A Vicious Cycle: More Infections and Antibiotic Overuse
Though bacterial antibiotic resistance is a natural phenomenon, societal factors also contribute to
the problem. These factors include increased infection transmission, coupled with inappropriate antibiotic use.
More people are contracting infections. Sinusitis among adults is on the rise, as are ear infections in children.
A report by CDC's Linda F. McCaig and James M. Hughes, M.D., in the Jan. 18, 1995, Journal of the American
Medical Association, tracks antibiotic use in treating common illnesses. The report cites nearly 6 million
antibiotic prescriptions for sinusitis in 1985, and nearly 13 million in 1992. Similarly, for middle ear
infections, the numbers are 15 million prescriptions in 1985, and 23.6 million in 1992.
Causes for the increase in reported infections are diverse. Some studies correlate the doubling in doctor's
office visits for ear infections for preschoolers between 1975 and 1990 to increased use of day-care facilities.
Homelessness contributes to the spread of infection. Ironically, advances in modern medicine have made more
people predisposed to infection. People on chemotherapy and transplant recipients taking drugs to suppress their
immune function are at greater risk of infection.
"There are the number of immunocompromised patients, who wouldn't have survived in earlier times," says Cranston.
"Radical procedures produce patients who are in difficult shape in the hospital, and are prone to nosocomial
[hospital-acquired] infections. Also, the general aging of patients who live longer, get sicker, and die
slower contributes to the problem," he adds.
Though some people clearly need to be treated with antibiotics, many experts are concerned about the inappropriate
use of these powerful drugs. "Many consumers have an expectation that when they're ill, antibiotics are the answer.
They put pressure on the physician to prescribe them. Most of the time the illness is viral, and antibiotics are
not the answer. This large burden of antibiotics is certainly selecting resistant bacteria," says Blum.
Another much-publicized concern is use of antibiotics in livestock, where the drugs are used in well animals to
prevent disease, and the animals are later slaughtered for food. "If an animal gets a bacterial infection, growth
is slowed and it doesn't put on weight as fast," says Joe Madden, Ph.D., strategic manager of microbiology at FDA's
Center for Food Safety and Applied Nutrition. In addition, antibiotics are sometimes administered at low levels in
feed for long durations to increase the rate of weight gain and improve the efficiency of converting animal feed to
units of animal production.
FDA's Center for Veterinary Medicine limits the amount of antibiotic residue in poultry and other meats, and the
U.S. Department of Agriculture monitors meats for drug residues. According to Margaret Miller, Ph.D., deputy division
director at the Center for Veterinary Medicine, the residue limits for antimicrobial animal drugs are set low enough
to ensure that the residues themselves do not select resistant bacteria in (human) gut flora.
FDA is investigating whether bacteria resistant to quinolone antibiotics can emerge in food animals and cause disease
in humans. Although thorough cooking sharply reduces the likelihood of antibiotic-resistant bacteria surviving in a
meat meal to infect a human, it could happen. Pathogens resistant to drugs other than fluoroquinolones have sporadically
been reported to survive in a meat meal to infect a human. In 1983, for example, 18 people in four midwestern states
developed multi-drug-resistant Salmonella food poisoning after eating beef from cows fed antibiotics. Eleven of the people
were hospitalized, and one died.
A study conducted by Alain Cometta, M.D., and his colleagues at the Centre Hospitalier Universitaire Vaudois in Lausanne,
Switzerland, and reported in the April 28, 1994, New England Journal of Medicine, showed that increase in antibiotic
resistance parallels increase in antibiotic use in humans. They examined a large group of cancer patients given antibiotics
called fluoroquinolones to prevent infection. The patients' white blood cell counts were very low as a result of their
cancer treatment, leaving them open to infection.
Between 1983 and 1993, the percentage of such patients receiving antibiotics rose from 1.4 to 45. During those years,
the researchers isolated Escherichia coli bacteria annually from the patients, and tested the microbes for resistance to
five types of fluoroquinolones. Between 1983 and 1990, all 92 E. coli strains tested were easily killed by the antibiotics.
But from 1991 to 1993, 11 of 40 tested strains (28 percent) were resistant to all five drugs.
Towards Solving the Problem...
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