Antibiotic Resistance

Nov 24, 2020

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

I feel nostalgic for small, weird things during this Code Red lock down. I haven't gone to a Ducks Unlimited Supper this fall and that is strange. It has been a year since I've seen my parents in person and that is odd. But recently, I found myself missing typing articles while watching a hockey practice. Strangely, I specifically miss typing articles at the Ste Rose rink. I'm not sure why, but that is the thought that came to me recently. I'm really very lucky to get to complain about little things. I haven't lost my job or the life of a loved one to this pandemic. But sometimes the small things just kind of stick with you.

A small change in our ability to treat bacterial infections may be coming down the pipe. Every year in November, the World Health Organization (WHO) has a World Antimicrobial Awareness Week. The event high-lights that antibiotic resistance is on the rise. If antibiotics don't work anymore, we will have a hard time treating infections that used to be easy to cure. There are some less obvious implications as well. Without antibiotics, things like gut surgery, caesarean sections, joint replacements, and cancer chemotherapy would be too dangerous to perform.

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 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. 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 bacterial 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. For example, let's say you go to the doctor and insist that she give you an antibiotic for your "cough". Your doctor tells you that your cough is probably caused by a virus, not a bacterium and an antibiotic won't help. You insist on an antibiotic and your doctor relents. The antibiotic doesn't affect the virus just like the doctor said. But, because you were taking an unnecessary antibiotic, you exposed some bacteria living on or in you to a low level of that antibiotic. The antibiotic killed off most of the bacteria but left 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 on those bacteria. If those bacteria eventually cause an infection in you or someone else, it will be an antibiotic resistant infection!

Health care professionals need to change our ways to combat antibiotic resistance as well. Overprescribing of antibiotics can be a problem. There are 3 types of overprescribing. 1) Giving an antibiotic when it isn't likely to help. This would be like in our previous example of giving an antibiotic for a viral infection. 2) The shotgun mosquito issue. If you use a shotgun to kill a mosquito, there will be a lot of collateral damage to things, animals, and people around the mosquito that you didn't intend. If we a broad spectrum antibiotic on a simple infection, we could cause unnecessary damage to the body and create resistance to a powerful antibiotic that should be saved only for really serious infections. 3) Prescribing an antibiotic for too long. This one surprised me. Taking antibiotics for too long is a two-part problem. The first part is side effects. The longer you are on an antibiotic, the more likely you are to have side effects. No, I'm not giving you an excuse to quit your antibiotic early. If you don't take your antibiotic long enough, you probably won't kill off the infection you were trying to treat. But if we give an antibiotic for longer than necessary, we might kill off the intended infection, but cause some other bacteria to become resistant. Before doing some reading for this article, I'd never thought of that before.

What can individuals do so our antibiotics will work when we need them? Wash your hands. Cough and sneeze into the crook of your elbow. Cook and handle your food properly to prevent food born illness. Wear a mask and social distance. I'm not joking. A lot of the things we are all doing right now because of the pandemic are good at preventing all types of infections.

Hopefully, these Code Red restrictions get lifted soon. Hopefully, the pandemic gets better soon. Hopefully, COVID-19 vaccines start rolling out soon. But until then, remember the small things. Give a friend a phone call. Send a text to that crazy Aunt. Pick up a pen and write an actual letter to someone. That'll shock them. I'm going to try a Zoom parent-teacher interview for the first time. Another small, weird thing I never would have thought of a year ago. I wonder what small, weird pandemic thing I'll feel nostalgic for next year?

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.

As always if you have any questions or concerns about these or other products, ask your pharmacist.


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