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Op-ed: Dr. Peter Daley

The overuse of antibiotics and the dangerous road ahead

By Dr. Peter Daley

Antibiotics are cheap, relatively non-toxic and save lives in patients with overwhelming bacterial infections, requiring only short courses of treatment.

They seem to be almost miraculously beneficial.

Yet, they are increasingly a topic of concern in the news, especially from the U.K.

What could be the problem?

A victim of their own success

Antibiotics have drastically improved patient outcomes in medicine and surgery since penicillin was accidentally discovered by Alexander Fleming in 1928.

Most Canadians have taken an antibiotic recently — 23 million antibiotic prescriptions were written for Canadians in 2014.

Once it was observed that antibiotics saved lives in the case of life-threatening infections, they began to be prescribed for minor bacterial infections, for which they were less beneficial.

Antibiotics were then prescribed for conditions which “might be” bacterial infections and were given to prevent bacterial infections.

When studies determined that they helped healthy farm animals to grow faster, antibiotics also began to be widely used in animal feed. Use rates exploded.

Different consequences

Inappropriate use of most types of drugs would create concerns over wasted cost to the health-care system or unnecessary side effects.

In addition to wasted costs and unnecessary side effects, the overuse of antibiotics leads to a wholly different set of consequences. (Interestingly, these consequences were accurately predicted by Dr. Fleming early after his discovery.)

“These resistant bacteria quickly become the main bacterial type causing infections in humans, meaning that first-line treatments stop working.”

Antibiotics given to populations of bacteria lead to rapid natural selection for survival of certain bacteria with spontaneous mutations providing resistance to antibiotics.

These resistant bacteria quickly become the main bacterial type causing infections in humans, meaning that first-line treatments stop working.

Global resistance

Important global examples of antibiotic resistance include tuberculosis, malaria, bowel bacteria, gonorrhea and skin bacteria.

Researchers predict the global impact of antibiotic resistance will cause 10 million deaths and a loss of USD $100 trillion by the year 2050.

Without significant new drug development, we may face a future in which routine surgery is life threatening, chemotherapy is too dangerous to use and common injuries may lead to overwhelming infections.

What does this mean for Canadians?

We need to protect our antibiotics for the future health of our country and our world, by using them very judiciously.

Unfortunately, antibiotic use rate has not decreased in Canada in the last eight years. Newfoundland and Labrador has the highest antibiotic use rate among all provinces.

Why are we not reducing our antibiotic consumption in the face of these ominous predictions of the impact of overuse?

Unnecessary treatment

One of the answers lies in the interaction between the patient and the physician.

When a healthy patient presents with a minor illness such as sore throat, sinusitis or cough, the patient often requests antibiotic treatment.

“The physician wants to assist the patient and the patient wants to have something to take for their symptoms.”

However, these illnesses are generally caused by viruses, which are not killed by antibiotics.

Even in cases when laboratory testing proves a bacterial infection is the cause, most patients still get better quickly without antibiotics.

And yet, the physician may still prescribe antibiotics because the physician wants to assist the patient and the patient wants to have something to take for their symptoms.

This results in unnecessary antibiotic treatment. With the next illness, the patient learns to expect the same treatment.

What can be done?

Both physicians and patients need to change their expectations.

The next time you see your doctor with a minor respiratory infection, ask your doctor this question: “Are there other treatments besides antibiotics which might be equally helpful for me?”

This provides an opportunity to look at options besides inappropriate antibiotic use.

Antibiotics are unique drugs which may also impact the health of people who do not take them.

Because of the selection effects on bacterial populations living in your body, antibiotics you take influence the expression of drug resistance among these bacteria, which spread from you to your family and friends, co-workers and even to your pets!

Choosing Wisely NL

The World Health Organization declared Nov. 13-19, 2017, as World Antibiotic Awareness Week.

Since then, Quality of Care NL/Choosing Wisely NL at Memorial University continues to share information about appropriate use of antibiotics.

For more information, you can watch the animations below.

Is the world running out of antibiotics?

Is Newfoundland and Labrador drowning in antibiotics?

Myth or reality: If you’re sick after a week, do you need antibiotics?

What are some signs and symptoms to watch out for?

Learn more about Quality of Care NL/Choosing Wisely NL here.

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