Stopping superbugs

Just say no to drugs — unnecessary antibiotics, that is. That’s the message health experts want doctors and patients to take to heart. It’s scary to think of what health care would be like without life-saving antibiotics, but we could soon find out if we’re not careful.

What’s the problem? Drug-resistant superbugs like clostridium difficile (C. difficile) and Methicillin-resistant Staphylococcus aureus (MRSA). We’ve been hearing about this problem for some time now with outbreaks in hospitals, cruise ships and even schools. Unfortunately, despite previous warnings and preventative measures, the problem continues to get worse. Superbugs are becoming a super threat in Europe, according to the results of a new report. Results showed not only a jump in cases but also a rise in the number of drug-resistant strains.

Superbugs are a classic case of “survival of the fittest”. Not only do they endure the cures we throw at them, but they live to pass on their survivor DNA to future generations. In the process, they can mingle with other bacteria too. If you know a thing or two about probiotics and prebiotics, you know that antibiotics wipe out the good bacteria along with the bad — meaning superbugs are often left without natural “enemies” to help keep them in check. It’s no wonder that doctors point the finger at antibiotic overuse as the culprit.

“Rising levels of resistance being reported across Europe to a number of essential antibiotics, and the emergence of bacteria that are resistant to all known antibiotics, is directly linked to the use of antibiotics,” warned Director of the European Centre of Disease Prevention (ECDC), Zsuzsanna Jakab, in a report from the UK’s Daily Telegraph. “Without effective antibiotics, modern medical treatments such as operations, transplants and intensive care will become impossible.” (Read the full article here.)

How is that possible? Think of how much we’ve come to rely on antibiotics in recent decades. Not only do we use them to treat infections, we use them as a “precaution” for surgeries and other contingencies too.

“If this wave of antibiotic resistance gets over us, we will not be able to do organ transplants, hip replacements, cancer chemotherapy, intensive care and neonatal care for premature babies,” said Dominic Monnet, a senior expert at the ECDC, quoted in a story by the BBC. “It is the whole span of modern medicine as we know it, that we will not be able to do if we lose antibiotics.” (Read the full story here.)

Antibiotics may not be the only issue. Antiviral medications (which treat viruses, not bacteria) are also a worry — we’ve already seen drug-resistant cases of H1N1 (swine flu) and the more deadly H5N1 (avian flu). Some experts are already warning that antivirals should be used to treat illnesses only — using them to prevent illness could promote drug-resistant strains.

In other words, if we want to be able to fight more infections in the future, we have to cut back on our drug use now.

How did we get to this point?

We don’t like to be sick, and we certainly don’t like to see our loved ones suffer with symptoms. People’s expectations to take a pill to “make it all better” are part of the problem. Research has shown that viruses are behind 90 per cent of illnesses like colds, flu and minor infections in the chest, ears and throat. However, many people still ask for antibiotics, not understanding this class of medications are actually useless against viruses because they’re designed to target bacteria. Some studies have shown that doctors bow to pressure from patients and prescribe pills even if they know better — especially when there are children involved.

Furthermore, many minor infections like ear aches in children resolve themselves without medication. That’s why we’ve been seeing recent changes in treatment guidelines, and there may be more to come.

But prescription medications are only part of the problem. We want a safe food supply, so animals are being fed antibiotics. We’re obsessed with clean homes and sanitary conditions, so we turn to “germ-fighting” products when research has shown that soap and water work just as well.

And when people do get prescriptions, many don’t take them or dispose of them properly. We know that antibiotics wipe out the beneficial bacteria in our guts, and the same thing can happen to the environment when antibiotics hit the water supply.

What can we do?

Microbes are going to become drug resistant — it’s in their nature to mutate and change, after all — but the goal is to slow down the process so medicine can keep pace.

We rely on medical experts and researchers to track the problem, revise treatment guidelines and devise new medications like antibiotic and probiotic treatments. (There are several governing bodies and task forces like the Canadian Committee on Antibiotic Resistance set up to monitor the problem and promote awareness.) Task forces are also looking at ways to work with farmers to promote healthier farming methods that don’t rely on drugs. And veterinary medicine needs to work in conjunction with “human” medicine.

However, as patients, part of the responsibility lies with us too. Here’s what experts say we can do to help:

– Don’t demand antibiotics for viruses. Talk to your doctor about the most effective way to deal with your illness, and be prepared to take “no” for an answer when the question of antibiotics comes up. Over the counter remedies like decongestants and pain relievers may be the best option to manage symptoms until the virus runs its course.

– Avoid antibacterial soaps and products. Soap, water and some scrubbing action will get the job done, or use a solution of vinegar or bleach to disinfect surfaces as needed. Remember, products that promise “germ-fighting” properties can lead to increased drug resistance. (Experts still recommend alcohol-based hand sanitizers when hand washing isn’t possible.)

– Follow directions. If you are prescribed a round of medication, follow your doctor’s orders. Take the full course even if you feel better after a few days. (Just because your symptoms have gone away, doesn’t mean the tough bugs are gone too.)

– Keep your meds to yourself. Don’t share your medication with anyone, and don’t take someone else’s prescription. The medication could be inappropriate for the infection or even dangerous in combination with other medications, medical conditions or allergies.

– Avoid hoarding. Another no-no: don’t save any medication “for next time.” Unless you’re told otherwise by a doctor, you need the full amount prescribed. Storing medication poses additional dangers like accidental ingestion or theft, and drugs can break down sooner than their expiration date if they aren’t stored properly.

– Dispose of medications properly. Forget about flushing. Experts warn the only safe way to get rid of your unwanted medications is to take them to your pharmacy or local hazardous waste program for proper disposal. If they go in the garbage or the toilet, they’ll end up in the water table.

– Take steps to prevent infection. Sounds simple, but if we can avoid infections we can avoid needing treatment. Thanks to major health concerns like H1N1 and food-borne outbreaks, we already know the steps: washing our hands frequently, staying home when we’re unwell, not sharing personal items like towels or razors, avoiding people who are sick and keeping things clean. Safe food handling practices like proper washing, refrigeration and cooking also help reduce food-borne illnesses.

The bottom line for patients: medical experts aren’t the only ones who should act on this issue. We have to stop taking antibiotics and antivirals for granted, and we need to be more careful how we use them and dispose of them.

ON THE WEB

For more information, visit Health Canada’s Antibiotic Resistance webpage and the U.S. Centers for Disease Control Antibiotic/Antimicrobial Resistance website.

Sources: Public Health Agency of Canada, European Center for Disease Control, U.S. Centers for Disease Control and Prevention, Health Canada, Canadian Committee on Antibiotic Resistance.

Photo ©iStockphoto.com/ Jon Schulte

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