The Toronto Star by Kelly Grindrod 29 January 2013
If the chief medical officer of England is to be believed, an “antibiotic apocalypse” is imminent. Dame Sally Davies made headlines when she warned British MPs about antibiotic resistance. She envisions the following medical scenario: “When I need a new hip in 20 years I’ll die from a routine infection because we’ve run out of antibiotics.” And she’s not alone: the World Health Organization also flagged this critical problem — two years ago.
But spend any time in a pharmacy during cold and flu season and you would never guess the imminent danger posed by the vast quantities of antibiotics that fly off drugstore shelves. If your doctor prescribes you pills ending in -illin, -mycin or -floxacin, and if she says you must take all of them even if the symptoms are relieved, then you have been given an antibiotic. Antibiotics effectively treat bacterial infections like pneumonia and meningitis. They do not heal viral infections (you need antivirals for that). And yet as many as 20 per cent of all antibiotic prescriptions are for acute viral illnesses, such as bronchitis, sinus infections and the common cold.
We call the misuse of antibiotics to treat viruses “over-prescribing,” and the practice is contributing to antibiotic resistance and the spread of superbugs. Unfortunately, we have not yet solved the problem of over-prescribing. The term implies that physicians need only prescribe fewer antibiotics. However, efforts to help physicians reduce such prescriptions have had only a modest impact. Too many people believe antibiotics will help with colds and flus, and busy physicians are ill-equipped to fix the myth.
Every month we hear about the strains of methicillin-resistant Staphylococcus aureus (now commonly known by its acronym MRSA) and clostridium difficile polluting our hospitals and nursing homes, causing illness and death. Great efforts are being made to contain the superbugs, but they are still spreading. In December, the first signs of a totally drug-resistant strain of gonorrhea emerged in Toronto.
Frustrating and terrifying as the situation is, we can all take measures to avoid the threatening apocalypse. We can wash our hands and demand that our health professionals do the same. We can get vaccinated, and stay at home when we are sick. If we get a prescription for antibiotics, we can take it as directed and not share it or save it for some future infection.
We also need to stop expecting antibiotics for minor infections. Adults get an average of two to four colds per year. Kids get six to eight. Colds are viral infections that regularly cause nasal congestion, headaches, sore throats and coughs. Yet research recently published in the Annals of Family Medicine revealed that people expect an acute cough to last around a week, when in fact, it lasts an average of two and a half weeks.
An antibiotic can relieve our sore throats an average of 16 hours earlier. But 90 per cent of all sore throats are caused by a virus. Instead of expecting an antibiotic, we can see a physician to confirm if we are among the 10 per cent of people with a bacterial infection. Or we can be patient and hope the antibiotic is instead used to save the life of someone hospitalized with pneumonia.
Or maybe, when we have a sinus infection, 99 per cent of which are caused by a virus, we can skip the antibiotic that only helps one out of every 18 people heal a little faster. Instead, we can ask our physician or pharmacist for other treatments that may help our symptoms.
And instead of being among the 60 to 80 per cent of people who get a prescription for acute bronchitis even though antibiotics don’t effectively treat it, well, we can prepare ourselves for a cough that may last three or more weeks and know that this, too, shall pass.
We are all responsible for antibiotic resistance. Patients, politicians, doctors, nurses, pharmacists and pharmaceutical manufacturers. We all need to stop perpetuating the myth that antibiotics can and should treat all infections. Antibiotics are a precious and limited resource. If we do not protect them, then soon enough they will not protect us, either.
Kelly Grindrod is an assistant professor at the University of Waterloo’s School of Pharmacy. She is also a practising pharmacist and frequent public speaker, focusing on how to improve medication use in the community.