Antibiotic Resistance

Sep 26, 2016

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

"Hyvä poika". That means, "Good boy" in Finnish. Those are two of the about half a dozen words I learned in Finnish from my grandmother, Ruth Shewfelt. So, if you meet future Jets star, Patrick Laine, you could say, "Hyvä poika" to him. But he might feel like you are talking to a 3 year old. My sister and I quizzed my grandmother for other Finnish words to insult each other with. We eventually settled on "puu pää" which translates to "tree head". Michelle and I got endless giggles out of calling each other tree head, but I'm sure that isn't a standard Finnish insult. When Ruth's family immigrated to Canada, they had to change their last name from a Finnish one, which honestly I don't know, to Brander so the Canadian Border Guards could pronounce it. Ruth was born in the 1920's, so many parts of her early life were difficult. She described "Date Night" near Thessalon, ON with my grandfather as being when she sawed the wood, and my grandfather, Stan, split it. Her date night advice was to not let your husband use a double headed axe. Stan had used one once and gouged his forehead with it.

During the first 20 years of Ruth's life, infections killed people. Child birth, surgeries, dental extractions, cuts and scrapes, like from an axe, could get infected and kill you. Antibiotics weren't commonly used until after World War 2. Unfortunately, in 2016, we might be going back to the future.

A recent CBC news article said "the medical world is losing the ability to keep ahead of microbial resistance. Antimicrobial resistance in bacteria, viruses and fungi already kills 700,000 people worldwide each year ".

Should you be worried? Yes. "By the year 2050, it's been estimated that more people will die from these kinds of infections than die from cancer today," said Keiji Fukuda, special representative for antimicrobial resistance in the office of the World Health Organization's director general.

Why does antibiotic resistance happen? 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 isn't 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 he'd 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!

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, let's 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 won't 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.

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 don't need an antibiotic for your cough. Treating a viral infection with an antibiotic won't 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 don't cause resistance.

My grandmother Ruth was an amazing and tenacious person. She spent most of her life in Wawa, ON. There is a beautiful beach on Lake Superior near Wawa, called Sandy Beach. It was even painted by Group of Seven Artist A.Y. Jackson. I saw my grandmother start a fire, in the rain on Sandy Beach once. She was smart and determined enough to look under rocks to find enough dry wood to start our fire. I recently learned my first new Finnish word in 40 years. It's "Sisu". It means roughly perseverance, drive, pluck or spunk. Keijo Rantala from Dauphin named his refurbished sailboat Sisu. I like the name Sisu. I think it applies to my grandmother. And if antibiotics stop working, we will all need a lot of perseverance.

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.

CBC story on Antibiotic Resistance - http://www.cbc.ca/news/health/superbugs-antibiotic-resistance-un-1.3770176

Maryn McKennan's article on a Post Antibiotic Future - https://medium.com/editors-picks/892b57499e77

 


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