Nov 24, 2015
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Emily! Go walk Sheldon. Sheldon doesn't need to be walked. He was just walked yesterday. He needs to be walked several times, every day. No he doesn't Yes he does Why can Eric do it? He is practicing his spelling words But I don't want to, and you can't make me! Emily just go! Uggggg! I hate you all! This little dog walk denying song and dance is just about etched into our morning routine now. But no matter if you are unaware of a dog's biologic needs, deny them, ignore them or forget about them, it doesn't make them go away. And if your dog doesn't go outside, there will be a mess for you to clean up later. It's like antibiotic resistance. Ignore at you own peril.
A recent CBC headline read that scientists in China discovered the ultimate super bug. It appears that some pigs in China have a bacterium that is resistant to a last line of defense antibiotic. Scientists figure the resistance to this last ditch antibiotic can be transferred with plasmids. This means human bacterial infections that cant be cured by any antibiotic will show up soon and spread around the world.
Should you be worried? Yes. The World Health Organization (WHO) just had its first Antibiotic Awareness Week, November 16-22, 2015. As part of their education campaign, they surveyed 10,000 people across 12 countries to see what the public knew about antibiotic resistance. Some of their findings include:
-Three quarters (76%) of respondents think that antibiotic resistance happens when the body becomes resistant to antibiotics. In fact bacterianot humans or animalsbecome resistant to antibiotics and their spread causes hard-to-treat infections.
-64% of respondents believe antibiotics can be used to treat colds and flu, despite the fact that antibiotics have no impact on viruses, and taking unnecessary antibiotics increase the chances of creating antibiotic resistant bacteria.
-Close to one third (32%) of people surveyed believe they should stop taking antibiotics when they feel better, rather than completing the prescribed course of treatment. This is another excellent way to create an antibiotic resistant bacterium.
-Two thirds (66%) of respondents believe that individuals are not at risk of a drug-resistant infection if they personally take their antibiotics as prescribed. Nearly half (44%) of people surveyed think antibiotic resistance is only a problem for people who take antibiotics regularly. In fact, anyone, of any age, in any country can get an antibiotic-resistant infection.
Why does antibiotic resistance happen at all? Most antibiotics come from mold or fungi. Mold or fungi have been fighting for space and food with bacteria for millions of years. For example, imagine to protect its food, a mold produces an antibiotic that kills off all the bacteria in the area. To get back into that area and get at the food, the bacteria must evolve a way to protect themselves from the mold's chemical weapon. The bacteria evolve antibiotic resistance. It is a microscopic arms race. Bacteria and mold have been engaged in chemical warfare for as long as there have been bacteria and mold. Antibiotic resistance isnt a new phenomenon.
Humans stumbled into this chemical arms race with Sir Alexander Fleming. He discovered penicillin in 1928. He was doing research on bacteria and was already known as a good researcher, but a messy lab technician. Coming back to his lab after a few days off, he found some cultures of his bacteria that hed forgotten had been spoiled by mold. Instead of just throwing out all the culture plates, he noticed a zone around some of the mold was completely free of bacteria. The mold (later named Penicillium notatum) produced a substance (now called penicillin) that killed the bacteria. Penicillin was eventually isolated and made in large quantities. When it was given to people, certain infections were cured!
Penicillin was a miraculous discovery. Bacterial infections can kill people. Before antibiotics, strept throat, sexually transmitted diseases and infected wounds often killed people. As miraculous as antibiotics are, they arent perfect. A few years after penicillin was discovered, doctors started noticing antibiotic resistance. Alexander Fleming himself warned of antibiotic resistance in his Nobel Prize speech in 1945.
How do bacteria in humans become resistant to an antibiotic? There are different ways but it often happens when the bacteria are exposed to a small dose of an antibiotic. This dose is either too small to kill them or given for too short a time to kill them. For example, lets say you go to the doctor and insist that she give you an antibiotic for your cough. Then, you only take 2 or 3 days worth of the antibiotics and save the rest for next time. This will kill off the most of the bacteria, but it will leave some alive. The ones that are left will have a natural immunity to the antibiotic. Those bacteria will reproduce and all their offspring will have a resistance to that antibiotic. Now that original antibiotic wont work anymore. You now have an antibiotic resistant infection!
The bacteria have yet another sneaky trick up their microscopic sleeves. They are called plasmids. You can only pass genetic traits like height onto your children. If you were a bacterium, things would be different. Let's say you are 6'8 and your neighbor who is 5'2 is trying out for a basketball team. Your neighbor says, Hey, I'd love to have your height!. You say, No problem! and hand them some DNA. Suddenly you neighbor grows up to 6'8 and makes the team. That is sort of what plasmids are like. One bacterium that has developed a resistance to an antibiotic can hand a package of DNA, called a plasmid, to a non-related bacterium, and suddenly that neighbor bacterium and all her offspring are resistant to that antibiotic.
There are many unsettling facts about a possible future in which antibiotics dont work. Without antibiotics, it would be very difficult to do common procedures like caesarian sections, prostate surgery or even kidney dialysis. Infections would kill many people who had these procedures. In cancer treatment, we routinely knock down the patients immune system to treat the disease. If you do that without viable antibiotics, the cancer treatment might become as dangerous as the cancer. Even things like a cut finger, piercing your ear or getting a tattoo could put your life in danger.
What should we do so our antibiotics will work when we need them? Start with non-drug measures. Wash your hands. Coughing and sneezing into the crook of your elbow reduces the chance of spreading infections. Listen to your doctor when she says you dont need an antibiotic for your cough. Treating a viral infection with an antibiotic wont make you better and can promote antibiotic resistance. And if your doctor gives you an antibiotic, finish your antibiotics! Do not stop taking an antibiotic part way through the course of treatment without first discussing it with your doctor. Even if you feel better, use the entire prescription as directed to make sure that all of the bacteria are destroyed. Dead bacteria dont cause resistance.
I suppose sometime in the distant future, I may miss loud argumentative mornings. Not having the same discussions about dog walking every day might make me sad. But right now, a non dog walk discussion morning seems like a peaceful, unattainable utopia. Now everyone, go walk the dog and finish off your entire course of antibiotics!
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca
As always if you have any questions or concerns about these or other products, ask your pharmacist.
WHO Antibiotic Awareness Week - www.who.int/mediacentre/events/2015/world-antibiotic-awareness-week/en/
CBC story on Antibiotic Resistance - www.cbc.ca/news/health/antibiotic-resistance-colistin-1.3325942
Maryn McKennan's article on a Post Antibiotic Future - https://medium.com/editors-picks/892b57499e77