Seven hard facts we all need to swallow about antibiotics

The global public health crisis of antibiotic resistance is in the spotlight. What’s at stake is the impending loss of antibiotics that threatens modern medicine as we know it.

There has been a dramatic increase in multi-drug-resistant bacteria in the last few years. This is happening in the community, with examples such as gonorrhoea, and in hospitals where some “superbugs” are now either virtually, or completely, untreatable. Currently 700,000 people die each year from resistant infections. That number is set to rise to ten million by 2050 if no action is taken.
Far from being someone else’s problem, the release of a World Health Organisation (WHO) multi-country survey describes public awareness around antibiotic resistance, and highlights common misconceptions that are driving the current crisis. Here are seven of them.

1. Antibiotics won’t cause resistance if I take them correctly

False.
Antibiotic resistance is all about Darwinian natural selection. For thousands of years bacteria have had to protect themselves from chemical substances produced by other bacteria and fungi, designed to kill them. Since 1928, when Alexander Fleming discovered penicillin, we have harnessed these substances as antibiotics.

The bacteria that are able to resist have a survival advantage and will survive an attack by an antibiotic. Some sensitive bacteria can also acquire resistance genes from other bacteria, also rendering them resistant. Whenever we use an antibiotic it kills all the bacteria that do not have a resistance mechanism – that is, those that are sensitive, but leave any that are resistant.
Given the right circumstances, the resistant bacteria will replicate and can either cause infection in the treated person, or colonise the skin and body surfaces. They are then able to be transferred to another person, for example by touch. This is one way in which antibiotic-resistant bacteria are spread, especially in healthcare settings, if healthcare professionals do not practice good hand hygiene.

However well you take an antibiotic, it can still cause resistance.

2. It’s our bodies that become resistant to the antibiotic

Nope, sorry, it’s the bacteria, not our bodies.
Therefore, there is nothing we can change about our bodies that will overcome the resistance to antibiotics in the bacteria.

3. Antibiotics are the cure for the common cold and flu

False.
Antibiotics are only active against bacteria. The common cold and flu are caused by viruses against which antibiotics have absolutely no effect. And the more antibiotics we use, the more resistant bacteria will be selected out and will increase in number.

The overuse and misuse of antibiotics for viral infections is one of the single biggest drivers of the increase in antibiotic resistance worldwide. The only result of taking an antibiotic for a cold is to:

• do yourself harm through unwanted side effects of the antibiotic; and
• do yourself, your family, friends and society harm by increasing antibiotic resistance.

The majority of respondents across the 12 countries surveyed by WHO incorrectly believe that viruses such as colds and flu (64%) can be treated with antibiotics. Nearly 70% of the 1002 South African respondents shared this misconception, which often translates into pressure put on doctors and nurses by patients to prescribe an antibiotic when they feel ill.

Overall, reported antibiotic use was higher in the lower income countries included in the survey, where 42% of people say they used antibiotics within the past month compared with 29% of people surveyed in higher income countries.

4. If I feel better, I can stop my antibiotics

False.
But there is a caveat. It clearly depends on whether you are taking the antibiotic for a bacterial infection, or incorrectly for, say, a viral infection. If this is the case, then the shorter the time you are on an antibiotic the better.

But if you have a bacterial infection that needs treating with an antibiotic, then it is vital that you take the course as prescribed. Our symptoms commonly improve before all the bacteria are killed and dealt with by the body.

If you stop your antibiotics early, or if you miss doses, then the amount of antibiotic available to kill the bacteria is not enough and the bacteria are still able to replicate. It is easier for bacteria to become resistant if there is too little antibiotic present. So always complete your course and don’t stop just because you feel better.

5. I can take leftovers, or some from family or friends

False.
Never take antibiotics that are left over from past treatments or given by family or friends. Only take antibiotics prescribed from a doctor or nurse. There are two good reasons for this:

• antibiotics past their date are more likely to cause resistance as the active ingredient may be impaired; and
• antibiotics from other people may not be the correct choice. There are many different types of antibiotics used to treat different infections, which means that your infection will not be treated correctly, also increasing the chance that bacteria can become resistant.

6. Resistance only happens from repeated courses

False.
Antibiotic resistance can occur whenever you take an antibiotic, whether it is a single course or multiple repeat courses. The more courses you take, the more resistance can occur. But that doesn’t mean it doesn’t occur with a single course.

On top of that, a single course of antibiotics can lead to life-threatening unwanted side effects and potentially catastrophic changes to the normal bacteria that live in our guts. The imbalance can allow dangerous bacteria like Clostridium difficile to predominate and cause severe diarrhoeal illness.

7. It’s the medical professions fault

It is fair to say that the medical profession has failed the general public. We need to do a lot more to educate and raise public awareness around the problem of antibiotic resistance and the appropriate use of antibiotics.

But the difficult truth is that we are all in this together. The pressure on doctors and nurses to prescribe antibiotics from the public can be intense. Good practice is often undermined by uncertainty either due to lack of knowledge and/or lack of point-of-care diagnostics. Patient pressure to prescribe compounds the problem.

The bottom line is that we are all responsible for our future. Antibiotics are a global common good. They belong to everyone, so what one person does affects the next one. It’s time we all became “Antibiotic Guardians” to retard the relentless rise of bacterial resistance through correcting inappropriate use of this vital resource.

Marc Mendelson, Professor of Infectious Diseases, University of Cape Town
This article was originally published on The Conversation.