The Resistant Knowledge Gap

By: Brett Gingold

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Antibiotic Resistance: How it directly impacts you, and what you can do to help.

Antibiotic drug resistance is a growing and deadly issue that can affect all of us directly. Have you heard of it? If you answered no, that’s exactly the problem. Antibiotic drug resistance is a current health concern in which the antibiotic medications that we use for bacterial infections are beginning to stop having effect. If you’ve ever had strep throat, an ear infection, the flu, and the countless other infections that antibiotics are used for, then this problem affects you. In addition, antibiotics are used on our food to prevent the spread of illnesses like E. Coli and salmonella, which affects all of us even further. Thousands of people are already dying every year because of antibiotic-resistant infections, yet so many are unaware of the issue; but there are things that we can all do to help. 

This issue is described by the Center for Disease Control (CDC) as “one of the biggest challenges of our times” and is widely discussed and talked about on various health sites. Despite this, I have come to realize that many people have never heard of this problem at all! The issue here is antibiotic resistance but if this was a widely known issue, would there be a problem at all? This knowledge gap is a big contributor to antibiotic resistance and is something that only we can fix. Antibiotic resistance is a problem globally and it’s only getting worse. We can already see this issue persisting in the United States with millions of people getting antibiotic resistant infections yearly and thousands dying as a result of them. 

To get a grasp on how many people know about this issue and how much it’s talked about in the news and media, I interviewed a classmate who has the same exposure to the news and media that I do. Prior to the interview, my classmate had never heard the term “antibiotic resistance” and didn’t know what it was. I asked various other questions, including whether or not she was worried about antibiotic resistance now that they have heard about it. She responded, “Hearing about antibiotic resistance does worry me a little, but after this conversation it will not be on my mind until I am reminded of it again.” This is a response that I think I would have if I hadn’t done any research on the issue. I also believe that many others will respond in the same way if they are given only a general description of the issue. This is why it’s not only important that we raise awareness about antibiotic resistance, but also educate ourselves and others about what it really is and how it affects all of us. The main thing to remember is that even though we don’t have a medical fix for this issue yet, spreading awareness and educating others can help slow this issue, as well as prevent antibiotic-resistant infections and the deaths that they result in.

To get answers to common questions I had about antibiotic resistance, that could also help to inform others, I reached out to an infectious disease specialist, Dr. David Helfgott, for some answers. Below are some common questions about antibiotic resistance and Dr. Helgott’s response to them.

In your time working have you seen and or treated someone with an antibiotic-resistant infection?

“I’ve treated plenty of patients with antibiotic-resistant infections. Every year there are millions of antibiotic-resistant infections in this country so it’s hard not to.  Antibiotic resistance can apply to bacteria, fungi, viruses, or parasites, but most commonly we think of it in terms of bacterial antibiotic resistance. The term ‘antibiotic-resistant’ doesn’t necessarily mean that there’s no antibiotic at all that will work—though that does rarely happen—it refers to the progressive loss of effective antibiotics as bacteria are exposed to them over time, so that our antibiotic possibilities for a particular infection become limited.  Antibiotic resistance issues make it more likely that we make the wrong antibiotic choice, based on past knowledge no longer accurate, before the microbiology lab makes us aware of the antibiotic sensitivities of a particular bacteria.”

If yes, how often do you see antibiotic resistant infections? 

“It’s hard to put a number on it, but perhaps about 25% of infections I see involve some degree of antibiotic resistance.”

Have you ever seen cases of antibiotic resistance with common infections like strep throat? 

Yes. Strep throat is caused by a bacteria called Streptococcus pyogenes, which used to always be sensitive to penicillins and a group of antibiotics called macrolides, which includes the common antibiotic erythromycin. These bacteria are still sensitive to penicillin, but erythromycin resistance has become common. Lots of doctors diagnose strep throat using an in-office rapid swab test so they get a positive result but don’t send a sample to a lab and get antibiotic sensitivities. So if they get a positive in-office test and use erythromycin to treat the patient, the erythromycin won’t work if the strep is antibiotic-resistant . That could be a real problem.

How are antibiotic resistant infections treated?

“Like I said, the likelihood of a microorganism being resistant to every known antibiotic is rare, though it’s not unheard of. Those infections could be impossible to treat with an antibiotic—surgery could even be necessary if the infection is local to a specific area. For antibiotic-resistant infections that are resistant to some antibiotics they used to be sensitive to but no longer are, we have to use newer, broad-spectrum antibiotics, sometimes with more side effects, often more expensive, and over time bacteria could emerge which are resistant to these antibiotics.  It becomes a never-ending cycle.”

What encourages the creation and growth of antibiotic resistant bacteria? 

“Bacteria with mutations that make it resistant to an antibiotic’s effect survive the use of that antibiotic and its progeny bacteria are likewise resistant. The survival of resistant bacteria is encouraged by inappropriate use or overuse of antibiotics. We all have bacteria which normally inhabit, or colonize, our skin and gastrointestinal tract. When physicians treat a cold with antibiotics, which are unnecessary since a cold is viral and antibacterial treatment won’t help, this encourages the growth of any colonizing bacteria which may be resistant to that antibiotic. When physicians use multiple antibiotics or broad spectrum antibiotics for a particular, routine infection in the hospital, it encourages the growth of antibiotic-resistant bacteria. Other places where inappropriate or overuse of antibiotics contributes to growth of resistant bacteria are the use of antibiotics in animal feed on farms (a very common practice) and antibiotic coating of toys (a more recent marketing ploy).”

Are there rules and regulations that you have to follow when prescribing antibiotics?

“Not really. If a drug is FDA-approved, physicians can prescribe it as they see fit. Some drugs, like narcotics, are more tightly controlled by special rules, but not antibiotics.”

As long as an antibiotic drug is FDA-approved, physicians can prescribe it as they see fit and for any illness they see fit, even a non-bacterial one.

Dr. Helfgott’s responses helped support many of the ideas that I described and the CDC warned us about. Antibiotics are being used inappropriately and as Dr, Helfgott said, being used for things like coating toys for marketing purposes. We also know from the information that Dr. Helfgott provided us that the term “antibiotic resistance” doesn’t necessarily mean that all antibiotics don’t work when treating one infection, as multiple antibiotics can be used. But antibiotic resistance is still a growing problem because it is rendering more and more medications ineffective. In addition, Dr. Helfgott also talked about issues with using new medications in terms of price, side effects, and those medications becoming ineffective against the infections. Antibiotic-resistant infections are more common than we all may think; Dr. Helfgott gives us the estimate of 25% of his cases having some degree of antibiotic resistance. Lastly, rules and regulations on antibiotics are broad, with Dr. Helfgott telling us that as long as the drug is FDA-approved, then they can be prescribed as a physician sees fit. This means that antibiotics can be prescribed for things like common colds, where they are not needed, which contributes to antibiotic resistance.

So what can we do to help? For the majority of us who are non-medical professionals, it doesn’t seem like we can do much to remedy the problem. But that’s not true; one thing that all of us can do is to help close this knowledge gap! Tell friends, family, colleagues, and peers because if this problem was mentioned in every household worldwide, we could all take preventative measures to fix it. In addition to making this problem known, you can follow CDC’s instructions to help protect yourself, your family, and others! Some instructions from the CDC include getting vaccinated, using antibiotics appropriately as instructed by doctors, preparing food safely, and staying healthy and aware when traveling.

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