With cold and flu season upon us, the annual pilgrimage to the doctor's office and hospital emergency wards will happen yet again. Many people will expect to be given an antibiotic to combat their illness but will find themselves leaving, rightfully so, without a prescription.
While this may seem frustrating, limiting the number of prescriptions is the new normal in a world where antibiotic resistance is rampant and we enter the post-antibiotic era.
Antibiotic resistance has been a scourge on health care for decades. The process has been studied extensively and the mechanisms behind the phenomenon are well known to many researchers and medical professionals. Yet, even a decade ago, up to 80 per cent of all antibiotic prescriptions were unnecessary. Back then, this trend in overprescribing was seen as a way to keep patients healthy and also to appease those with certain expectations. Yet, with the revelation that certain strains of bacteria were not only becoming resistant to a number of antibiotics but also all known ones, the public health community realized things had to change.
Unfortunately, reducing the number of antibiotics prescribed in medicine may only have a minor effect on the rise of antibiotic resistance. A number of different environments have already shown their contribution to this rise including soil and water, agriculture and aquaculture. Much like those who demanded antibiotics in the past for their colds and flus, these industries continue to stress the need for antibiotics to ensure proper production and harvest. Efforts to control their use are underway but much needs to be done.
While healthcare and agriculture battle resistance and the debate on the need for antibiotics continues, a new study out this week suggests that a third environment could become the next hotbed. This one, however, may take the world by shock and signal that the end for antibiotics is indeed nigh.
That resistance contributing environment is you, the human; specifically, your gut.
The article was published by a team of researchers from universities and hospitals in St. Louis and Seattle. Their initial goal was to identify if they could find any signs of antibiotic resistance in the gut microbiome of children. The method was fairly straightforward in that they collected fecal matter from healthy infants, children and adolescents. They then checked the fecal matter for any bacteria that could be antibiotic resistance as well as any signs of genetic material -- DNA -- that could cause antibiotic resistance. The initial intent was to show that the levels of antibiotic resistance increased with age and that there were only a few potential mechanisms present. The idea made common sense as exposure to these bacteria and DNA would rise over age and presumably become part of the gut microbiome.
What they found, however, was simply unbelievable. Antibiotic-resistant bacteria were found in all age groups. But what was even more startling was the widespread presence of antibiotic resistance DNA. No matter what age group, the gut bacteria presented the potential for resistance against 14 different types of antibiotics. These included popular names such as tetracycline, penicillin and chloramphenicol as well as a host of others used to treat various bacterial infections. Every single child was a potential antibiotic resistance incubator and yet not a single one was ill nor had all but one been exposed to antibiotics in the previous month.
From a public health perspective, this finding could be the death knell for antibiotics. The realization that we are all contributors suggests that there is simply no option but to look towards other options. From the perspective of microbial ecology, however, this is to be expected.
All bacteria, pathogen and probiotic have the ability to develop resistance. The fact that the same bacteria that make us healthy can also resist antibiotics may even be beneficial to us. Antibiotics have been shown to wipe out a healthy microbiome and have long lasting effects. By having a resistant gut microbiome, this could lead to an even better outcome when antibiotics are needed. The trouble happens when we allow pathogens to find a home in our intestines. They can interact with the healthy bacteria and eventually acquire resistance, complicating our lives and our medical options.
The key therefore is to have a healthy gut microbiome from the beginning of life to the end. A combination of exposure to good germs, a good-germs friendly diet and proper hygiene is really all that is needed to stay healthy. When infections do occur, the best route is to take in all the facts and treat to restore health rather than simply to kill the pathogens. In some cases, such as flesh-eating disease and pneumonia, antibiotics are a must. But for those of us with more simple problems, such as those colds and flus, seeking out better options than antibiotics is always possible.
In this case, the best route to follow is to notify your health professional, don't ask for antibiotics and then begin the traditional and effective routine of drinking fluids, keeping up the probiotics and giving the body the time it needs to heal itself.
Though you may not stem the tide of antimicrobial resistance, you at least will not be contributing to it.