Category: Biofilms

The Antibiotic Reflex

Lost in the numerous daily stories about Ebola is this gem: When Thomas Duncan, the first Ebola patient to enter the U.S. undetected, first presented himself to a hospital in Dallas, he and his fiancée told staff more than once that he had been to Liberia. And even though his presenting symptoms were consistent with Ebola, that disease was never considered. Instead, he was diagnosed with a low-grade viral infection, given a prescription and sent home. Three days later he returned to the hospital in worse shape and was diagnosed with Ebola virus disease. The following week Thomas Duncan died.

Subsequent news stories about Mr. Duncan focused largely on two things: How on Earth did hospital workers not consider Ebola when he first appeared there (his family is understandably angry about this). And did he infect other people during that 3 days before he went back to the hospital and was finally admitted (so far, no).

But let’s back up. That prescription he was sent home with when he first went to the hospital – it was for an antibiotic. Never mind that they fumbled the Ebola ball, they also prescribed an antibiotic because they thought he had a low-grade viral infection. Which is like giving a fishing rod to a deer hunter: antibiotics treat bacterial-based infections only, not viral-based ones – so what were they thinking when they prescribed an antibiotic for a viral problem?

Thomas Duncan had the Ebola virus. But he was sent home from the hospital with an antibiotic.

Here’s the thing. Wrongly prescribing antibiotics happens far too often – about 40% of the time according to the US Centers for Disease Control: when presented with illness, the reflex to both seek and prescribe an antibiotic is common to both patient and doctor.

More often than not when you or your child have an ear ache, a sore throat, or cold, flu, or bronchitis-like symptoms, it is some virus that’s doing it to you. Nevertheless, people reflexively seek, and receive, antibiotics.

The physician reflex to over-prescribe is due to patient pressure, the fear patients will go elsewhere, not wanting to bother with lab tests, fear of being sued in the event that an antibiotic should indeed have been described, and, the big catch-all – even if antibiotics aren’t warranted, at least they’ll do no harm.

The assumption of no harm, however, has proven flat-out wrong. Because when you’re improperly prescribed an antibiotic two things happen: your bugs, not wanting to die, fight back and evolve into “superbugs” that are able to resist antibiotics in the future. So the next time you get a bacterial infection and really do need that prescription it won’t help you. Second, you don’t keep those superbugs to yourself. Instead, you spread them to the people closest to you, like family and friends. And like you – and because of you – should these people eventually need an antibiotic the chance of it not working has now increased.

We don’t know whether or not Mr. Duncan asked for an antibiotic. What we do know is that when he first went to the hospital the world in general and health care workers in particular were on notice (2d para below the Gov. Perry video) that a deadly viral outbreak in West Africa was just one flight away from our doorstep. Despite that, and despite having all the evidence it needed to treat Mr. Duncan as a possible Ebola case, the Dallas hospital antibiotic reflex sprang into action with dire consequences: Thomas Duncan died, his family are mourning, the hospital staff who got it wrong are surely not feeling good about themselves, and the nation is scared.

Harming our Good Bacteria may be Harming Us in the Long Run

By the time we are 18, we have received 10-20 courses of antibiotics. This antibiotic usage has enabled us to live longer and healthier lives, by overcoming bouts of infections. But there are, of course, drawbacks to this antibiotic consumption. The most obvious and most worrying of these drawbacks, is the development of drug resistant bacteria (superbugs) such as MRSA. However, antibiotics also kill the normal microflora, the ‘good bacteria’ that we need to maintain good overall health. The long term implications of repetitive disruption of our microflora by antibiotics, unfortunately, are not understood and not being adequately investigated.

When in the right concentrations and when the body’s natural immune system is healthy, bacteria are an important part of us. In fact, there are 10 times more bacteria cells in us than there are human cells.5 Human cells and bacteria have developed a symbiotic relationship over time. In order to answer the question of whether harming the good bacteria is harmful to us in the long run, we need to understand more about bacteria.  So how are bacteria beneficial to us?

Firstly, in our stomach, intestines and colon, we have “good” bacteria that play a major role in breaking down our food into nutrients to be absorbed by our body and into waste material that is eventually eliminated.  Along the way, these good bacteria take up colonization sites thereby preventing harmful bacteria, and other pathogens, from taking residence where they do not belong.

Secondly, bacteria can also play a major role in the production of key elements in our body. For example, Bacteroides species of bacteria live in our colon and help us produce Vitamin K, needed for blood clotting. Helicobacter pylori (H. pylori) is another example of the body needing a bacteria to function properly. H. Pylori, while responsible for stomach ulcers in some people when in overabundance, seem to play a major role in the generation of key hormones that control our appetites. H. Pylori appears to affect the regulation of the two hormones, ghrelin and leptin, involved in human energy homeostasis and implicated in the control of food intake such as controlling hunger. Leptin signals to your body it is full while ghrelin stimulates appetite. In one study, it was determined that fewer than 6% of children’s stomachs in the United States, Sweden, and Germany now carry H. Pylori. The lack of Helicobacter pylori has been thought to be linked to the increase in gastroesophageal reflux, Barrett’s esophagus, and esophageal cancer. Interestingly, those lacking H. pylori are also more likely to develop asthma, hay fever or skin allergies.1 Dr. Martin Blaser, a professor of microbiology at New York University Langone Medical Center, suggests ‘that antibiotics may permanently alter your gut bacteria and interfere with important hunger hormones secreted by your stomach, leading to increased appetite and body mass index (BMI)’.3

Our bodies have been living in balance with our bacteria for thousands of years. It is a symbiotic relationship that is now being permanently altered by the use, overuse and misuse of antibiotics. No one knows at this point how seriously antibiotics are harming our long term health prospects. It will take decades worth of research and the resolve of governmental forces to undertake this large scale investigation. However, for today, it is worth asking the question; “By harming our good bacteria, are we not also harming ourselves in the long run?”

References: 1




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