Overuse of antibiotics putting general public at risk

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TORONTO — A new report on antibiotic resistance released this week shows just how great a problem this is becoming on a global scale, with increasing reports of “superbugs” — particularly in developing nations.

Antibiotic resistance is not something new. Penicillin was discovered in the 1920s and used extensively by the 1940s.

By the 1950s, many organisms had developed resistance, which then spurred the development of new classes of antibiotics.

The problem is that the number of newly approved drugs is no longer keeping up with the number of newly resistant organisms, which means that we may now be losing this battle.

READ MORE: Meant to save your life, now overuse of antibiotics may endanger it: study

Why is this happening? Bacteria are very good at evolving defenses against threats in their environment. Hence, the more we use antibiotics, the more likely we are to select out populations of bacteria that have evolved mechanisms to resist them.

So the cause of antibiotic resistance is antibiotic overuse. And the two biggest sources of this are medicine and in agriculture.

In Canada, 22.8 million antibiotic prescriptions were dispensed in 2013 . The most common diagnoses they were used for were pneumonia, bronchitis and sinusitis.

Yet we know that the vast majority of cases of bronchitis and sinusitis are caused by viruses, which antibiotics have no effect on.

This means that a large proportion of antibiotic prescriptions for these conditions were probably not needed.

In Canada, at least doctors make decisions about the need for antibiotics.

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The problem is much worse in some developing nations, where 90 per cent of antibiotics are dispensed without a prescription, which means that even more people are taking them when they don’t need to.

And the problem is getting even bigger in agriculture, were antibiotic use now surpasses medical use.

The reason for this is that with increasing prosperity and population growth, the world is consuming more and more animal proteins, which means that farmers are using more intensive agricultural techniques, including antibiotics to promote livestock growth.

And the resistant organisms in these animals then find their way into humans through direct contact or through our meat, eggs, and milk. Infections with resistant organisms can happen both in the hospital and the community.

In Canada, we saw a dramatic overall increase in methicillin resistant Staphylococcus aureus (or “MRSA”) infections in hospitalized patients in the early 2000s, which has recently started to taper off.

In the community, we’ve seen a huge increase in the number of cases of gonorrhea across the country, and in Ontario, 10 per cent of cases last year were treatment-resistant.

How can we fix this problem? If the cause of resistance is antibiotic overuse, then the solution is controlling the use of antibiotics – which we call “antibiotic stewardship.”

READ MORE: Allergic to penicillin? Maybe not. How that mistake could be putting your life at risk

This has to happen on several different levels.

It starts with doctors — we need to get better at differentiating viral from bacterial infections, and prescribing less unnecessary antibiotics.

But in my experience, the decision to write a prescription is also influenced by the patient’s desires.

This means that the public must also play a role.

We need to make people more aware of the fact that they don’t need antibiotics for most colds, and getting a prescription “just in case” is not without harm.

And how will we change agricultural practice?

A big part of how this is happening is also through public awareness, which is driving market forces.

For example, chains such as Chipotle use only antibiotic-free meat, abd competitors such as McDonald’s and Pizza Nova have now adopted a similar policy.

The take home message is that each one of us has an important part to play in tackling this global crisis.