Antibiotics are one of the most significant medical advances of the past century. Countless lives have been saved since the discovery of penicillin in the 1920s. We assume that common skin or urine infections are easily treated with a simple course of antibiotics. But caring for infections isn’t always simple. In fact, antibiotic resistance has brought new challenges.
What is antibiotic resistance?
Though doctors hailed penicillin as a wonder drug, bacteria may be smarter than antibiotics. Bacteria quickly figure out how to overcome the antibiotics we develop, resulting in infections such as methicillin-resistant Staphylococcus aureus (MRSA). These infections are difficult to treat and require specialized antibiotics. Unfortunately, new drugs for these difficult infections are not being developed fast enough.
We need to preserve the antibiotics we have now. Antibiotic use leads to antibiotic resistance. While antibiotics are critical to fighting infections, up to half are prescribed inappropriately, meaning that an antibiotic was not needed, the wrong drug and/or dose was chosen or the drug was continued for longer than necessary. Doctors need to “find the right drug for the right bug.” But doctors aren’t the only ones who can battle antibiotic resistance.
National awareness about antibiotic resistance and overuse is increasing. In September, President Obama signed an Executive Order to combat antibiotic resistance. This week, the Centers for Disease Control and Prevention are promoting their annual GET SMART About Antibiotics Week, a week of education and social media events that focus on antibiotic use and resistance.
As clinicians, we need to think carefully about the antibiotics we prescribe. The goal of treatment, when necessary, is to select an antibiotic that targets only the bacteria causing the infection. Using a broad antibiotic that treats many types of bacteria may lead to increased resistance without providing an advantage over a more targeted antibiotic. Many pediatric hospitals, including Boston Children’s Hospital, have Antimicrobial Stewardship Programs that help clinicians choose the right antibiotic with the right dose and duration for the infection they are treating.
What can parents do about antibiotic resistance?
1. Reduce antibiotic use by preventing infections.
Our current vaccines have made remarkable progress in protecting children from serious bacterial illnesses. Fewer bacterial illnesses means fewer antibiotics.
Vaccines that prevent viruses such as measles and the flu (influenza) also play a role. Many of the viruses that are prevented by vaccines can leave the body vulnerable to bacterial infections, such as pneumonia, during or shortly after the viral illness. In severe viral illnesses, clinicians also may start antibiotics if they cannot distinguish between a viral and bacterial infection. Fewer viral infections reduces inappropriate antibiotic use.
Finally, since many bacteria are spread by simple hand-to-hand contact, proper hand washing prevents the spread of both bacterial and viral infections from person to person.
2. Understand the reasons to use or not use antibiotics.
Parents may be increasingly told that their child’s illness does not require antibiotics. We can all educate ourselves on antibiotic use and resistance and spread this knowledge to others in the community.
Talk to your child’s pediatrician when she or he prescribes an antibiotic. Ask why the particular antibiotic was selected and what it is treating. When prescribed, make sure your child takes antibiotics as instructed. Taking fewer antibiotics than prescribed or missing doses can increase resistance.
3. Raise awareness about the complex causes of antibiotic resistance.
Antibiotics are used in agriculture to promote growth, leading to significant overuse in animals that do not have an infection. There is increasing concern that the antibiotics given to animals also contribute to the problem of antibiotic resistance. While research is ongoing, parents can consider purchasing antibiotic-free products, perhaps starting with their Thanksgiving turkey!
Bacteria will always be able to develop resistance, but we can help preserve the antibiotics we have today by using them only when needed. Parents are critical to the process and can join physicians and policy makers in the fight against antibiotic resistance.
About the blogger: Kelly Flett, MD, is medical director of Boston Children’s Hospital Antimicrobial Stewardship Program.