Our Precious Antibiotics

(c) Gage Skidmore

Just a day after reading about a woman in Nevada who died from a bacterial infection resistant to EVERY SINGLE antibiotic, I discovered that my sister had just finished a course of antibiotics for an upper respiratory infection known as pharyngitis.  Not all that interesting until you consider that my sister had strep test-negative pharyngitis, meaning not caused by the bacteria Streptococcus.  As my palm smacked my forehead in disbelief and I attempted to explain why taking antibiotics might not have been a great idea, I said to myself, “gosh darn it Heather, you’ve got a blog, go blog.”

Bacteria were likely the first inhabitants of Earth.  Today they live in every nook and cranny of our world we’ve ever thought to look.  From frozen tundra and hot springs to the highest land peaks and the deepest underwater valleys, we’ve found bacteria living and thriving.  They’ve been in the neighborhood way longer than us and there is no doubt about it–they rule this roost.

Fortunately for us, most bacteria don’t cause disease.  In fact, we actually have more bacterial cells within our own bodies than we have human cells (they’re just a lot smaller).  Despite being cesspools of bacteria, not only are we not always sick, many of our roommates have beneficial properties–keeping us healthy!  Mice that are born in a sterile environment in a lab have a bunch of health problems, which tells us that the bacteria they encounter upon birth and in the world (even a world consisting of laboratory cages, bedding, and whatever “food” is in those pellets) are good for them.

Ever since Anton van Leewenhoek first saw bacteria in his microscope in 1674, we ‘the people’ have viewed them as enemies.  Some are certainly bad for humans and cause disease, and yet others live in peace until they identify some new opportunity to exploit.  Each bacterial species is neither good nor evil, hero nor villain.  They are just trying to survive in this world–same as us.

In 1928, Alexander Fleming discovered a molecule in mold that killed bacteria. He named this compound after the strain of mold itself–penicillin.  It wasn’t until the 1950s that Dorothy Crowfoot Hodgkin figured out what penicillin looked like, which allowed scientists to create it in a lab.  Thus the antibiotic era was born.  An onslaught of antibiotics were discovered and produced in the latter half of the 20th century.  Twenty-six in total, with activity against bacteria from staphylococcus to tuberculosis and we were able to thwart diseases from skin infections to pneumonia.  It’s no doubt that antibiotics (in addition to water filtration techniques and vaccines) have greatly contributed to lengthening the human life span.

But, as Uncle Ben told young Peter Parker, “with great power comes great responsibility”.  Unfortunately we have not taken heed for this responsibility when it comes to the power of antibiotics.  We have overused them by treating diseases to which they have no effect (like viral infections).  We have misused them by inappropriately treating livestock and erroneously adding them to soaps and lotions.  To top it all off, we have stopped discovering more.  Once, 26 sounded like overkill.  Today, it’s not nearly enough.

For the most part, bacteria live in communities known as colonies.  But because they are individual single-celled organisms that replicate themselves frequently, each one has the incredible ability to rapidly evolve.  One single bacteria with a mutation that gives it an advantage over its peers (like resistance to an antibiotic in the environment) will soon dominate the colony because it can continue to make offspring while its neighbors are killed by the antibiotic.  In this way, colonies are continuously morphing and adapting to their environments–the perfect example of Charles Darwin’s survival of the fittest.

A recent study in the CDC’s Morbidity and Mortality Report was an intriguing and horrifying case report of a woman in Nevada who developed septic shock and died.  She had a history of multiple hospitalizations in India for bone infections.  It appears that these infections weren’t effectively treated, allowing the bacteria to morph and adapt, to persist and resist.  The infection was caused by a bug known as Klebsiella pneumoniae and samples tested at the CDC after her death revealed that it was resistant to all 26 available antibiotics.   This is, of course, incredibly rare, but this example shows that it is feasible for bacteria to become resistant to all of our weapons against it.  This is the stuff that feeds my nightmares.

My sister certainly didn’t do anything wrong by taking antibiotics for her pharyngitis.  She was sick, went to the doctor, and took the medication prescribed to her.  She thought the antibiotic worked because she got well.  I can’t say with any certainty that she didn’t have a bacterial infection, but more likely than not it was a viral infection and she would have gotten better anyway.

The Infectious Diseases Society of America (IDSA) recommends that antibiotics should be reserved only for patients with laboratory-confirmed group A beta-hemolytic streptococcal   (GAS) pharyngitis. That’s a longwinded way of saying those with a positive strep test.  Since my sister had a negative strep test, her physician shouldn’t have prescribed her the antibiotic, or perhaps her doctor could have sent her home with a prescription only to fill if the test came back positive.

Now, I realize that nothing happens in a black box. Medicine can be messy and not every situation is clearly yes or no, antibiotic or not.  My sister has a 1 year old at home.  Perhaps that plus her very swollen glands and symptoms were enough for her general practitioner to hedge her bets.  Better safe than sorry, right?  Well, for any single individual, it probably has little impact.  But in the grand scheme of life where the microorganisms are kings and we’re just along for the ride, we can all be a little more careful about using our precious antibiotics.  And for god sakes, let’s put some money into developing more.

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