The Growing Threat Doctors and Patients Are Creating

Since we’ve yet to legislate or innovate our way out of this "urgent threat," patients must speak up.

The statistics on antibiotic use are jarring. Five prescriptions written each year for every six people in the United States. One-third of those antibiotics not needed at all.

Overuse of antibiotics has been a top concern for decades, and public health officials say the growth of antibiotic-resistant bacteria is picking up speed. More than 2.8 million antibiotic-resistant infections occur in the United States annually, according to the U.S. Centers for Disease Control and Prevention. Of those, about 35,000 people die.

Others, like Christina Fuhrman, have their lives upended. She had six hospital stays in seven months at 31, fighting for her life after a Clostridoiodes difficile (C. diff) infection left her with intense fatigue, pain, and diarrhea. The Pew Charitable Trust shared her story as an example of what can happen when a healthcare provider inappropriately prescribes antibiotics.

C. diff is the overgrowth of this bacteria that most of us have in our gastrointestinal (GI) tracts but can get thrown out of balance after taking antibiotics. The infection is particularly deadly to seniors and those with compromised immune systems.

In Fuhrman’s case, a dentist prescribed a “precautionary” round of antibiotics after her root canal. It’s an example of the 47 million unnecessary prescriptions handed out each year, according to Pew Charitable Trusts. Of those who do have an infection that could be helped by antibiotics, only half are given the correct protocol.

Exacerbating the overprescription dilemma, Pew said there was a 15 percent increase in infections and deaths related to drug-resistant bacteria in the first year of the COVID-19 pandemic, likely due to an uptick in unjustified antibiotic use.

Antibiotics Aren’t Risk-Free

Rachel Zetts, senior officer for Pew’s antibiotic resistance project, told The Epoch Times the nonprofit is shifting its antibiotic stewardship efforts to outpatient and community settings and encouraging patients to use their voice to protect their own health. Pew has been working to lower antibiotic overprescribing in hospitals since 2015.

“A lot of times there is a perception antibiotics are safe, and they are largely a safe and efficacious drug. There’s always a risk anytime a medication is prescribed,” Ms. Zetts said. “It’s really critical from our perspective that these antibiotics are used appropriately and when needed, both from a resistant perspective and a patient quality care perspective.”

One fairly recent finding is that adverse effects appear to be worse for those who didn’t need the antibiotic in the first place, highlighted in a study published in 2020 in JAMA Network Open. Examining 2.8 million children prescribed antibiotics, the study found that children who received a non-recommended antibiotic for bacterial infections were at three to eight times higher risk for developing C. diff infections. They also had an elevated risk of other GI-related side effects and serious allergic reactions.

The Evolution of Bacteria

Antibiotics only treat infections caused by bacteria, and many unnecessary prescriptions are written for similar symptoms that have different root causes. Antibiotics don’t cure viral infections—like the common cold, influenza, COVID-19, coughs, stomach bugs, and even some ear and sinus infections.

In spite of that, one study of 1,705 patients with COVID-19 found 56 percent were given antibiotics, even though only 3.5 percent had a confirmed bacterial infection. Hospital antibiotic use for the virus early in the pandemic varied from 27 percent to 84 percent. Results were published in 2021 Clinical Infectious Diseases.

“It’s tough because when you’re suffering, you want something to ease that suffering,” Romney Humphries, division director of the laboratory at Vanderbilt University Medical Center, told The Epoch Times.

“Sometimes antibiotics make you feel a little bit better...some of them have a little anti-inflammatory response. But all you're really doing is training your own bacteria to become resistant to that antibiotic,” she said.

One of the ways bacteria learn to resist antibiotics is by building a membrane around themselves. (Shutterstock)

One way bacteria resist the antibiotic is by developing a thick outer membrane the antibiotic can't penetrate. They can also evolve to remove a component of their own makeup that is targeted by the antibiotic, among other mutations.

“Bacteria are very wily creatures, and they are able to evolve in lots of ways in response to antibiotics,” Ms. Humphries said. “Sometimes that can be very regional, so you can have one area of the world where they evolve in one way to become resistant to an antibiotic, and in another area, they can evolve in another way.”

That it continues to happen is no more a surprise than the sun rising in the morning. The year he won the Nobel prize for the discovery of penicillin, Alexander Fleming warned its misuse could result in selection for resistant bacteria.

Ms. Humphries wrote an opinion article in 2022 in Clinical Chemistry noting both the immediacy of tackling what she called “one of the most urgent threats to modern medicine.”

What Are Doctors Doing?

Antibiotic resistance is an important issue but not as pressing as obesity and opioids, according to doctors interviewed in eight focus groups for a 2020 study published in BMJ Open. They believed key drivers on antibiotic resistance were non-primary care settings, such as urgent care clinics, as well as patients who demand prescriptions.

Pew conducted a national survey of 1,550 primary care physicians who said they prescribe antibiotics more appropriately than their peers. They overwhelmingly agreed antibiotic stewardship is needed, but said they would need resources to implement it. And, 79 percent of respondents said without patient education, efforts would be futile.

Right or wrong, physicians tend to have the perception that patients want an antibiotic, Ms. Zetts said.

Targeting physicians who improperly prescribe antibiotics, Denver Health created the outpatient automated stewardship information system (OASIS) launched this year with support from Pew. It uses electronic health records to track and monitor antibiotic prescriptions. It’s been implemented in Kentucky, which uses more antibiotics per capita than any other state. Kentucky children in rural areas also receive antibiotics at three times the rate of children living in non-rural areas.

Using state Medicaid data, OASIS identified all Kentucky physicians prescribing 12 or more antibiotic prescriptions per year. They received letters with their prescribing data and an antibiotic “report card” showing how they compare to their peers.

Another novel idea is unofficial prescription pads for non-pharmaceutical interventions, Ms. Zetts said. That way, patients feel supported when they visit their doctors, leaving with over-the-counter suggestions for alleviating their symptoms.

Finally, she said there’s the “watchful waiting” concept growing among doctors who encourage patients to treat symptoms at home for a few days, returning only if they need to be re-evaluated because they aren’t improving.

‘Best Guess’ Therapy

Another reason doctors say overprescription is a problem is diagnostic uncertainties. Samples taken from patients are cultured on petri dishes in labs—a practice that is time-consuming and not foolproof, Ms. Humphries noted.

“Today we are still very reliant on the tools we used 100 years ago,” she said. “We are always beholden to the amount of time it takes the bacteria to grow in the culture.”

That could be days in some cases, and severe infections necessitate more immediate action. That’s led to empiric therapy—the “best guess” based on data as to which antibiotic will work—which is right oftentimes, Ms. Humphries said. However, premature prescribing is what leads to patients being treated too narrowly or too broadly, and both scenarios can cause antibiotic resistance.

New testing explored in a proof-of-concept study published in 2022 in Nature used machine learning to predict bacterial susceptibilities with surprising accuracy, which Ms. Humphries called “a tantalizing notion.”

However, she said it has no way to factor the myriad of pathways a bacteria can mutate. A predictive model misses how this happens—data that is needed for the machine to keep making predictions. Another risk is if the test is “trained” in one region and then marketed in another, it could miss local bacterial resistance trends—as well as globe-trotting mutations.

What Is the Government Doing?

Beyond better, faster testing, new antibiotics could help—and there’s been legislation introduced for several years aimed at funding them. That’s because most pharmaceutical companies simply are not interested in developing a product that won’t be a money-maker.

According to Pew, drug companies made more than $8 billion in profits on cancer drugs alone between 2014-2016, but incurred a net loss of $100 million on antibiotics during the same period.

“If you think of an antibiotic, you only want to take it once, and if it does its job you never have to take it again,” Ms. Humphries said. “If you compare it to an antidepressant or birth control, which you’re going to be taking for a long period of time, the return on investment is very different.”

Additionally, treatment guidelines call for older antibiotics to be used when possible to preserve effectiveness of new ones. The business of antibiotics is just bad business for drug makers, which is why many support the Pioneering Antimicrobial Subscriptions To End Upsurging Resistance Act, better known as the PASTEUR Act, which was first introduced in 2020 but has stalled in committee and was reintroduced in 2023.

It would provide funding for antibiotic development, which doesn’t look promising according to a World Health Organization report that found only six of the 27 antibiotics in development appear capable of handling antibiotic-resistant infections.

What Can Patients Do?

Because the gut is home to at least 70 percent of the body’s immune cells, it makes sense that nurturing good gut health can be protective against infections.

It’s in our gut microbiome—home to the largest community of bacteria, viruses, and fungi in the human body—where cross talk between microbes forms the intestinal epithelial layer and mucosal immune system that protect the body from pathogenic invasions.

Chronic dysbiosis, an imbalance of microbes that can be created by antibiotics, can cause dysregulated immune responses, inflammation, oxidative stress, and insulin resistance. It puts us at risk for more than just an infection but also other diseases including cancer, according to a 2020 review article in Microorganisms. 

According to the Michigan Antibiotic Resistance Reduction Coalition, you can protect your health by:

• Not pressuring doctors to prescribe an antibiotic unless they feel your infection is caused by bacteria.

• Refusing “just in case” prescriptions and asking for testing.

• Telling your doctor you are concerned about antibiotic resistance and ask:

• Can you prescribe a “narrow spectrum” antibiotic for this infection? A “broad spectrum” antibiotic kills a wider variety of bacteria and can kill good bacteria in your body leading to side effects such as diarrhea or yeast infections.

• Can this infection be treated with fewer doses?

Source