Avoiding The Antibiotic Doomsday Scenario

Does anyone remember the late director Stanley Kubrick’s 1964 movie “Dr. Strangelove Or: How I Learned to Stop Worrying and Love the Bomb”? A deranged US Air Force officer manages to launch a nuclear attack against the Soviet Union (now Russia). When the president calls in the Russian ambassador to apologize for this embarrassment, the ambassador informs him that the attack will trigger the much-feared “doomsday machine” and the world will end in a mass of nuclear explosions. If you’ve not seen Dr. Strangelove, let me reassure you the movie is a comedy, albeit one of the darkest ever made.

I bring this up only because two days after watching Dr. Strangelove for the umpteenth time, I came across the phrase “doomsday scenario” in several articles from the UK about antibiotic resistance. You might remember that last month I wrote about the ubiquity of health warnings and how we’re being cautioned against everything from backyard charcoal grilling to overly enthusiastic yoga postures.

Listen up. This recent warning is deadly serious.

Britain’s Chief Medical Officer Dame Sally Davies, an MD, went on record stating that antibiotic resistance is a greater threat to the world than international terrorism and annually far more lethal. Later, apparently thinking terrorism an insufficiently intense comparison, she upped the ante and called antibiotic resistance a greater threat than global warming. With Pakistan reportedly building a nuclear bomb and the polar icecap melt drowning small islands in the Pacific, I think all three scenarios are pretty awful.

The final moments of Dr. Davies’ doomsday scenario play out with all bacteria becoming resistant to all antibiotics. Very Stephen King. Strep throat invariably progresses to fatal pneumonia, a minor scratch to terminal blood poisoning. Surgical incisions routinely infect despite all precautions.

It didn’t have to be this way. Antibiotics changed healthcare in the 20th century. It’s the sulfas, ‘cillins, and ‘mycins that are the principal reason we now enjoy a lifespan decades longer than our great grandparents. Right now, in 2013, every third baby born in the US will likely live to age 100. This, too, is possible courtesy of antibiotics.

But overusing antibiotics can kill us off, a real-life doomsday scenario.
Currently we’re encountering the result of antibiotic overuse primarily in hospitals, where multi-drug combinations are needed to deal with bacteria that have the ability to outsmart our drugs. How they do this is actually quite interesting. Apparently the bacteria have a sort of antibiotic pumping system in their cell walls which works so efficiently that as fast as a drug enters a cell, the pump activates and starts bailing the antibiotic out. And yes, to you scientifically minded, the latest research on antibiotic resistance focuses on discovering so-called bacterial pump inhibitors.

If your sensibilities trend more toward sci-fi, imagine the following real-life scenarios. Worldwide, the most resistant bacteria is tuberculosis, for which many antibiotics must  be administered simultaneously for successful treatment. Yet multi-drug-resistant TB is responsible for hundreds of thousands of deaths every year. Hundreds of thousands.

Here in the US, the villain is MRSA (methicillin-resistant staph aureus), which kills about 25,000 hospital patients a year. We used to destroy MRSA with a second antibiotic, vancomycin, but as luck would have it VRSA (you can guess what the initials stand for) emerged.

In a primary-care setting like WholeHealth Chicago, we’ve seen little evidence so far of antibiotic resistance. I’m told penicillin-resistant gonorrhea is out there, but it’s NIMBY (not in my backyard) for us. I got the sense this year that the generally useful Z-Pak (azithromycin) wasn’t working as well as usual, but there have been no official warnings about this.

Remember: antibiotics work against bacteria and only bacteria.
The dire alerts about antibiotic overuse from the World Health Organization (WHO) are directed at two groups in charge of antibiotic distribution:

• First and foremost, primary care physicians are urged to avoid overprescribing antibiotics for conditions that simply don’t require them and will never respond to them (mainly those caused by viruses).
• Second, the agricultural industry, which pours broad-spectrum antibiotics into livestock, is being urged to stop. Animals raised this way for meat become infected with resistant bacteria that are then passed onto (and into) consumers.

Physicians and farmers alike offer up all sorts of excuses to justify their behavior, but the WHO is right. Everyone with access to antibiotics seems to be overusing them. For you, I recommend thinking twice before calling your physician or heading to a minute clinic for an antibiotic. Keep in mind…

• Virtually all colds (sore throat, runny nose, nonproductive cough) are viral and definitely need no antibiotic. Just treat symptoms as they come and they’ll resolve on their own.
• The vast majority of sinus infections and bronchitis are also caused by viruses and can be self-treated with steam inhalation, mucous-thinners like Mucaplex, decongestants like Soledum, immunity enhancers like Host Defense, neti pots, and/or asthma inhalers. If you get a respiratory infection and are slowly feeling a little better, though “not fast enough,” be patient. “Not fast enough” is not a call for antibiotics.

The rule-of-thumb about antibiotic need is this: if you have an infection and at first thought you were getting better but suddenly started getting worse (fever, deeper cough, copious sputum), then you really might need an antibiotic. Also, as a rule, you’ll need an antibiotic for many skin infections and virtually all kidney and bladder infections. You can try natural treatments, like cranberry for bladder infections, for a day or two, but if you’re not improving, contact your doctor.

What none of these doomsday articles on antibiotics mentions is that the very best way to prevent antibiotic overuse is for people to maintain a healthful lifestyle and simply not need antibiotics at all. Any physician will tell you that the worst infections occur in patients who have compromised their immunity through years of self-neglect. Cigarettes, excessive alcohol or recreational drugs, unchecked stress, lack of exercise, and dreadful eating habits can all lead to an increased susceptibility to infections.

In medical school, the term we learned was “host susceptibility.” This meant an infection occurred not because a species of bacteria was particularly vicious, but rather because the patient was especially vulnerable. For example, obesity can lead to diabetes and diabetics are more susceptible to infections than the rest of the population.

If you’d like to start eating antibiotic-free meats (and I recommend it), choose certified organic products at Whole Foods, yes, but also check out Chicago’s Butcher & Larder, which supports regional farmers who grow meat sustainably.

The central lesson (as always) is to take good care of yourself. If you’re not a susceptible host, you may never need an antibiotic and thus you’ll never contribute to the doomsday scenario of antibiotic resistance.

Be well,
David Edelberg, MD