THE BAD SIDE OF GOODDRUGSANTIBIOTIC RESISTANCEJames R. Ginder, MS,NREMT,PI,CHES,NCEEHealth Education SpecialistHamilton County Health Departmentwww.hamiltoncounty.in.gov
THE READER WILL BE ABLE TO…• Define what an antibiotic drug resistantbacteria is• Describe three reasons why antibioticresistance occurs• Explain three ways to prevent antibioticresistance• Recall how antibiotics work• Name three current drug resistantbacteria
DISCOVERY OF ANTIBIOTICS…• In the 1920s, British scientist AlexanderFleming was working in his laboratory at St.Mary’s Hospital in London when, almost byaccident, he discovered a naturally growingsubstance that could attack certain bacteria• In one of his experiments in 1928, Flemingobserved colonies of the commonStaphylococcus aureus bacteria that had beenworn down or killed by mold growing on thesame plate or petri dish• He determined that the mold made a substancethat could dissolve the bacteria. He called thissubstance penicillin, named after thePenicillium mold that made it
DISCOVERY OF ANTIBIOTICS…• Fleming and others conducted a series ofexperiments over the next 2 decadesusing penicillin removed from moldcultures that showed its ability todestroy infectious bacteria.• Starting in 1941, scientists found thateven low levels of penicillin cured veryserious infections and saved many lives• For his discoveries, Alexander Flemingwon the Nobel Prize in Physiology andMedicine
WHAT ARE ANTIBIOTICS?• Antibiotics, also know asantimicrobial drugs, are drugs thatfight infection caused by a bacteria• After the use of antibiotics in the1940s, this new drug reduced illnessand death from infectious diseases• The term antibiotic originally referredto a natural compound produced by afungus or another microorganism thatkills bacteria which cause disease inhumans and animals.
WHAT ARE ANTIBIOTICS?• Antibiotics have been used for the last70 years to treat patients who havebacterial infections• Antibiotic use has been beneficialwhen prescribed and taken properly• These drugs have been used so widelyand for so long that the bacteria thatantibiotics are designed to kill haveadapted to them, making the drugsless effective
HOW ANTIBIOTICS WORK...• Some antibiotics (e.g., penicillin,cephalosporin) kill bacteria outrightand are called bactericidal:• They may directly attack the bacterialcell wall, which injures the cell• The bacteria can no longer attack thebody, preventing these cells fromdoing any further damage within thebodyThe effects of the antibiotic drug onStaphylococcus aurousbacteria. The antibiotic kills thebacteria (red) by causing the cellwall to disintegrate(yellow remnants).Source: American Academy of Pediatrics
HOW ANTIBIOTICS WORK…• Other antibiotics (e.g.,tetracycline, erythromycin) blockthe bacteria’s growth orreproduction:• Often called bacteriostaticantibiotics, they prevent nutrientsfrom reaching the bacteria, whichstops them from dividing andmultiplying• Because millions of bacteria areneeded to continue the diseaseprocess, these antibiotics can stopthe infection and give the body’s ownimmune system time to attackSource: Encyclopedia of SurgerySource: American Academy of Pediatrics
WHAT IS DRUG RESISTANCE…• Antibiotic resistance is the ability ofbacteria or other infectious diseasesto resist the effects of an antibiotic• Antibiotic resistance occurs when abacteria changes in some way thatreduces or eliminates theeffectiveness of the drug• The bacteria survives and continuesto multiply causing more harm to theperson
WHAT IS DRUG RESISTANCE…• Some bacteria have developed resistance to asingle antibiotic, while others developresistance to several different types ofantibiotics• These bacteria are often referred to asmultidrug-resistant or MDR strains• In some cases, the bacteria have become soresistant that no available antibiotics areeffective against them
DRUG RESISTANCE…• Antibiotic drug resistance occurseverywhere in the world• Hospitals and other healthcaresettings are battling drug-resistantorganisms that spread inside theseinstitutions• Drug-resistant infections, such asdrug-resistant pneumonias, sexuallytransmitted infections (STIs), and skinand soft tissue infections (MRSA), alsospread in the community.
NON-DRUG RESISTANCE VS. DRUGRESISTANCE…• This diagram shows thedifference between nonresistantbacteria and drugresistant bacteria• Non-resistant bacteria multiply,and upon drug treatment, thebacteria die• Drug resistant bacteria multiplyas well, but upon drugtreatment, the bacteriacontinue to spreadSource: NIH
HOW DRUG RESISTANCE OCCURS…• Selective Pressure :• Microbes are either killed or, if they carry resistancegenes, survive. These survivors will replicate, andtheir progeny will quickly become the dominant typethroughout the microbial population• Mutation:• During replication, mutations arise and some ofthese mutations may help an individual microbesurvive exposure to an antimicrobial• Gene Transfer:• Microbes also may get genes from each other,including genes that make the microbe drugresistantMutation
WHAT CAUSES DRUG RESISTANTINFECTIONS?• The improper use and abuse of antibiotics hasled to the development of antibiotic resistance• The most common misuse and abuse ofantibiotics are:• Health Care Providers prescribing antibiotics forviral infections• Not finishing the full dosage of an antibiotic• When an antibiotic prescription is not finished (evenleaving one or two pills), it leaves some bacteriaalive and "resistant" to future antibiotic treatment
WHAT CAUSES DRUG RESISTANTINFECTIONS?• Many individuals either expect or asktheir health care provider to prescribeantibiotics when they feel sick or havea common cold• Patients should understand, though,that antibiotics are intended to treatbacterial infections, not viral infections• Many times a common cold is a viralinfection and antibiotics should not betaken if you have a cold or the flu
SOME EXAMPLES OF DRUG RESISTANTBACTERIA…• Anthrax• Carbapenem-resistant Enterobacteriaceae• E. Coli• Gonorrhea• Group B Strep• MRSA• Neisseria meningitidis• Shigella• TBMRSASource: DisvoerR8.com• Vancomycine-resistant EnterococciTo learn about these drug resistance bacteria, click on their name
THE COST OF DRUG RESISTANCE…• According to the Centers forDisease Control and Prevention(April 2011), antibiotic resistancein the United States costs anestimated $20 billion a year inexcess health care costs, $35million in other societal costs andmore than 8 million additionaldays that people spend in thehospital (NIH)• Antibiotic resistance is one of theworld's most pressing publichealth threats (CDC)
EFFECTS OF DRUG RESISTANTDISEASES…• People infected with drug-resistantorganisms are more likely to havelonger and more expensive hospitalstays, and may be more likely to dieas a result of the infection• When the drug of choice for treatingtheir infection doesn’t work, theyrequire treatment with second- orthird-choice drugs that may be lesseffective, more toxic, and moreexpensive• This means that patients with anantibiotic-resistant infection maysuffer more and pay more fortreatment.
DIAGNOSIS OF BACTERIAL INFECTIONS…• Diagnostic tests are designed to determinewhich microbe is causing infection and towhich antibiotic the bacteria might beresistant• This information would be used by ahealthcare provider to choose anappropriate antimicrobial treatment• However, current diagnostic tests oftentake a few days or weeks to give results• This is because many of today's testsrequire the microbe to grow over a periodof time before it can be identified.
LAB RESULT…Example ofa lab resultCourtesy of Sydney Ehmke, MSN,MBA,FNPRiverview Hospital Community Clinic
WHAT QUESTIONS SHOULD I ASK MYHEALTH CARE PROVIDER?• Why do I need an antibiotic• What is this particular antibioticsupposed to do• Is this drug likely to cause any sideeffects• Is there anything I can do to preventthese side effects• Should I take the drug at a specific time
WHAT QUESTIONS SHOULD I ASK MYHEALTH CARE PROVIDER?• With or without food• Does this drug interfere with theeffectiveness of other medication?(i.e., birth control pills)• Do I need to avoid alcohol or otherfoods
HOW TO PREVENT DRUG RESISTANCE…• Both health care providers and patients have arole to play in decreasing the misuse ofantibiotics• Antibiotics should only be prescribed when atest (such as a throat culture) shows thatthere is a bacterial infection present• Antibiotics are not effective in fighting a viralinfection• Patients should not demand that their healthcare provider prescribe antibiotics when theyare not neededThroat culture
HOW TO PREVENT DRUG RESISTANCE…• Washing your hands with soap and water is thebest way to prevent the spread of bacterial andviral diseases• If soap and water are not available, you canuse alcohol based hand antiseptic thatcontains 60% alcohol• You need to wash your hands with soap andwater as soon as possible• Hand antiseptics do not kill all types ofbacteria or virus• Hand antiseptics are not effective when handsare visibly dirty
TREATMENT…• As healthcare providers often cannot waitseveral days for that information beforetreating their patient, they may reach for abroad-acting drug they hope will killwhatever is infecting the patient• Unfortunately, the practice of using broadspectrumdrugs before the specificmicrobe is identified can accelerate theemergence of drug-resistant strains
HOW TO PREVENT DRUG RESISTANCE…• Taking antibiotics when you have a viralinfection not only wastes your time andmoney, but also contributes to increasingantibiotic resistance• Patients should ask their healthcareprovider if they have a viral or bacterialinfection and which tests have been doneto prove this• Healthcare providers too, must changetheir prescribing practices and onlyprescribe antibiotics for their patientswhen a bacterial infection is present
THINGS TO THINK ABOUT..• Understand when antibiotics should be used:• Don't expect to take antibiotics every time you'resick• Antibiotics are effective in treating most bacterialinfections, but they're not useful against viralinfections, such as colds, acute bronchitis or theflu• Even some common bacterial ailments, such asmild ear infections, don't benefit much fromantibiotics• Don't pressure your health care provider forantibiotics if you have a viral illness:• Instead, talk with your healthcare provider aboutways to relieve your symptoms
THINGS TO THINK ABOUT..• Take antibiotics exactly as prescribed:• Follow your healthcare provider's instructions whentaking medication• Don't stop treatment a few days early because you'refeeling better• Taking the full course of antibiotics is the only way tokill all of the harmful bacteria• A shortened course of antibiotics, on the other hand,often wipes out only the most vulnerable bacteria whileallowing relatively resistant bacteria to survive• If you have questions about your antibiotics:• Call your healthcare provider• Call your pharmacy
SOURCE…• American Academy of Family Physicians• American Academy of Pediatrics• Alliance For The Prudent Use Of Antibiotics• Centers For Disease Control and Prevention• Mayo Clinic• Medicine.Net• National Institute of Health