Antibiotic overuse

Since antibiotics were introduced into medicine in the 1940s, they’ve become indispensable in fighting disease. But even so, their overuse has been raising serious concerns.

The federal Interagency Task Force on Antimicrobial Resistance warns that the “extensive use of antimicrobial drugs has resulted in drug resistance that threatens to reverse the medical advances of the last seventy years.” According to the Centers for Disease Control and Prevention (CDC), “Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics, and at least 23,000 people die each year as a direct result of these infections. Many more people die from other conditions that were complicated by an antibioticresistant infection.”

“Antibiotic resistance is rising for many different pathogens that are threats to health,” said CDC director Tom Frieden, M.D., M.P.H. “If we don’t act now, our medicine cabinet will be empty and we won’t have the antibiotics we need to save lives.”

Overuse is harmful in two main ways. First, antibiotics can disturb the natural balance of good and bad bacteria in the body, thus making the person more susceptible to illness. Second, overuse can lead to the development of “superbugs,” bacteria that are resistant to multiple antibiotics.

Understanding antibiotic resistance

When encountering antibiotics, bacteria evolve in ways that cause them to resist the drugs. When bacteria become resistant, they can multiply quickly and cause dangerous infections; and by sharing genetic information with other bacteria, they can cause the other bacteria also to become resistant. As bacteria become more resistant, treatment options for a particular disease become more limited, thus creating greater risk to patients. The CDC points out that people can become infected with antibiotic-resistant bacteria in the general community and in healthcare settings such as hospitals and nursing homes.

“Every time antibiotics are used in any setting, bacteria evolve by developing resistance. This process can happen with alarming speed,” said Steve Solomon, M.D., director of the CDC’s Office of Antimicrobial Resistance. “These drugs are a precious, limited resource — the more we use antibiotics today, the less likely we are to have effective antibiotics tomorrow.”

Responsible use in human medicine

There are many ways antibiotics are misused or overused in human medicine. Sometimes the drugs are used to treat illnesses such as the common cold or flu, which are caused by viruses, not by bacteria. Sometimes the drugs are prescribed because of patient demand, and in some cases doctors prescribe antibiotics earlier than necessary rather than waiting a few days to see if the symptoms will subside on their own. Another misuse of antibiotics is turning too quickly to a “broad spectrum” drug, one that attacks several kinds of bacteria at once. That tactic runs the risk of breeding resistance and wiping out protective bacteria.

The CDC encourages responsible use of antibiotics and offers these guidelines for patients:

• Don’t demand for your doctor to prescribe antibiotics.
• Don’t take antibiotics not prescribed for your particular illness at a particular time. 
• Don’t skip doses when you take antibiotics. 
• Follow your doctor’s directions for dosage. 

The CDC points out that responsible use also means practicing good hygiene and taking other measures to prevent disease:

• Stay up-to-date on vaccinations. 
• Wash your hands before meals and after using the restroom. 
• Wash your hands after handling uncooked food. 
• Cook meat and poultry thoroughly to kill bacteria. 

Responsible use in agriculture

According to the CDC, the widespread use of antibiotics in food-producing animals contributes to antibiotic resistance and can be a public health hazard: “These resistant bacteria can contaminate the foods that come from those animals, and persons who consume these foods can develop antibiotic-resistant infections.” The CDC says there’s strong scientific evidence that using antibiotics in food-producing animals “can have a negative impact on public health.”

Consumers Union, like some other advocacy groups, says that “the threat to public health  … is real and growing. Humans are at risk both due to potential presence of superbugs in meat and poultry, and to the general migration of superbugs into the environment” through farm workers, runoff, wind and wildlife. Organizations such as the American Medical Association, the Infectious Disease Society of America, the American Public Health Association and the World Health Association have called for substantial reductions in the use of antibiotics for food-producing animals.

Antibiotics in food-producing animals have been used in four ways: (1) to treat animals that are sick; (2) to control disease for a group of animals when some of them are sick; (3) to prevent disease in healthy animals who are at risk of becoming sick; (4) to promote growth or increase feed efficiency in order to promote weight gain.

One controversial issue is the unnecessary giving of “subtherapeutic” levels of antibiotics to animal in order to promote growth. Another is giving antibiotics that are primarily used for humans to food animals, thus putting those persons at risk of becoming resistant to antibiotic treatment.

Progress is underway. To help ensure responsible use of antibiotics in agriculture, the Food and Drug Administration (FDA) is promoting “the judicious use of medically important antimicrobial drugs in food animals.” Its stated strategy is “to work with industry to protect public health” by phasing out “the use of medically important antimicrobials in food animals for production purposes (e.g., to enhance growth or improve feed efficiency), and to bring the therapeutic uses of such drugs (to treat, control or prevent specific diseases) under the oversight of licensed veterinarians.” The industry has supported this strategy.

Faith informing decisions

How does faith guide us as we make decisions about the use of antibiotics? The first of John Wesley’s General Rules for the early Methodist societies was to do no harm, and the second was to do good.

In decisions about the use of antibiotics, these rules can be guidelines that encourage us — whether we are patients, doctors, veterinarians or farmers — to ask questions such as these: Is an antibiotic really needed in this case? What is the best use of an antibiotic in this situation? When does this use cease to do good and begin to do harm? How does this use positively or negatively affect public health now and in the future?

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