Antibiotic misuse

Antibiotic misuse refers to situations wherein antibiotics are used inappropriately or incorrectly. Inappropriate usage includes taking antibiotics in situations wherein the medication will not help, or for usage in which the medication is not intended. Incorrect use refers to not taking the antibiotic in the right dose, either because it was not prescribed correctly or because the patient did not take it as intended. Effective antibiotics are essential to treating and preventing the spread of many life-threatening diseases. Antibiotic misuse is a concern because it can lead to antibiotic resistance, which causes organisms to develop immunity to the medication's effects.

Background

Antibiotics are medications that are used to treat infections. The word antibiotic comes from the Greek words anti, meaning "against," and bios, meaning "life." Antibiotics are used to treat a variety of infections caused by certain harmful organisms. These include bacteria, fungi, and some types of parasites, and each of these is responsible for different types of illnesses.

When bacteria, fungi, or parasites enter the body, the immune system is activated. White blood cells attack and can often wipe out the invading organism. Sometimes, however, the organism is too strong or the immune system is too weak to fight it off. In that case, physicians turn to antibiotics.

Alexander Fleming discovered the first antibiotic, penicillin, in 1928. He was working on some staphylococcus bacteria cultures when one developed mold. Fleming noticed that no bacteria was growing in an area around the mold. Further testing revealed that the mold could be used to kill the bacteria. Fleming called it penicillin.

Since then, scientists have developed a number of other types of antibiotics. Some are derivatives of penicillin, while others are from completely different origins. They work by affecting the functions of the invader organisms that are different from the functions of the body's cells. For example, body cells do not have cell walls, but bacteria cells do; beta-lactam antibiotics prevent these walls from forming and cause the bacteria cells to collapse. Macrolide antibiotics prevent bacteria from forming specific proteins necessary for their survival, while quinolones interfere with the invading organism's ability to make and repair its deoxyribonucleic acid (DNA), preventing the organism from reproducing.

These abilities make antibiotics an invaluable tool in fighting illnesses. However, antibiotics do not work on all types of illnesses. They have no influence on diseases caused by viruses, for instance. When antibiotics are misused, such as when they are used in conditions where they cannot help, or when they are not taken long enough to completely kill the invading organism, it contributes to organisms becoming immune to the effects of the antibiotic, or in other words become antibiotic resistant. This is also known as antimicrobial resistant.

Bacteria develop resistance to antibiotics in several ways. Some instances occur as a matter of evolution; bacteria that survive treatment with an antibiotic pass along the traits as they reproduce. In other instances, bacteria become resistant through mutations. A mutation may allow the bacteria to produce enzymes that counter the antibiotic, or they may remove the part of the cell that the antibiotic is designed to target. Other mutations block the antibiotic from working by either preventing it from entering the cell or pushing it back outside when it gets in.

Antibiotic resistance is spread when new generations of bacteria inherit resistant characteristics. Bacteria can even share these resistant traits with different forms of bacteria from the one where the resistance developed. Resistance spreads further when bacteria are transported from one person to another and from one area to another. Bacteria can be transported by simple human activities such as touch or coughing, and they can travel by means of wind and air.

Overview

It is inevitable that bacteria and other organisms will develop resistance to antibiotics in time; it is part of natural selection—survival of the fittest—and of evolution. However, some actions make this happen faster than would be expected by natural means. Most of these actions are the result of antibiotic misuse.

The most common form of antibiotic misuse is when the medication is prescribed to treat a condition that is not caused by a bacterium, fungus, or parasite that responds to antibiotics. For example, antibiotics have no impact on viruses. Viruses cause many common illnesses, such as colds, influenza (the flu), gastroenteritis ("stomach bugs"), and bronchitis. Many coughs, sore throats, ear infections, and sinus infections are also caused by viruses.

When a patient is given an antibiotic by a doctor who has not ascertained that the illness is not caused by a virus, or when the patient procures antibiotics from another source (leftovers from a previous illness or from another person's supply, for instance), this misuse can lead to antibiotic resistance. This is because antibiotics work indiscriminately on both the dangerous bacteria causing the illness and the many beneficial or harmless bacteria that are found in the normal human body. The digestive tract, for instance, is filled with bacteria that help in the processing of food. The antibiotic will affect these bacteria as well. Some of them can develop resistant traits, which they can pass on to other bacteria, even bacteria that cause illnesses.

Another form of antibiotic misuse is when a patient does not take the antibiotic as prescribed. The physician writes a prescription for a certain number of days' worth of medication, based on how long science has determined it will take the antibiotic to completely clear the system of the infecting organism. Many people, however, stop taking the medication once they feel better. This allows the organisms to linger and gives the bacteria the opportunity to develop immunity to the antibiotic. This can then be shared with other bacteria, causing a different strain of antibiotic resistance to develop.

American farmers' use of antibiotics has also been criticized as a form of antibiotic misuse. Antibiotics given to livestock for disease prevention are consumed by humans along with the meat and are also distributed in the local environment; some orchardists also apply antibiotic sprays as pesticides. Moreover, antibiotic-resistant bacteria can be transferred from livestock to human consumers, who are then infected.

According to the US Centers for Disease Control and Prevention (CDC), by 2014, at least two million Americans were being affected by antibiotic-resistant infections each year. The CDC reported in 2017 that more than twenty-three thousand Americans and twenty-five thousand Europeans die from these infections annually. Others are subjected to longer hospital stays, more expensive treatments, more invasive treatments (such as repeat surgeries), and longer recoveries. The World Health Organization reported in 2018 that antibiotic resistance was worsening in countries around the world, particularly for Klebsiella pneumoniae, Escherichia coli, Staphlylococcus aureus, Salmonella spp., Neisseria gonorrheae, Mycobacterium tuberculosis, and Enterobacteriaceae.

Health officials say the best way for members of the public to combat these problems is to follow physicians' instructions for taking antibiotics, to use antimicrobial products judiciously, and to observe good hygiene, such as handwashing and covering mouths when coughing or sneezing. Additional research into new antibiotic drugs will also be necessary to address the growing problem of antibiotic resistance.

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