Antibiotic Resistance

Aug 31, 2017

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

"Democracy Dies in Darkness." That is the fantastic newish tag line for the Washington Post. For most of its 140 years, the Washington Post didn't have a tag line. However in February 2017, after the inauguration of some guy with funny hair whose name escapes me, "Democracy Dies in Darkness" started to appear. Bob Woodward of Watergate fame, is the current editor of the Washington Post and is rumored to have said "Democracy Dies in Darkness" over the years.

I read a recent article in the Washington Post article that wasn't full of darkness at all. It actually had some good news about antibiotic resistance. Blue Cross and Blue Shield in the US looked at 173 million insurance claims of people under the age of 65 from 2010 to 2016. The report found the number of antibiotic prescriptions went down about 9%. The antibiotic use rates in the Blue Cross and Blue Shield data dropped 16% in children and only 6% in adults. The drop was the largest infants where antibiotic use dropped 22%.

Why do we keep talking about antibiotic resistance? Without antibiotics things like gut surgery, caesarean sections, joint replacements and cancer chemotherapy would be too dangerous to perform. While I'm not saying we should let our guard down against antibiotic resistance, at least this report in the Washington Post offers a glimmer of hope.

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 evolves 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 have created 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.

In the Game of Thrones Universe, there is a constant battle between the forces of light and darkness. However, being Game of Thrones, it is often hard to tell which characters are on the side of darkness or not. And aside from the Iron Born, there is no democracy in Game of Thrones. This means the Washington Post Tag line of "Democracy Dies in Darkness" doesn't apply. They have their own fantastic tag line. "The Night is Dark and Full of Terrors." Hopefully that doesn't describe our future when antibiotics don't work anymore.

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.

Washington Post article - www.washingtonpost.com/news/to-your-health/wp/2017/08/24/fewer-antibiotic-prescriptions-are-being-filled-a-new-analysis-finds/?utm_term=.cbd7795fef42

Review on Antimicrobial Resistance - https://amr-review.org/home.html

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

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 ".


 


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