From good … to dangerous

Misuse of good things can turn them into very dangerous things. Even friends can turn into enemies! But in medical terms, antibiotics are a good example as they are extremely useful but can turn dangerous.

Antibiotics are important drugs used in treating bacterial infections. They save countless lives, prevent the spread of disease and minimise serious complications.

Misuse and overuse of these drugs, however, has increased the number of drug-resistant germs contributing to a phenomenon known as antibiotic resistance.

Misuse puts you and others at risk

Antibiotic misuse, abuse or overuse refers to the incorrect use of antibiotics, with potentially serious effects on health. Drugs that used to be standard treatments for bacterial infections are now less effective or do not work at all.

When an antibiotic drug no longer has an effect on a certain strain of bacteria, those bacteria are said to be antibiotic resistant. Relatively harmless bacteria can develop resistance to multiple antibiotics, including the creation of multi-resistant bacteria, informally called “super bugs”, and cause life-threatening infections.

The overuse and misuse of antibiotics are key factors contributing to antibiotic resistance.

Everyone, from the general public to doctors and hospitals, play a role in ensuring proper use of the drugs and minimising the development of antibiotic resistance.

What is antibiotic resistance?

A bacterium is resistant to a drug when it has changed in some way that either protects itself from the action of the drug or neutralises the drug. Any bacterium that survives an antibiotic treatment can then multiply and pass on its resistant properties. Some bacteria can also transfer their acquired drug-resistant properties to other bacteria, as if passing along a cheat sheet to help each other survive.

The fact that bacteria may develop resistance to a drug is normal and expected. However, the way that drugs are used affects how quickly and to what extent drug resistance occurs.

Inappropriate/overuse of antibiotics

The overuse of antibiotics, especially taking antibiotics even when they are not the appropriate treatment, promotes antibiotic resistance.

Antibiotics treat bacterial infections but have no effect on viral infections.

If you take an antibiotic when you have a viral infection, the antibiotic is still attacking bacteria in your body, bacteria that are either beneficial or at least not causing disease. This misdirected treatment can then promote antibiotic-resistant properties in harmless bacteria that can be shared with other bacteria.

When penicillin and other antibiotics were first introduced, they were perceived as wonder drugs because they worked quickly and with relatively few side effects, seeming like an answer to all common illnesses.

Consequences of antibiotic resistance

The rate of introduction of new antibiotics outpaced, for many years, the development of antibiotic resistance. In recent years, however, things have been different and the increasing pace of drug resistance has brought up a progressively higher number of healthcare problems.

The increasing number of drug-resistant infections results in:
■ More-serious illness or disability
■ More deaths from previously treatable illnesses
■ Prolonged recovery
■ More frequent or longer hospitalisation
■ More doctor visits
■ Less effective or more invasive treatments
■ More expensive treatments

Appropriate use

The appropriate use of antibiotics can help to preserve the effectiveness of current antibiotics, extend their life span and protect the public from antibiotic-resistant infections.

Many hospitals and medical associations have implemented new diagnostic and treatment guidelines to ensure effective treatments for bacterial infections and reduce inappropriate use of antibiotics.

But the public plays a major role in reducing the development of antibiotic resistance by taking the following steps:

■ Use antibiotics only as prescribed by your doctor.
■ Take the appropriate daily dosage and complete the entire course of treatment.
■ If you have an antibiotic prescription, ask your doctor what you should do if you forget to take a dose.
■ If for some reason you have leftover antibiotics, throw them away. Never take leftover antibiotics for a later illness. They may not be the correct antibiotic and would not be a full course of treatment.
■ Never take antibiotics prescribed for another person.
■ Do not pressure your doctor to give you an antibiotic prescription.
■ Practice good hygiene. Wash your hands regularly with soap and water, especially after using the toilet, before eating, before preparing food and after handling fresh meat. Wash fruits and vegetables thoroughly, and keep kitchen work surfaces clean.
■ Make sure you or your children receive recommended vaccinations. Some recommended vaccines protect against bacterial infections, such as diphtheria and whooping cough.
■ If you think you may have penicillin allergy, talk to your doctor about getting an allergy skin test. Research has shown that penicillin or other antibiotic allergies may be over-reported. Ruling out an antibiotic allergy can help your doctor prescribe the most appropriate antibiotic when it is needed.

A world without effective antibiotics is a terrifying but real prospect. The situation is so acute that the director-general of the World Health Organisation, Dr. Margaret Chan, has warned of “a post-antibiotic era, in which many common infections will no longer have a cure and, once again, kill unabated”.

Antibiotic resistance is a very serious, worrying problem. Everyone can help.

Best health wishes,
Dr. Maria Alice

By Dr Maria Alice
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Dr Maria Alice is a consultant in General and Family Medicine. General Manager/Medical Director – Luzdoc International Medical Service / Medilagos. Medical Director – Grupo Hospital Particular do Algarve