Antibiotic Resistance: It Starts with your Prescription

Staphylococcus aureus: anti-biotics have created strains which are resistant to all medicines.staph-a-3

Before 1928, people would die from Whooping cough and Ear infections. Since the discovery of Penicillin, however, anti-microbial medicines like anti-biotics have had the power to prevent and treat many diseases caused by bacteria, such as phenomena and strep throat.

Some bacteria, however, have developed the ability to resist this medicine via an induced fast-tracked natural selection environment caused by the use and misuse of anti-biotics. Anti-biotics kill most bacteria, but those few with the advantage to survive pass on their resistance, either by sharing their genetic information, or by inheritance.

These resistance mechanisms threaten to lead us to a post-antibiotic era where standard infectious diseases and surgeries once again become potentially life-threatening. Horrifyingly, examples of this are already occurring – resistance to first-line and last resort medicines for UTI’s, Gonorrhoea, Staph. a, Tuberculosis and Salmonella is widespread. Many ‘super-bugs’ that are resistant to all forms of anti-biotics have also arisen.

The Centre for Disease Control has called this “one of the world’s most pressing health problems in the 21st century”.

The overuse and misuse of anti-biotics contributing to this resistance is occurring in agriculture, household products, and in Doctor’s surgeries and Hospitals.

The World Health Organization published an international public awareness of anti-microbial resistance survey in 2015. It found that 70% and 64% of respondents incorrectly believed that anti-biotics could treat viral infections such as sore throats and colds/flu respectively, and would therefore expect to be provided a prescription for anti-biotics from their healthcare professional.

Similar sentiments can be found in an Australian Government survey that polled the public’s perspective of antibiotic usage. The 2014 survey not only found that 65% of people polled believed taking antibiotics would help them recover from their cold or flu more quickly, but startlingly, that 60% of GPs would prescribe antibiotics to meet a patient’s demands or expectations.

Yes, 60% of GPs would prescribe antibiotics to meet a patient’s demands or expectations.

Over-prescription is one of the leading causes of anti-biotic resistance. Doctors feel obliged to meet their patients’ expectations of walking away with reassurance, and a prescription. If a Doctor is uncertain whether an ailment is viral or bacterial, anti-biotics are often prescribed to be on the safe side.

Therein lies part of the problem.

By unnecessarily prescribing anti-biotics to a patient with a viral infection, resistant bacteria in the patient’s flora flourish, and have the ability to genetically exchange this resistance with potentially harmful bacteria.

Currently, methods to test whether infections are viral or bacterial cannot be conducted in the length of an appointment time. Physicians, therefore, rely on physical examination and the consideration of symptoms to make a diagnosis. According to Dr Ephraim from Duke School of Medicine, however, ¾ of patients walk away with an anti-biotic prescription, despite the majority having a viral infection.

Fast in-clinic testing is what is needed to eliminate this uncertainty, and luckily, rapid in-clinic testing is being developed. Israeli doctors have developed MeMed, which can diagnose the type of infection based on the distinctively different immune responses that viral and bacterial infections cause. Currently the results take 2 hours, and while this suits a hospital/clinical setting, a faster point of care product is still under development.

Similarly, doctors at the Duke University School of Medicine have developed a blood test for determining types of respiratory infections, which are incidentally one of the most common reasons patients visit doctors, and the infections most commonly misdiagnosed as bacterial. The test identifies a ‘genetic fingerprint’ of the response to the infection – the pattern and type of genes that are switched on/off in response to the infection are unique to bacterial and viruses. Nevertheless, this test still takes 10 hours, with the aim of 1 hour in the future.

Both of these tests are advantageous over traditional lab tests in that they do not require direct sampling of the pathogen from the location of the infection. The tests are also more valuable for cases like middle-ear infections, where direct sampling is not possible at all. These tests also remove the risk of a false-alarm diagnosis in cases where bacteria causing the infection are also a part of healthy flora, such is the case with bacterial phenomena.

Whilst these diagnostics provide hope, they need to be refined to a 1-hour turnover in a clinical setting, and preferably less in a GP surgery setting. This would be a step in the right direction towards completely eliminating the misuse of anti-biotics, and therefore fighting anti-bacterial resistance.

Before these tests are implemented, however, the public needs to be educated about the efficacy of anti-biotics on different types of infections, removing the pressure on physicians to always prescribe medicine. Patients given unnecessary anti-biotics are likely to revisit and thus perpetuate the problem anyway. Ignorance of the adverse effects of anti-biotic misuse will hasten the speed in which anti-bacterial resistance grows, and contribute to leading us into a post-antibiotic era.