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Antibiotic Uses and Overuse

When are antibiotics good, and when are they harmful? How is overuse of them harmful? And what do mutant armies have to do with this? Dr. Rob answers all.

By
Rob Lamberts, MD
10-minute read
Episode #5

Mutant Bacteria

Eventually, mutants from different people join forces with each other. The more antibiotics are used, the more mutants survive, team up, and finally create armies of resistant mutant bacteria. They are not scared of antibiotics; they scoff at the puny threat of these once deadly drugs. They probably have a little high-pitched evil laugh, but I’ve never heard one.

But seriously, they really are mutants. I am not just saying that to keep your interest. The emergence of resistant bacteria in this way has gone on since antibiotics were first used.

To deal with these mutant armies, we humans created new antibiotics that would counteract the resistance strategy of the bacteria and kill off the mutants. But guess what happened then? You got it: more mutants; but this time they’re even more resistant and difficult to kill. And so the cycle went on for a good portion of the last century: the good guys would make stronger weapons, and the bad guys would figure out a way to resist them.

When will the madness end? Unfortunately, we were the ones to run out of solutions. Now there are bacteria out there that are resistant to nearly every antibiotic made. It’s a scary thing.

Why this Happened: Overuse of Antibiotics

One thing that contributed to the emergence of these evil mutant bacteria criminals was the overuse of antibiotics. Antibiotics are only good against certain infections. The antibiotics most people know--penicillin, sulfa drugs, erythromycin, to name a few -- are weapons aimed at bacteria. Viruses are totally different than bacteria, and so are not vulnerable to these medicines. They thumb their little noses at them.

Viral Infections Versus Bacterial Infections.

Virus infections are very common, and most of them are pretty wimpy. They cause cough, runny nose, and maybe a short case of the runs -- not exactly a fun frolic, but not deadly. The virus infections that cause respiratory symptoms like stuffy nose and cough cause the body to put out a lot of mucous. Unfortunately, the mucous is like an all-you-can-eat buffet for some bacteria. If mucous builds up in the sinuses, bacteria can creep in, take up shop in there, and cause the infection called sinusitis. In the same way, mucous in the ears can lead to bacterial ear infections, and lung mucous can turn into pneumonia. These bacteria are much worse guests than the viruses, causing pain, fever, and more serious complications.

But it’s sometimes hard to tell a bacterial from a viral infection, and so doctors figured it was better err on the side of caution and gave antibiotics to people with virus infections. Guess what happened to those people? They got better! People get better from virus infections without treatment, but if they are on an antibiotic they tend to think the antibiotic made them better. The antibiotic wrongly gets the praise for the job that the immune system did. Poor immune system, nobody ever appreciates it!

So what happens when the person gets their next viral infection? They run to the doctor and say, “Hey doctor guy! The wonder drug you gave me last time made me better, and I want it again!” The doctor, wanting to please the patient, gives another antibiotic prescription. They what happens? Bingo! The person gets better again! That cycle was repeated again and again for many years in many doctors’ offices.

Including mine.

Yes, I gave into that pressure. I have to tell you, getting that off of my chest makes me feel much better. Thanks for being there for me. When I first became a doctor (not long after Columbus discovered America), I really wanted my patients to like me. I was a little insecure that nobody would want me as their doctor-- or if they did-- it would only be when they had no other option. It’s common for young doctors to want to impress their patients, and even more common for them to want to avoid making their patients angry. So even though I knew most infections were viral and did not need antibiotics, I caved to the desire to please patients. It was hard not to because many of them were really sure they needed antibiotics.

It’s not as big of a battle anymore. Part of this is that I’m an old fart now and don’t mind making people mad at me. I’ve got plenty of patients and don’t need to practice bad medicine to keep my office full. Another factor is the fact that big bad resistant bacteria like MRSA have made the news. People are finally aware of the harm of antibiotic overuse, and so will crumple when I say something like: “I certainly don’t want to use antibiotics if they aren’t needed. I don’t want to create resistant bacteria.” 

Now What?

But the damage has been done, and now we really have nasty mutant bacteria armies causing havoc in certain places. Some have even referred to this time as the post-antibiotic era. I wouldn’t go that far.

The good news is that not all mutations make bacteria stronger. What caused the creation of antibiotic-resisting super bacteria in the first place was the presence of antibiotics. If a population of resistant bacteria is left alone, the need for this antibiotic-resistant trait disappears, and eventually fat and lazy bacteria without the resistant genes replace those nasty resistant bacteria. I’m sure there are old resistant bacteria that say something like: “I remember back in the amoxicillin era, bacteria were dying left and right. Kids these days don’t think resistance is important. Bah!”

The moral of the story is that the more you use antibiotics, the less they work; but the less you use them, the more they work. But here’s the catch: that rule only works well when everyone everywhere follows it, as the bad bacteria off of your uncle Fred who overuses antibiotics can jump on you and make you sick. We all have to be careful to avoid overuse.

So when are antibiotics needed and when should they be avoided? Here are my quick and dirty tips about antibiotics:

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