We are in the middle of an entire week devoted to educating the public about the dangers of overusing antibiotics. With several decades of bad information already behind the opinions formed by a seriously misinformed public, making things right in just seven days will never happen.
Let's start with defining the problem: Antimicrobial Resistance. The definition is pretty straight forward, even if the solutions are not and the conversation often takes some odd and fact-free turns. Wikipedia explains it this way:
"Antimicrobial resistance (AMR) is when microbes are less treatable with one or more antimicrobial medications used to treat or prevent infection. There are three main ways by which resistance can occur: by natural resistance in certain types of bacteria, by genetic mutation, or by one species acquiring resistance from another. Resistance can happen spontaneously owing to random mutations, to a build up of resistance over time, or to misuse of antibiotics or antimicrobials, although the latter two pathways are the most important. Resistant microbes become increasingly difficult to treat, requiring alternative medications or higher doses, both of which may be more costly or more toxic."
The science behind why it happens and what to do about it is well-known. Unfortunately, the 'unscience' behind it is too often given more credibility because it makes a better story. Scare tactics almost always work better; they definitely make for eye-catching headlines and they are a more efficient way to whip up a frenzy among the short attention span theater ticket holders who can be counted on to rise up and demand action.
Are a lot of antibiotics used with animals - those that are part of agriculture as well as those that are part of our households? Yeah, because it is the humane thing to do. Bossy the cow and Fido the pup are usually treated to a dose or two of something whenever they're sick, just as little Noah and Emma will get a Z-pack when they get the sniffles.
How about the sheer volume of meds given to cows vs kids? Are we giving more to our animals than our children and the rest of our human population? Let me point out that the U.S. has a higher cow population than a kid population and a cow weighs around 40 to 50 times as much as the average child so the correct answer is "of course we do!" Doses of most meds are usually given based on weight.
But Dr. Richard Raymond often points out the overlooked obvious fact - most antibiotics used with animals are never used with humans. If animal ag immediately stopped using all their medicinal tools to combat infections, there would be no real effect outside the barnyard or feedlot. The only predictable outcome would be the needless suffering and death of our pets and the millions of animals that make up our herds and flocks.
We can't dismiss the problem, though. The CDC says "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."
The BBC, usually a less apocalyptic news source, reporting about a bacteria able to shrug off the drug of last resort - colistin - in patients and livestock in China, wrote, "Bacteria becoming completely resistant to treatment - also known as the antibiotic apocalypse - could plunge medicine back into the dark ages."
To quote their story, "Prof Timothy Walsh, of the University of Cardiff, told the BBC News website, 'All the key players are now in place to make the post-antibiotic world a reality.
If MCR-1 becomes global, which is a case of when not if, and the gene aligns itself with other antibiotic resistance genes, which is inevitable, then we will have very likely reached the start of the post-antibiotic era.
At that point if a patient is seriously ill, say with E. coli, then there is virtually nothing you can do.'"
Possibly trying to divert attention away from their own peculiar prescription happy drug habit, the American Academy of Pediatrics (AAP) issued a misleading report stating that 80% of antibiotics were used on animals and that was causing a significant problem within the human population. Their board should request an immediate consult with Dr. Raymond.
Responding to the narrow approach to the problem taken by AAP, Barry Carpenter, Chief Executive Officer with the North American Meat Institute, said “We are disappointed that AAP relied on old data and outdated policies and practices in reaching their conclusions. We are also surprised that AAP cites a misleading statistic that 80 percent of antibiotics are used in livestock – a claim that has been debunked many times, including in our own Media MythCrusher.”
Interviewed last year about their MythCrusher videos, Janet Riley, NAMI Senior Vice President of Public Affairs and Member Services, said, "It is unusual for us to devote so many Meat MythCrusher videos to one topic, but antibiotic use and resistance is such a complex issue with and so much confusion exists. We felt it was important to address the myths in a series with several different leading experts."
There are five videos in the series: "80 Percent of Antibiotics are Used in Animals," "Antibiotics are Used in Animal Agriculture to Cover Up for Unsanitary Conditions," "Antibiotics are Primarily Used for Growth Promotion," "Animal Agriculture is the Biggest Contributor to Antibiotic Resistance" and "Denmark has Eliminated Antibiotic Resistance by Banning Use of Antibiotics for Growth Promotion.."
To be sure, the overuse of antibiotics in animal agriculture and for human illnesses is the root of the antimicrobial resistance problem and animal agriculture, both big and small, has rallied to the cause, cutting back significantly on usage as a growth promotant.
According to Neil Conklin, President of the National Farm Foundation, the educational group will begin preparing farmers and ranchers for the stricter government rules on antibiotics, which will take effect in 2017 when they will no longer be able to use antibiotics to promote growth, but only to treat infections. In addition, the drugs must be prescribed and administered by a veterinarian.
I found no such similar effort to oversee antibiotic drug use in the human population backed by the AAP or any other human health organization. It seems your friendly neighborhood Doc will still be able to prescribe an antibiotic for a viral infection, something that will only soothe the fears of a frantic Mom but do nothing to help little Noah recover.
Using a hockey term, even if your G.P. is unwilling to do the right thing, Pharmacists are ready to do a hard 'check' on his prescription pad. An article in the November 19 issue of Pharmacy Times said, "Pharmacists can play a critical role in coordinating better strategies to enhance antimicrobial stewardship. Often, they are already working directly with medical and nursing staff to ensure that patients are prescribed the best treatment by advising on drug selection, dose, and administration method.
Nevertheless, the International Pharmaceutical Federation (FIP) recently published a report that called for greater pharmacist involvement in antimicrobial stewardship efforts and detailed specific contributions that pharmacists can make."
Fred M. Eckel, ScD, Editor-in-Chief of the magazine, wrote, “Pharmacists can’t just expect others to do it. We must make our own contributions if we want to fix this problem.”
To help reduce the more deadly and critical rampant overuse by humans, Dr. Saul Hymes, assistant professor of clinical pediatrics and a specialist in pediatric infectious diseases at Stony Brook Children’s Hospital, warned, “Overuse — (the) unnecessary use for viruses or colds—leads to resistance that much faster."
He offered seven important tips to help combat human overuse:
1. Get educated: Antibiotics cure bacterial infections, not viral infections such as colds or the flu, most coughs and bronchitis, most sore throats, or runny noses. Taking antibiotics for viral infections will not cure the infection, protect others from catching it, or help you feel better.
2. Read the fine print: Antibiotics also can kill the healthy bacteria in your intestines, which can allow more harmful bacteria to develop. Also, when your child is prescribed an antibiotic, make sure they take every dose and stop when the health professional says to, not before.
3. Treat at home first: Symptoms of most upper respiratory infections, including sore throats, ear infections, sinus infections, colds, and bronchitis, can be less intense without antibiotics. Try the following: Getting plenty of rest; drinking plenty of fluids; avoid smoking, secondhand smoke, and other pollutants (airborne chemicals or irritants); taking acetaminophen or ibuprofen to relieve pain or fever; Soothing a sore throat with ice chips, popsicles, lozenges (for older children).
4. Identify: Does your child have a cold or is it allergies? With the change in seasons and temperature fluctuations, sinus pain or pressure is very common. But antibiotics are not always needed. A warm compress over the nose and forehead can help relieve sinus pressure. Or, for adults or older children, try a decongestant or saline nasal spray or breathing in steam from a bowl of hot water or shower.
5. Resist the pressure: Don’t ever be pressured into giving your child antibiotics. Let your healthcare professional know your concerns. But also, don’t pressure your healthcare professional to prescribe antibiotics—they will if they feel it’s necessary.
6. Don’t pass it on: Kids either love or hate to share their toys and snacks, but never give antibiotics that are prescribed for one child to another and never use antibiotics without a prescription. And do not keep extra antibiotics “for next time.”
7. Get vaccinated: Make sure your children are vaccinated on time with the full schedule of childhood vaccines. Many bacterial illnesses can be prevented altogether.