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Antibiotics Resistance

If you or your child gets bacterial pneumonia, will the antibiotic your doctor prescribes be effective in fighting the infection? Not too many years ago the answer would have been an unequivocal "Yes." Today the number of bacterial strains that are resistant to one or more antibiotics is multiplying at an alarming rate. In 1997, a strain of Staphylococcus aureus, a common bacteria that can cause deadly infections, was found to be resistant to the antibiotic vancomycin. This was not an isolated incident, but occurred in three geographically separate locations. Because many strains of S. aureus are already resistant to all antibiotics except vancomycin, the possibility of wide-spread vancomycin-resistant S. aureus is ominous.

While antibiotics still easily control many common bacterial infections, this trend is changing rapidly. The Centers for Disease Control and Prevention (CDC) and the Washington State Department of Health (DOH) consider this problem to be so serious that they have mounted an intensive campaign to educate the public and health care providers about the dangers of antibiotic overuse and misuse, and the proper way to use antibiotics.

Most of us living today do not recall a time when there were no antibiotics to counter serious infections. Prior to the widespread availability of Penicillin in the early 1940s, people often died from infected wounds. Before the advent of antibiotics, pneumonia was often a fatal illness. Are we faced with a return to those days?

Some Facts about Antibiotics Resistance

  • According to the CDC, an estimated 2 million people a year develop infections as a result of hospital care. Of those, 70% are resistant to at least one of the antibiotics most commonly used to treat them.
  • Some years back, more than 12,000 people died from Shigella diarrhea in an epidemic in Guatemala. That strain of Shigella was found to be resistant to four different antibiotics. While Guatemala may seem a world away in both miles and living conditions, that distance is made short by the ease and regularity of international travel.
  • The Centers for Disease Control (CDC) and Prevention reports that in 1992, 13,300 hospital patients in the US died of bacterial infections that were resistant to antibiotic treatment. More recently that number has been reported to be as high as 150,000, although the CDC says that we don't really know precise numbers.
  • Last summer an acquaintance related the story of a friend of hers who had entered the hospital to have her appendix removed. While in the hospital she acquired an infection in her leg that would not respond to antibiotics. The woman's leg had to be amputated to save her life.
  • The CDC reports that the annual cost of managing the results of antimicrobial resistance by a single pathogen (Staphylococcus aureus) is $122 million. The estimated medical care costs associated with treating infections in people due to antibiotic-resistant microorganisms are estimated to be over $4 billion annually in the U.S.

How Does Antibiotics Resistance Develop?

How did bacteria start being able to defend themselves against one of the 20th century's greatest achievements? Let's start with a bit of history:

In 1928 Alexander Fleming, a Scottish physician, discovered penicillin. In 1943 penicillin was becoming widely available and was considered a medical miracle, capable of defeating the biggest killer of US soldiers in World War II Ñ infected wounds. Yet in 1947, only four years later, strains of bacteria that could defend themselves against penicillin began appearing. Since then, as medical science has developed a succession of different and more powerful antibiotics, the bacteria haven't been far behind in developing defenses to these miracle drugs.

How do bacteria learn to resist antibiotics? Imagine a soccer game. Team A (Antibiotic) has devised a daring new strategy for getting inside Team B's (Bacteria) defenses. The first time Team B plays Team A they will be surprised by Team A and they will be defeated. But when Team B meets Team A in subsequent games they will start to learn Team A's strategies and will begin to develop defenses against them. Likewise, when bacteria are exposed to antibiotics often enough, they start to develop defenses against the antibiotics. These defenses include developing enzymes that deactivate the antibiotics and developing cellular "pumps" that pump antibiotics back out of the bacterial cell before they can do their work.

And bacteria are surprisingly generous with their learned defenses. They will not only share their defenses with other members of their "team", they will also pass their defensive information on to "teams" of completely unrelated bacteria. As a matter of fact, geneticist and textbook author Ricki Lewis described bacteria as swapping "resistance genes like teenagers swap T-shirts." This promiscuous swapping of genes among bacteria is why we are already faced with deadly bacterial strains that are resistant to all known antibiotics. Scientists and health care professionals fear that if the trend is not reversed we may soon be returned to the days when people commonly died of bacterial infections.

Not all bacteria are bad. We all have many "friendly" and "neutral" bacteria that live in and on our bodies, some of which are important for our health and well being. But these friendly bacteria can develop resistance to the antibiotics they are exposed to and can pass that resistance on to nastier pathogenic (disease causing) bacteria that pass their way.

People often ask me how they can tell whether or not they are "resistant" to antibiotics. But it is bacteria, not people, who become resistant to antibiotics. Even if you have never taken antibiotics (and very few people can say that) you can get resistant bacteria from other people and objects around you. If you happen to be in a weakened state at the time - perhaps under stress from a busy life - you can develop an infection that is resistant to antibiotics. If you don't develop an infection, those resistant bacteria can still pass their defense mechanisms on to your native bacteria, which can then pass it on . . . and on, and on.

Is Antibiotic Resistance A Problem In  Washington State?

According to the Washington State Department of Health (DOH), "Washington faces a growing health problem with the emergence of bacteria that are resistant to antibiotics. Overuse and misuse of drugs such as penicillin, tetracycline, and erythromycin is fast contributing to an increase in bacteria that are able to survive antibiotic treatment. These 'super bugs' can cause hard-to-treat or recurrent illnesses."

Recently a researcher at the University of Washington studying antibiotic resistance in bacteria causing bladder infections found that more than 20% of the bacterial strains studied demonstrated a resistance to the three antibiotics most commonly prescribed for urinary tract infections. The DOH reports that in 1999 in Washington State, "the most common bacteria causing ear infections in children had developed a resistance to penicillin in over 30% of cases."

Why Is Antibiotic Resistance Growing So Rapidly?

Antibiotic Overuse

Antibiotic overuse is one reason. People take 235 million doses of antibiotics every year. The Centers for Disease Control and Prevention estimates that one third to one half of that use is unnecessary.

Overuse includes taking antibiotics for colds or other viral infections, chronic antibiotic use to prevent infections, and use of antibiotics for minor conditions that will resolve on their own. Doctors often report feeling pressured by worried parents or patients to prescribe antibiotics. It is often easier to write a prescription than to take the time to explain why an antibiotic isn't needed, especially in these days of managed care when health care providers are being forced to spend less and less time in each patient contact. Health care providers may also not be certain whether an infection is bacterial or viral. Laboratory tests to identify the cause of the infection require extra time, additional expense and often an extra office visit.

Chronic antibiotic use to prevent recurrent infections is frequently seen in children with middle ear infections. New Centers for Disease Control and Prevention guidelines recommend use of antibiotics only in clearly documented cases of acute ear infections, with very specific criteria. Antibiotics are not recommended for the vast majority of ear infections.

Antibiotic Misuse

Each time bacteria are exposed to an insufficient dose of antibiotics they develop stronger defenses. One way antibiotics are misused is if patients stop taking their antibiotics after they start feeling better but before they have finished the prescription. If they then save the rest of the prescription to use at a later time or give to another family member they are contributing to antibiotic resistance yet again.

Agricultural Usage

An important way that antibiotic resistance is developing is through the use of antibiotics in agriculture. Forty percent of the antibiotics used in the United States are used this way. In the 1950s it was observed that adding low levels of antibiotics to animal feed caused the animals to gain weight faster and thus get to market faster. Since that time antibiotic use in animal feed has been widespread. An outbreak of multi-drug resistant Salmonella poisoning affected 18 people in four mid-Western states, in 1983, of which 11 required hospitalization, and one died. This outbreak was linked to eating beef from cows fed antibiotics. It is estimated that there are between two and four million Campylobacter infections per year from exposure to Campylobacter infected poultry. Many infections are minor, but about 250 people die each year from these infections and another one in 1000 infections leads to Guillan-Barre syndrome, which can cause paralysis. Campylobacter is now becoming resistant to an important class of human antibiotics that was recently approved for use in poultry.

Is it safer to be vegetarian? Not when it comes to antibiotic resistant bacteria. Tens of thousands of acres of fruit trees are sprayed with antibiotics each year to prevent bacterial infections that will make the fruit less cosmetically appealing. The residues of these antibiotics can then contribute to the development of antibiotic resistant bacteria, which may be on the apple you are about to eat.

Solutions to Antibiotic Resistance?

There are actions you can take to reduce your risk of exposure to antibiotic resistant bacteria. Fortunately, by taking these actions you will not only be protecting yourself, you will also be helping with the larger problem. It has been demonstrated that when communities make a concerted effort to reduce the misuse and unnecessary use of antibiotics the number of antibiotic resistant bacteria begin to decline. Here are some important Do's and Don'ts:

Do:

  • Wash your hands regularly with soap and water to prevent illness. This is the single best way to prevent the spread of infections. Wash before, during, and after preparing food, before eating, after using the bathroom or changing diapers, and after handling animals or animal waste. Friction, friction, friction is the rule in hand washing. The friction loosens bacteria and other pathogens from your hands. The water then rinses them away. If you find yourself in a situation with no soap available, sufficient friction and rinsing can do a very good job. Ordinary soap (not antibacterial soap) will help loosen the bacteria.
  • If your doctor prescribes an antibiotic, ask if you have a bacterial infection. If the answer is "no" or "maybe" and the antibiotic is "just in case" or to "prevent secondary (bacterial) infection", ask if your state of health really warrants that precaution. If you have a normally functioning immune system taking an antibiotic may be overkill.
  • Take the entire prescription as directed when you are taking a prescribed antibiotic.
  • Eat organically grown foods, as much as possible. You will not only be getting better nutrition; you will avoid unnecessary exposure to antibiotics. Meat from animals raised without hormones and antibiotics can be found in such stores as Puget Consumers Coop (PCC), Whole Foods, and some Thriftways, as well as others. If these aren't available in your supermarket, ask why not?
  • Go to health care practitioners who know how to treat illnesses without antibiotics. Naturopathic doctors (NDs), acupuncturists (LAcs), and other trained alternative care providers can provide you with remedies and treatments that can effectively fight viral infections and minor bacterial infections so that antibiotics are unnecessary. They can also help you strengthen your immune system so that you get sick less often. NDs are also trained and licensed to prescribe antibiotics when necessary.

Don't:

  • Don't take antibiotics for a cold or flu. These are viral infections. Antibiotics can kill only bacteria and fungus. Antibiotics never kill viruses. If your doctor says that you or your child has a viral infection, don't ask for antibiotics.
  • If you are taking a prescribed antibiotic don't stop taking your prescription when you feel better unless directed to do so by your physician.
  • Don't give "leftover" antibiotics to others or accept leftover antibiotics from others. The bug you have may not be susceptible to the antibiotic prescribed to someone else, even if it was prescribed for the same condition.
  • Don't use antibacterial soaps and cleansers. There is evidence that these products may contribute to the development of antibiotic resistant bacteria. Incidentally, they may also cause problems in septic tanks when antibacterial soaps washed down the drain diminish the populations of bacteria in the septic tanks that help break down waste products.
  • Don't flush unused antibiotics down the toilet. Antibiotics in the water supply are an increasing problem that contributes to the development of antibiotic resistance.

Helpful Supplements & Herbs

The information in this section should not be considered to be medical advice. If you have a severe illness, a minor illness that is getting worse, or an illness that persists more than a few days, consult your physician or other health care practitioner.

There are many vitamins, minerals, herbs, and homeopathic remedies that can be helpful in maintaining optimum health or getting through the discomfort of a cold, flu, or other minor infections. The following section lists only a very few. Colds and flus, although they make you feel awful, are considered minor in a normally healthy person. People with compromised immune systems or who are very depleted due to other chronic illnesses should consult their health care provider when they get ill.

Multivitamin/Mineral Supplements: A high-quality multivitamin/mineral supplement can go a long way toward helping you maintain your health and thus prevent getting sick in the first place. Many people feel that eating a healthy, varied diet with plenty of fresh fruits and vegetables should give them adequate nutrition. Under ideal circumstances, I would agree with this. However, we live in a far from ideal world. Our soils have been depleted of many minerals resulting in fruits and vegetables with less nutritional value than you might expect. Buying only locally-grown organic produce helps, but that is not always possible for all people. In addition to the quality of our food supply, most of us are living in a highly stressful environment. Just driving to work each day can put you into sympathetic or "fight-or-flight" mode several times in a half-hour drive. We tend to be overscheduled and often under-rested. All these stressors put an extra demand on the body for vitamins and minerals that are used up in responding to stress.

We are also living in a world in which we are exposed daily to many toxins, many of which we are unaware of. These toxins come from chemicals, traffic fumes, pesticides and many other sources. Even women living in remote villages that have little or no contact with the outside world have been found to have pesticides in their breast milk. Imagine how much more you are exposed to living in or near a metropolitan area. Our bodies need extra vitamins and minerals to help protect our tissues from these poisons and to help in detoxification processes. These are some of the reasons that I recommend a multivitamin/mineral supplement for almost everyone.

Vitamin C: Vitamin C promotes the healing of tissues and supports immune function. When your body is fighting an infection, it is using up more vitamin C than usual. Most animals can make their own Vitamin C, but humans cannot. Therefore, supplementation is beneficial. Vitamin C can be taken in fairly large dosages without ill effects. When I get a cold I take 1000mg of buffered C every couple of hours. Some people get stomach upset when taking Vitamin C on an empty stomach, so I always recommend taking it with a little food. If you are taking large amounts of Vitamin C and develop loose stools, reducing Vitamin C intake can help your stools return to normal.

Vitamin A: Vitamin A enhances immune function and resistance to infection by promoting tissue integrity and healing in the types of tissue that make up the skin, the lining of the respiratory tract and the lining of the gastrointestinal tract. Vitamin A gets used up quickly in infections and higher than normal doses for a short period of time (3-5 days) may be helpful in reducing the length of an acute viral illness. However, Vitamin A can be toxic in high doses and should not be taken in doses larger than 10,000 I.U.s daily by women who are or could be pregnant.

Zinc: Zinc is an important mineral for the immune system and zinc lozenges can be very effective in fighting off a cold in the early stages. When choosing a lozenge, look for zinc gluconate in a base of glycine, as this is the form that is most effective for this purpose. Zinc deficiency is very common in the United States.

Echinacea: Everyone has heard of Echinacea (Echinacea purpurea, Echinacea augustifolium) and there are many good echinacea products on the shelves of your health food store or the natural products section of your supermarket. My preference is for a tincture (an alcohol extraction) of the whole plant. Echinacea is a natural immune stimulant. When I feel the first hint of a sore throat or the fatigue that signals that I am coming down with something, I take echinacea tincture in a little bit of water every few hours until the symptoms start to diminish. Does it always work? No. But it usually does if I catch it early enough and if I decrease my stress and increase my rest along with taking the herbs. Echinacea products are also available in glycerites for children. Glycerites are naturally sweet and usually more palatable to children.

Berberine: Berberine is a compound found in many plants, the most well known being Goldenseal (Hydrastis canadensis) and Oregon Grape root (Berberis aquifolium). Berberine has strong anti-bacterial properties. Wild Goldenseal has become endangered in recent years due to overharvesting, so I look for berberine preparations made from Oregon Grape root or from cultivated Goldenseal. I have used berberine preparations topically for infected wounds, as a wash for eye infections in my dog, and in tincture or capsule form for fighting off bacterial infections.

Essential Oils: Essential oils can be very beneficial in respiratory infections because they can be used in steams and inhaled. My favorites for this are Thyme oil (Thymus vulgaris) and Eucalyptus oil (Eucalyptus globulus). I have found them very helpful with congestion and coughs. A few drops can be added to a bowl of steaming water or the well of a vaporizer. Be careful not to burn yourself on the steam.

Mullein/Garlic/St.John's Wort oil: An oil with extracts of Mullein (Verbascum thapsus) and garlic (Allium sativum), and St.John's Wort (Hypericum perforatum) can be soothing and healing in cases of ear infection. It is important to not use this if the eardrum is ruptured or punctured. If you are not sure, seek the advice of your doctor.

Licorice: Licorice (Glycyrrhiza glabra) has antiviral properties and helps combat the effects of stress. It makes a wonderful flavorful tea to use when you are feeling worn down or are fighting a viral infection such as a cold or flu. Licorice should not be used by people with high blood pressure without a doctor's supervision.

Calendula/Bitter orange: A combination Marigold (Calendula officinalis) succus with a little Bitter Orange essential oil and glycerin is my favorite remedy for a sore throat. Calendula is soothing and healing and has anti-viral properties. Bitter orange has antiseptic properties. The glycerin sweetens the mix and helps it "stick" to your throat a little longer on the way down. A succus is the juice of the fresh plant that has been preserved in a small amount of alcohol. If a sore throat is severe, accompanied by a fever, or persists more than a couple of days, consult with your physician.

Homeopathic remedies: Homeopathic remedies are substances that have been highly diluted so that very little (if any) of the original substance remains. They are designed to stimulate the body's natural healing responses and many people consider them to work on an energetic level. They are generally considered to be safe and free of side effects. Two remedies that I use most often are those for colds and flu and those used for treating earaches in children. These can be found in the homeopathic sections of many grocery stores and pharmacies. In the cold and flu "season" you will often see these displayed right next to the check-out stands.

There are many, many more natural remedies that can be used to promote optimum health, prevent illness, and treat minor illnesses. It is beyond the scope of this article to discuss these in more detail. Take some time to explore the supplements, herbs, and homeopathic remedies offered in your natural food store, supermarket or pharmacy. Get to know what is available so that you have an idea of what to look for when you are starting to get sick. The more we can use these natural remedies to get us through minor illnesses that don't require antibiotics, the greater chance we have of gradually reducing the problem of antibiotic-resistant bacteria, and the more likely it will be that if you or your child does develop a bacterial pneumonia, the antibiotics your doctor prescribes will be effective.

Pushpa Larsen, ND, LM is a Naturopathic Physician, Licensed Midwife and Certified HypnoBirthingª Instructor, who focuses on health care for women and children, as well as general family practice. She practices at Arbor Vitae Natural Medicine & Childbirth in West Seattle.