Without question, one of the greatest advances in medicine in the last century has been the introduction of antibiotics. In fact, it is reasonable to say that we currently live in the “antibiotic era” of medicine.
Every day, thousands of Americans are treated with these life-saving drugs that combat the broad range of bacterial infections that have long impacted human health and survival. Collectively, antibiotics are perhaps the closest thing to a “silver bullet” that modern medicine can provide against the countless bacterial pathogens that cause serious infections.
However, the overuse of antibiotics is rapidly becoming one of the most challenging problems in contemporary medical practice. The key to the success of these powerful agents is appropriate use.
The safe and appropriate use of antibiotics is a national public health priority and the campaign to promote it is known in medical parlance as antimicrobial stewardship. In other words, we must be good stewards of this important resource if we expect it to remain effective.
Like so many other living things, bacteria evolve in response to environmental pressure. In fact, they happen to be exceedingly good at it, in large part because of their rapid reproduction. Subjected to antibiotic pressure, bacteria can evolve resistance, meaning that they are less or completely unresponsive to those antibiotics to which they have been exposed.
In addition, the overuse of antibiotics confers a selective advantage to those bacteria that are inherently resistant, giving them a competitive advantage. Many bacteria with antibiotic resistance have the potential to cause more serious infections than their nonresistant counterparts.
Hospitals, which house the sickest people with the most serious infections requiring use of the most powerful antibiotics, have long implemented strategies to reduce both resistance and the spread of drug-resistant and even multi-drug-resistant bacteria. Yet the community spread of resistant bacteria in many locations has become more commonplace.
This includes a resistant form of skin bacteria known as methicillin-resistant staph aureus – or MRSA. MRSA causes skin and soft tissue infections and does not respond to the most common antibiotics for the treatment of these conditions.
Another common type of resistant bacteria is Clostridium difficile (sometimes referred to as C. Diff). These spore-forming gut bacteria exist in environments where normal healthy gut bacteria have been eradicated by antibiotics, especially among the elderly and those with weakened immune systems.
Everyone plays a role in curbing the advance of antibiotic resistant bacteria. Health care providers, pharmacists and infection control and laboratory professionals are all responsible for surveillance and the development of appropriate protocols and prescribing procedures for infections that are based on the best available science.
Patients support safe and effective antibiotic prescribing through a shared decision-making approach to treatment that acknowledges the non-effectiveness of antibiotics for nonbacterial conditions.
Working together, we can all make sure that these important tools in our treatment toolbox remain available and effective for generations to come.
Dr. Matthew A. Clark, a board-certified physician in internal medicine and pediatrics, works for the Indian Health Service.
