When the Black Plague hit 14th century Europe, the knowledge about microorganisms was so limited that the most scientific explanation for the cause of infection was an imbalance in the four bodily humors. It was a time when culture teemed with ludicrous superstitions, shrouded in ignorance. Slowly, of course, as the focus of science shifted from the macroscopic to the microscopic, these superstitions evaporated. By the time Fleming discovered penicillin, a drug effective against bacterial diseases, Pasteur had already performed experimentation proving the Germ Theory. At the time of his experimentation, the idea of microscopic organisms was ripe in the public’s mind. Any student, even one whose eyes drooped with drowsiness at the mere mention of bacteria in a biology class, identifies penicillin as one of the greatest medical breakthroughs alongside the smallpox vaccine and the discovery of DNA. This is for good reason. No longer did surgeries cause more harm—by way of bacterial infections—than good. No longer did parents have to fear for their children’s lives if they brought home a cough. Penicillin, 50 years after its discovery, increased life expectancy by almost 30 years, eradicating some of the most deadly and unbearable diseases. However, as with any miracle drug, it has become rampantly overused.
There have been several efforts to stem the over-prescription of antibiotics, yet to no avail. A study, published on September 15, revealed that 11.4 million antibiotic prescriptions each year for children and teens with acute respiratory tract infections (ARTI) are likely unnecessary. Researchers at Seattle Children Hospital determined the bacterial prevalence rate for ARTI, which can manifest itself in both bacterial and viral forms. They then compared these rates to the to the antimicrobial prescription rate for ARTI in the US. Only 27.4 percent of those with the infection harbored disease-causing bacteria; however, 56.9 percent of patients received antibiotics. The study concluded, along with the appalling amount of unnecessary antibiotic prescriptions, that over-prescription has remained static over the last decade.
The cost of over-prescription is a large price to pay. Bacteria, due to their rapid reproduction, mutate extremely rapidly. As Leslie Pray, a population genetics PhD, shockingly illustrates, “With a genome size of 2.8 x 106 and a mutation rate of 1 mutation per 1010 base pairs, it would take a single bacterium 30 hours to grow into a population in which every single base pair in the genome will have mutated not once, but 30 times!” Equipped with the valuable ability to swiftly adapt to the ever-changing world, bacteria can easily produce several antibiotic resistant strains by mutating their gene sequence. In the absence of antibiotics, nature does not favor the resistant strain over the non-resistant one, and the resistant bacteria experience the same population dynamics that the normal bacteria do. However, when antibiotics are used to kill the disease-causing bacteria, the resistant strain becomes the fittest. Thus, it survives and propagates, resulting in a new strain that is untreatable until new drugs are developed to select against it. Not only do antibiotic drugs select for antibiotic-resistant bacterial strains, but they also, in some cases, even increase the mutability of the bacteria. Therefore, when antibiotics are unnecessarily used, it harms both the sick individual—as it provides an environment for resistant strains to thrive—and the larger community—as it puts people at risk for infection by resistant bacteria. In 2013, U.S. Centers for Disease Control and Prevention issued a “threat report” that claimed that 23,000 Americans die each year from antibiotic-resistant infections. This government organization, in an attempt to decrease overprescription, even started an online campaign detailing appropriate antibiotic use and explaining the dangers of antibiotic resistance. So why, after years of recognizing the prevalence of the issue, do physicians still tend to needlessly prescribe antimicrobial medications?
One of the largest issues surrounding overprescription is the lack of ability to clearly distinguish between bacterial and viral infections. Viruses, non-living agents that depend upon living cells to reproduce, are the source of numerous infections that are, otherwise, virtually indistinguishable from sickness caused by bacteria: both are spread by contact with infected saliva and contaminated surfaces, and both can manifest as acute, chronic or latent infections with similar symptoms. Several labs are dedicated to developing an easy method for discrimination. In fact, researchers at Duke University, in the last year, succeeded in creating an extremely accurate blood test to conclude what the source of infection is. However, despite efforts made to easily differentiate between the two types, the fact still remains that any test, as of now, is much too expensive and inconvenient in a clinical setting. And, as if navigating the blurry line between the two types of infections is not difficult enough for a physician, many patients demand a rapid recovery. In an attempt to placate their persistent patients, physicians, oftentimes, end up prescribing antibiotics to patients with viral infections, which are only treatable by preventative vaccination or a select few antiviral treatments.
The number of preventable deaths caused by overprescription of antibiotic drugs illustrates not only a dire need for an accessible technology to help physicians distinguish viral and bacterial infections, but also a deficiency in the system itself. A study published by researchers in Seattle Children Hospital shows how much easier it is for doctors to simply prescribe an antibiotic for an unknown infection than to investigate the cause or to refuse prescription when it is unnecessary. In the world of antibiotics, doctors serve as the gatekeepers, left with the responsibility of eradicating of lethal, bacteria- causing infection while cautiously avoiding overprescription. And that’s not fair. Although much of the fault lies with the physicians and current technology, we share the blame as well. We, as a culture, desire rapid results, swift recovery, a quick cure. We’ve socially evolved from blindly accepting that plagues can be caused by different mixtures of bodily fluids. However, our blindness manifests in different forms: Even when we are educated that viral infections cannot be treated with antibiotics, we cannot accept the prospect of an infection without adequate medication. So, we demand medication and pressure physicians. Just as the choice to not vaccinate a child is potentially dangerous to the entire community, so is the unnecessary use of antibiotics. And, for physicians to reduce overprescription, it must be seen as such by the public.
Heitz, David. “Is Your Illness Viral or Bacterial? A New Rapid Blood Test Can Tell.” Healthlines RSS News. Healthline Networks, 18 Sept. 2013. Web. 25 Sept. 2014.
Kronman, Matthew P., Chuan Zhou, and Rita Mangione-Smith. “Bacterial Prevalence and Antimicrobial Prescribing Trends for Acute Respiratory Tract Infections.” Pediatrics (2014): n. pag. Web.
Martinez, J. L., and F. Baquero. “Mutation Frequencies and Antibiotic Resistance.” Antimicrobial Agents and Chemotherapy 44.7 (2000): 1771-777. Web.