Antibiotics: risks in overusing the magic medicine

In 1945, Howard Florey, Alexander Fleming and Ernst Chain were awarded the Nobel Prize in Medicine for their role in discovering penicillin, the first mass-produced antibiotic. The introduction of this cure in the 20th century revolutionized the world of medicine and upgraded considerably human longevity.

Antibiotics allow the treatment of bacterial infections, such as pneumonia.   During the previous century, pneumonia was among the main causes of death. After discovery of antibiotics, however, the world of pharmaceutics and the research development sector both increased in importance during the second half of the 20th century and permitted the full development of antibiotics and their consequent distribution.

The new wave of globalism, and the new technologies of the second half of the 20th century, allowed a fast and cheap distribution of the cure and its knowledge.

Unfortunately, this did not convey only benefits to global health. The high rate of availability for governments and the easy access offered to the citizens, but also a inattentive medical conduct, often results in over-prescribing that leads to antibiotic resistance — a process in which the bacteria leading to infections improve their structure and become more resistant and less threatened by the antibiotics.

Considering the ability of the bacteria to challenge the medicine, more investment in research and development are needed to produce  effective cures. But money is not the only problem, because there is also a time element involved that renders this challenge more difficult: the process of resistance is outpacing the progress made by innovation and research.

From the patient’s point of view,  antibiotic resistance can means a higher possibility of infection, longer hospitalization, and therapeutic inefficacy that can lead to fatality. At present, antibiotic resistance is considered one of the major global issues, worthy of consideration in the Global Health agenda of the World Health Organization.

Antibiotic resistance can be particularly common in wealthy countries of resistance, depending on the medicine distribution, posology and the policies chosen by the government. In order to understand this phenomenon, consider the Netherlands and the United States as  as case studies.

The Netherlands has the lowest rate of antibiotic prescribing in the OECD. This is the result of a constant effort by the Dutch government to fight antibiotic resistance. For the last 20 years, the rate of antibiotic use in the country has been in a steady decline. The government employed a multi-sectoral strategy that involved not only humans, but also animals. This included new General Practitioner’s criteria for physician dosing of antibiotics, but also new regulations on the use of them with  animals — especially on the limitations on hormones given to animals. Hormones are often given to animals to maximize their growth, yielding higher profit when the animal is sold to the market. The approach chosen by the Dutch government aims to both fight antibiotic resistance, and to tackle the costs of public health: with the introduction of new antibiotic medicines, the costs for healthcare may rise depending on the price fixed by the pharmaceutical companies; but also consider that antibiotic resistance made the average hospitalization of an individual longer, increasing the costs of public health.

The path taken by the Netherlands as been noted and promoted internationally. In 2015, Edith Schippers, Dutch Minister of Health, successfully presented to the European Council a multilateral health plan, namely the One Health approach, that seeks cooperation among states in tackling antibiotic resistance. The plan included suggested actions in the sectors of public health, agriculture and farming.

Conversely, the US has maintained a different approach towards antibiotics. According to the U.S. Centers for Disease Control and Prevention (CDC), one third of the antibiotics prescribed in the US are unnecessary or wrongly assigned in curing a viral infection.

Unlike many other medicines, antibiotics in the US require a doctor’s prescription and cannot be obtained independently by the patient. Nevertheless, it is worth considering that a doctor’s prescription is not always needed, as the medication can be prescribed also by nurse practitioners and physiotherapists — and, according to the CDC, those entities are most inclined to give unnecessary prescriptions.

Despite the situation described above, the abuse of antibiotics  is most outrageous in the agriculture and cattle sectors. Nearly three quarters of the total use of antibiotics worldwide is thought to be on animals rather than humans.

In the US, many food products are banned because of the presence of hormones such as the controversial “rBGH” that enhances the milk from  cows. This hormonal substance not only increases antibiotic resistance, but it can also increase the insulin’s rate in our body — leading to dangerous conditions, including a decrease in life expectancy.

The Obama administration worked hard to limit the use of antibiotics in the US and aimed for a drastic cut by the 2020. Unfortunately, the expectations are far from met, and the government of Donald Trump is strongly resisting the WHO effort to restrain the use of antibiotics in farming and medicine.

Antibiotic resistance is seen by many as a future global problem, but the truth is that it must be recognized as a current challenge. International organizations, civil society efforts,  university research departments and some governments are aware of the risk and are working to cooperate for the common good, as in the case of the One Health approach.

Nevertheless, the limitation of antibiotics — and even an outright ban — cannot be seen as the only solution. Part of the answer consists in educating the patient on the use, posology and counter effects of medicines in general, and not just antibiotics. On the other hand, also doctors need to be educated on ways of communicating such information to the patient.

Finally, a better understanding on the part of doctors as to the dangers of antibiotic overuse can lead to more appropriate prescribing and a drastic cut in antibiotic use overall.  

 

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