses, the other common, disease-causing “germ.”

Bacteria are live, microscopic, one-cell organisms that multiply in certain conditions. In contrast, a virus is a microscopic particle that must have a living cell as a host. With such a cell, a virus can reproduce itself.

Like other organisms, as bacteria and viruses multiply, they mutate, developing offspring that are better able to survive in a changing environment. When bacteria are able to multiply in conditions that expose them to minimal levels of antibiotics – but not enough to entirely kill them off – some of the offspring survive and acquire enhanced resistance to these antibiotics. Over time, modified strains of bacteria can develop that cannot be killed by today’s antibiotics.

In fact, according to the Centers for Disease Control, that is exactly what is happening. Due to misuse or overuse of antibiotics, strains of bacteria have developed that are resistant to many of the antibiotics that were so effective in the past.

For instance, nearly all strains of Staphlococcus aureus (Staph infections) – which cause infections in wounds and, also, some forms of food poisoning – are now resistant to penicillin, and many are resistant to new antibiotics as well. One strain of Salmonella is resistant to five different antibiotics. Many other examples can be cited.

The Problem

Misuse and overuse of antibiotics occur in two situations: human medical treatment and corporate farming (agribusiness).

Soon after antibiotics were developed, agricultural researchers discovered that the medicines, if used routinely in flocks and herds, promote growth and help compensate for the unsanitary conditions in which farm animals often live. According to the Union of Concerned Scientists, about 70 percent of all antibiotics used in the U.S. today are fed to healthy pigs, poultry and cattle.

Because many of the bacteria that infect farm animals are similar to those that infect humans, the widespread use of antibiotics in agribusiness contributes significantly to the development of resistant bacterial strains that can cross over to humans. For example, six years ago, fluoroquinolone, the antibiotic most commonly used to treat the most common form of food poisoning in humans (Campylobacter infection), was approved for use in poultry. At the time of approval, bacterial resistance to the drug was slight, but today one in six cases of Campylobacter infection cannot be killed by fluoroquinolone.

Antibiotics are also misused in human populations.

For instance, though everyone, at one time or another, has had the flu or the common cold, many people cannot distinguish one from the other, especially in their initial stage of development. Many of the symptoms are similar or overlap: runny nose, sore throat, cough, aches and pains, swollen glands and general fatigue. Other and more serious diseases – for instance, bronchitis, sinusitis, pneumonia and tuberculosis – have some of the same symptoms.

However, though tuberculosis, for instance, is always bacterial and the flu and a cold are viral, pneumonia, bronchitis and sinusitis are infections that can be caused by bacteria, viruses or, sometimes, other agents such as fungi. Antibiotics can kill bacterial infections but will not kill viral infections.

To really know what is going on and get proper treatment, a patient needs an evaluation by a medical professional.

However, until the practice came under sharper criticism in the last decade or so, doctors often took a quick look at a patient’s throat and immediately prescribed an antibiotic. Though they knew the antibiotic would have no effect if the infection was viral (for which, generally, there are not pharmacological treatments), they felt they could get a treatment started, even as they awaited results of a throat culture.  If the infection did prove to be bacterial, the head start would accelerate the healing process, and the patient would be more satisfied with his or her care. It was thought that if the infection turned out to be viral, there was no harm other than the unnecessary expense of the antibiotics.

Decades of experience, however, has proven otherwise. This is because bacteria are always present in the body. Most are not harmful, and under normal conditions, the body’s immune system is managing the presence of any that are. However, when antibiotics are taken for what turns out to be a viral infection, some harmful bacteria that are present strengthen their resistance to the medication. This is particularly true if the patient, upon learning that the infection is viral, discontinues the antibiotic treatment.

Standard antibiotic treatment calls for taking the medications for a definite period – usually ten days – even if symptoms clear up before the antibiotic is gone. The sustained dosage is needed to make sure that all the bacteria are killed. However, when treatment is stopped early, some bacteria survive, possibly with enhanced resistance to the antibiotic. Patients always should complete their prescribed treatment, even if their symptoms clear up.

Unfortunately, once their symptoms are gone, some patients have been known to cut short their treatment and save the remaining antibiotics, thinking they can avoid a trip to the doctor the next time they have a sore throat. Not only do they avoid killing their present infection, they risk using a weakened antibiotic (medicines deteriorate over time) the next time, which again may help stimulate the development of drug-resistant bacteria.

“While each individual’s actions may seem trivial in the big picture,” Borck warns, “the cumulative effect of our misuse and overuse of these drugs is undermining a once-powerful treatment tool. Today, when you go to the hospital with a serious infection, there’s no certainty that it can be controlled. Sometimes, a series of options have to be tried while the infection continues to worsen. Particularly with vulnerable patients – a child, an elderly person or someone with a compromised immune system – we’re seeing an increase in the failure rate. These drugs are not performing the miracles they used to.”

The Prognosis

Drug companies will go on trying to invent new antibiotic medicines, but those efforts are slow, expensive and without certainty of success. Even once developed, any antibiotic drug will become ineffective if patients do not follow directions for its use.

Critics of agribusiness antibiotic use have started a battle with federal authorities. Inevitably, agribusiness is opposed to restrictions, and Congressional or Food and Drug Administration action will likely be necessary. Other nations have begun to take action. While efforts proceed on that front, Laborers, their families and their health care providers also have a role to play.

As noted, the medical profession has been taking steps to educate itself and patients about the dangers in the overuse and misuse of antibiotics. Patients must help.

If it is a bacterial infection and patients receive an antibiotic prescription, they must carry through on the complete treatment program. They should never attempt to accumulate left-over drugs. If the infection is viral, they must follow the care-giver’s orders and be patient in recovery. In most cases, no medications will be prescribed.

Patients should not expect nor pressure their health care providers to prescribe drugs before the results of a throat culture or other tests are known. While patients with bacterial infections may endure an extra day or two of discomfort as they await test results, they will be protecting themselves and everyone else against the demise of one of our most important medicines. This is a small price to pay to avoid the return of the era in which humans had little protection at all against the ravages of bacterial disease.

[Steve Clark]