The antibiotic wars

Philip J. Goscienski, M.D.

February 2013

Most Americans were born after the discovery of antibiotics and many citizens are only alive because of that breakthrough. Until the mid-twentieth century an infected insect bite could lead to death, pneumonia was often the final illness of the elderly and high infant mortality resulted from infection acquired during childbirth.

Penicillin and sulfa drugs arrived on the scene just in time to save tens of thousands of military personnel in the Second World War. In the following decades one infectious disease after another succumbed to the rapidly advancing technology of the pharmaceutical industry.

It didn't take long for physicians to recognize a harsh reality: germs were finding ways to overcome these wonder drugs. Antimicrobial resistance, the ability of a microbe to survive and thrive in a sea of penicillin or any other antibiotic, spread slowly at first. At the start of the second millennium many bacteria had become able to resist most antibiotics and a few are now resistant to all of them. For diseases such as tuberculosis, cure only became possible by combining three or even four antibiotics.

Resistance to antibiotics has several causes. Decades of overprescription of antibiotics by physicians is a serious one, such that these infection-fighting drugs are rigidly controlled in some hospitals and their use must be approved by infectious diseases specialists. A common example of overuse is the treatment of a sore throat with penicillin or a related antibiotic. Most sore throats are caused by viruses. Sometimes a "strep" throat can be diagnosed immediately. For doubtful cases appropriate testing may take a few minutes or at most about 24 hours. Delaying treatment is not harmful although it does pose an inconvenience for the patient. Selective, appropriate treatment is good policy for the patient (lower cost, avoidance of drug side effects) and for the population at large (less antibiotic resistance).

About half of the antibiotic production in the United States is used to treat animals raised for food. Resistant bacteria may escape into the community.

When your physician prescribes an antibiotic, take it as directed. Do not discontinue treatment just because you feel better. Doing so encourages the emergence of resistant strains.

Don't push your physician into prescribing an antibiotic when he or she feels that none is indicated. Many infections, especially of the respiratory tract, are caused by viruses and will resolve spontaneously.

Let's not squander a lifesaving resource. The drug industry can't keep up.

Philip J. Goscienski, M.D. is the author of Health Secrets of the Stone Age, Better Life Publishers 2005. Contact him at drphil@stoneagedoc.com.