Maine Voices: How antibiotics can make us sicker

Maine Voices: How antibiotics can make us sicker

Sun. Nov 11, 2012

By Dr. Stephen Sears, state epidemiologist 

AUGUSTA – The Maine Center for Disease Control and Prevention, Maine doctors and Maine hospitals have news for parents this cold and flu season: Antibiotics don't work for a cold or the flu.

Antibiotics kill bacteria, not viruses. And colds, flu and most sore throats are caused by viruses. Antibiotics don't touch viruses – never have, never will. And it's not really news. It's a long-documented medical fact.

But tell that to parents seeking relief for a child's runny nose. Research shows that most Americans have either missed the message about appropriate antibiotic use or they simply don't believe it.

According to public opinion research, there is a perception that "antibiotics cure everything."

Americans believe in the power of antibiotics so much that patients go to the doctor expecting to get a prescription. And many do. Three out of 10 children who visit an outpatient provider with the common cold receive an antibiotic. This is an improvement from previous years, but antibiotics are not indicated for a common cold.

Why does this happen? Physicians often are too pressured for time to engage in lengthy explanations of why antibiotics won't work. And when the diagnosis is uncertain – as many symptoms for viral and bacterial infections are similar – doctors are more likely to yield to patient demands for antibiotics.

The problem is, taking antibiotics when they are not needed can do more harm than good. Widespread inappropriate use of antibiotics is one of the major reasons for an increase in drug-resistant bacteria. Families and entire communities feel the impact when disease-causing germs become resistant to antibiotics.

The most obvious consequence of inappropriate antibiotic use is its effect on the sick patient. When antibiotics are incorrectly used to treat children or adults with viral infections, such as colds and flu, they aren't getting the best care for their condition. A course of antibiotics won't fight the virus, make the patient feel better, yield a quicker recovery or keep others from getting sick.

Antibiotics also can have serious side effects ranging from nausea, vomiting and diarrhea to life-threatening allergic reactions.

A less obvious consequence of antibiotic overuse is the boost it gives to drug-resistant disease-causing bacteria. Almost every type of bacteria has become less responsive to antibiotic treatment when it really is needed. These antibiotic-resistant bacteria can quickly spread to relatives, classmates and co-workers – threatening the community with a new strain of infectious disease that is more difficult to cure and more expensive to treat.

For example, cases of H1N1 flu have shown resistance to oseltamivir, one of only two antivirals that work against it. Methicillin-resistant Staphylococcus aureus, known as MRSA, remains a problem in many health care settings and can be life-threatening for patients who have weakened immune systems. Even the common sexually transmitted disease gonorrhea is now showing potential for resistance to cephalosporins, the only recommended antibiotic left to treat this infection.

Antibiotic resistance increases the economic burden on the entire health care system. Resistant infections are often more severe, leading to longer hospital stays and increased costs for treatment.

According to the latest available data, antibiotic resistance in the United States costs an estimated $20 billion a year in excess health care costs, $35 million in other societal costs and more than 8 million additional days that people spend in the hospital.

The U.S. Centers for Disease Control and Prevention has stated that antibiotic resistance is one of the world's most pressing public health problems. For this reason, the Maine CDC, the Maine Medical Association, the Maine Hospital Association, the Maine Osteopathic Association and the Maine Public Health Association have joined with the U.S. CDC to recognize Nov. 12-18 as Get Smart About Antibiotics Week.

Americans of all ages can lower this risk by talking to their doctors and using antibiotics appropriately during this cold and flu season.

Maine Sunday Telegram

Antibiotics: friend or foe?

Antibiotics: friend or foe?


Monday, November 05, 2012

By David Templeton, Pittsburgh Post-Gazette

The overuse of antibiotics not only boosts health care costs but causes bacterial resistance to the drugs -- and possibly health problems in childhood

When patients demand antibiotics for a cold, the flu, or any other viral infections, physicians sometimes appease them with a prescription. On other occasions, doctors prescribe antibiotics for infections most commonly caused by viruses but sometimes caused by bacteria or that progress to a bacterial infection.

Antibiotics kill germs -- bacteria -- and have no effect on viruses, making the above practices unnecessary and dangerous to health.

The overuse of antibiotics not only boosts health care costs but also causes bacterial resistance to the drugs. Examples include the growing difficulty in treating serious and sometimes fatal bacterial infections, methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C diff), both of which are on the rise.

Researchers also are linking health problems during childhood to early use and overuse of antibiotics.

When given in the first six months of life, antibiotics are now being suspected of leading to obesity and even type 2 diabetes, with a lifelong ripple effect on health. Antibiotics also can alter a child's immune system, although the health impacts are not yet clear.

"Antibiotic resistance is one of the world's most pressing public health threats," the U.S. Centers for Disease Control and Prevention states. More than 50 percent of antibiotics are unnecessarily prescribed in doctors' offices for upper respiratory infections including coughs and colds, most of which are caused by viruses. Half of all antibiotics used in hospitals are unnecessary or inappropriate, the CDC says.


Reactions that children have to antibiotics "are the most common cause of emergency department visits for adverse drug events," according to the CDC. Children can have as many as nine colds a year. Studies show that three of 10 children who receive outpatient health care for the common cold are prescribed unneeded antibiotics.

While those numbers have been improving in recent years, any unneeded use of antibiotics causes harm. For the past 70 years, antibiotics have been powerful tools, but their overuse is changing that. 

"Antibiotic resistance occurs when bacteria change in a way that reduces or eliminates the effectiveness of antibiotics," the CDC's "Get Smart" program states. "Infections with resistant bacteria have become more common in health care and community settings, and many bacteria have become resistant to more than one type or class of antibiotics."

It also is getting more difficult to develop new antibiotic drugs.

"The problem is that we expect antibiotics to work for every illness, but they don't," the CDC says, calling for more effective antibiotic stewardship programs.

Arjun Srinivasan, associate director of CDC's health-care-associated infection prevention programs, said the "Get Smart" programs are making progress in improving how antibiotics are used, but the problem is far from being resolved. Next week is CDC's "Get Smart" week to raise national awareness about the problem.

Recent research completed at New York University's Langone Medical Center has found that antibiotics prescribed for infants in the first six months of life can alter the baby's metabolism in ways that can lead to obesity and even type 2 diabetes, with the chance of those health impacts resonating throughout the person's life.

Studies completed under the leadership of Martin Blaser, chairman of the medical center's department of medicine, determined that early doses of antibiotics kill off the natural flora in the gut, or the good bacteria that are  not only necessary to defend against bacterial infections but also involved in metabolism.

Early doses of antibiotics intensify the metabolism, causing extraction of more calories than normal from food, leading to weight gain. Dr. Blaser said a 15-year-long epidemiological study in England found that children treated with antibiotics in the first months of life had a 22 percent higher rate of obesity than those who didn't receive antibiotics during that time period. The findings, he said, may help explain the rise in type 2 diabetes in children.

A mouse study, done earlier by the team, reached similar conclusions about antibiotics altering the metabolism and immune system, he said. But evidence long has existed that antibiotics cause weight gain.

"One of the things that pointed me in this direction was the knowledge over the last 60 years that farmers were giving low doses of antibiotics to livestock to fatten them up," Dr. Blaser said. "Antibiotics are growth promoters, and they established the principles that antibiotics early in life affect early development."

The research also documented changes induced by antibiotics in different T-cell populations in the immune system.

"We are changing the composition of the natural flora and the change in composition is happening at a critical time in the child's development," Dr. Blaser said. "What happens in early life sets the stage for overall development for the rest of the person's life."

He's now working to identify how changes in the natural flora, or "microbiota," cause changes to metabolism and the immune system with hope of developing a probiotic treatment to restore the natural flora to counter or reduce the health impacts of antibiotics.

Dr. Srinivasan praised Dr. Blaser's research that identifies other health concerns linked to the use of antibiotics. But the focus is on bacterial resistance.

"Certainly the situation with antibiotic resistance is getting worse," he said. "Bacteria are developing resistance to more antibiotics, making it more difficult to treat patients or to find the right treatments for the right patients."
• The overuse of antibiotics isn't limited by age group.

A University of Pittsburgh-based research team, using Medicare Part D data from 2007 to 2009, found that one in five people 65 and older are taking at last one course of antibiotic during any three-month season of the year, with 47 percent taking at least one dose of antibiotics sometime during the year.

The study was published Sept. 24 online in the Journal of the American Medical Association's Archives of Internal Medicine.

Doctors who treat older adults in Southern states prescribe antibiotics more often than any other region in the United States, the study says. On average, 21.4 percent of older adults in the South are taking antibiotics during any three-month period of the year. Western states have the lowest seasonal rate of 17.4 percent, with the Northeast at 18.2 percent and the Midwest at 19.2 percent. The usage rate is highest January through March, and lowest from July through September.

The study found variations in antibiotic use across the regions, even after researchers adjusted for differences in population, suggesting that physicians and health care systems differ region to region in how antibiotics are prescribed.

Oregon and Wyoming had the lowest rate of antibiotic use among seniors, while Alabama and Mississippi had the highest. Pennsylvania ranked 23rd with 46 percent of older adults taking a course of antibiotics at least once during the year.

"Some conditions require antibiotics and some don't justify the use of antibiotics," said Yuting Zhang, the study author and assistant professor at Pitt's department of health policy and management. "Some regions do really well. What can we learn from them? What programs are they using? Can programs they are using in the West be adapted to the South?"

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