Antibiotic Use Poses Resistance Risk

ByMelinda T. Willis

Oct. 15, 2001 -- As nationwide sales of antibiotics continue to mount, the threat of antibiotic resistance becomes more real. Many experts are concerned about the implications that such a large influx of antibiotics into the hands of the public will carry for society.

Inappropriate or liberal use of antibiotics can lead to the development of so-called superbugs, or bacteria that are resistant to a wide range of antibiotics making them difficult, if not impossible, to treat.

"The general rule is the more you use an antibiotic the more you develop resistance," says Dr. Marvin Bittner, associate professor of medical microbiology and immunology at Creighton University School of Medicine.

Dangers of 'Superbugs'

"Antibiotic resistance has been known ever since antibiotics were discovered 40 to 50 years ago," says Dr. Calvin Kunin, professor emeritus of internal medicine at Ohio State University.

Antibiotic resistance is a function of natural selection: The more antibiotics used and the greater the frequency of use, the greater chance that bacteria will evolve the ability to resist their effects.

Current research supports just how dangerous a problem antibiotic resistance can be. For example, a study published in the Oct. 1 issue of Clinical Infectious Diseases looked at an outbreak of hemolytic uremic syndrome (HUS) in Scotland. HUS is a blood infection caused by a strain of E.coli that can lead to kidney failure.

The study found that recent use of Cipro doubled the risk of developing HUS. Antibiotic use allowed more virulent E.coli strains that were resistant to the antibiotic to develop.

Perhaps even more frightening is the fact that, "There are currently five different kinds of bacteria that are resistant to every drug we have," says Dr. Stuart Levy, director of the Center for Adaptation Genetics and Drug Resistance at Tufts University.

While these bacteria are rare, antibiotic resistance remains a very real problem.

Implications of the Anthrax Scare

Nationwide, new prescriptions of Cipro increased 12 percent in early October compared to prescriptions written during the same period one year ago, according to NDCHealth, a leading health care information services company.

This increase means that more antibiotics are in the hands of more people. While an ABCNEWS/Washington Post poll finds that only 1 percent of adults have bought antibiotics out of concerns about terrorism, many experts want the public to be aware of the potential impact of antibiotic misuse.

"When you take an antibiotic, it has implications for other people. It has effects beyond the individual," warns Kunin.

This is because antibiotic resistant bacteria can be transmitted from person to person, causing potential life-threatening problems for the community.

"The real harm is that we will be converting all of the bacteria that are currently treatable to resistance," says Levy.

Many conditions such as pneumonia and urinary tract infections are currently treatable with Cipro. Levy feels that continuous misuse of Cipro could produce multitudes of resistant organisms in as little as two weeks.

Initiatives for Protection

In 1999 the Centers for Disease Control, the Food and Drug Administration and the National Institutes of Health founded an interagency task force on Antimicrobial Resistance that developed an action plan identifying ways to alleviate the problem of antibiotic resistance.

A key part of the plan is educating the public about their role in preventing antibiotic resistance. "One of the issues is patients who demand antibiotics," says Bittner.

Patients need to be aware that antibiotics are not required to treat many illnesses and that they should not pressure their physicians into prescribing them.

Experts say that patient awareness combined with efforts to develop new antibiotics and restrict improper use of old ones will effectively minimize the threat of antibiotic resistance.