The development of antibiotics (antimicrobial agents) is usually included with radio, television, computers, genetic engineering and space travel as one of the landmarks of scientific achievement in the twentieth century (and even of the second millennium). As the century comes to a close, there is growing evidence, horrific and irrefutable, that antibiotics are strengthening the very disease-causing microbes they were created to target and destroy. These dire warnings have been featured in recent articles and editorials in such prestigious journals as the New England Journal of Medicine and the Journal of the American Medical Association.
Antibiotics do kill bacteria by the billions. Unfortunately, the process that kills most of a particular species of microbe can leave some mutant germs, which have a natural resistance to the antibiotic that wiped out their weaker relatives. This process of natural selection, by which humans create better bugs while eradicating less-adaptive ones, is fundamental to evolution, the natural process by which new species emerge and survive because they are better able to cope with a changed environment. In the twentieth-century environment of hospitals, clinics and nursing homes, and such in-patient and out-patient facilities as dialysis centers, antibiotics are regularly overprescribed and often indiscriminately dispensed. As a result, better microbes are constantly being created and thrive. What makes them better is their resistance to the antibiotics that helped bring them into existence. Being "better" in this way, makes existence much worse for human beings who are afflicted by them.
In the few decades since penicillin began to give humans apparent mastery over microbial infections, many new and seemingly stronger antibiotics have been developed to counter more diseases and overcome germs' resistance to earlier antibiotics. For a time, synthetically produced penicillin (methicillin) and combinations of antibiotics appeared to have bacterial infections in check. More-resistant bacterial strains have appeared. For the last two decades, vancomycin has been seen as the only drug that could be depended on to eradicate Staphylococcus aureus, a microbe that commonly infects hospital patients already weakened by illness or surgery.2
In 1996, the first case of a patient infected with avancomycin-resistant strain of S. aureus was reported in Japan.3-4 In the last two years, similarly resistant S. aureus strainshave appeared in the United States in patients who had beentreated with vancomycin. The vancomycin-resistant microbes in thefirst two U.S. patients were wiped out by a combination ofvancomycin and other drugs, but both patients still died. Thesewere only the initial encounters with what could become anonslaught affecting the in-patient and out-patient medicalfacilities of entire cities.5-6 They should raise an alarm thatall health care professionals must heed, because "the emergenceof such resistance could produce morbidity and mortality similarto that caused by S. aureus infections in the era beforeantibiotics became available."1
The natural selection of drug-resistant bacteria is a result of the unnatural and unnecessary overuse of powerful antibiotics that rapidly alter microbes in ways that are becoming harder to overcome. Merely creating yet-more-powerful drugs only leads to yet-more-powerful bacterial adversaries that may dispatch first the infected who are old, sick, infirm and institutionalized. Such "super bugs" could eventually be virtually unstoppable and begin incapacitating and decimating younger and otherwise healthier people.
All health care and public health professionals must be educated to implement guidelines for prescribing and dispensing antibiotics and even issuing "antibiotic stop orders" when appropriate.3 They must strive to use antibiotics only in the most judicious manner, to employ programs to detect antibiotic resistance and take all steps necessary to limit contagion. 7-8
Chiropractors can protect and empower their patients by counseling them to demand judicious use of antibiotics. Patients must learn to ask doctors some critical questions when medications are prescribed for them or their loved ones:
- Is the medication you're prescribing an antibiotic?
- What good is it supposed to do?
- What problems, side effects, or interactions with other medications or nutritional supplements might result from taking this antibiotic?
- Is there reason to believe this or related antibiotics may contribute to the creation of antibiotic-resistant bacteria that could be difficult to combat in the future?
- Can you recommend a less-potent medication or, better yet, other therapeutic approaches that may be equally protective and curative without the difficulties and dangers that antibiotic use can involve?
Members of the biomedical scientific community are echoing positions long held by doctors of chiropractic: Victory over drug-resistant bacteria can no longer be thought of in terms of increasing the strength of weapons used against microbes. It must take the form of "a major war against the misuse of antibiotics."1
Chiropractors and now biomedical scientists are clearly enlisted in the war against injudicious use of antibiotics. But the war can be won only if medical clinicians, the MDs who are empowered to prescribe antibiotics, accept their responsibility for reducing overuse of antimicrobials. They decide if antibiotics are indicated. They must make the day-by-day, patient-by-patient decisions to stop the dangerous practice of using antibiotics as cure-alls--when the facts show they may be helping create bacteria that nothing can cure.
References
- Waldvogel FA. New resistance in Staphylococcus aureus. N Engl J Med 1999;340:556-7.
- Sieradzki K, Roberts RB, Haber SW, Tomasz A. The development of vancomycin resistance in a patient with methicillin-resistant Staphylococcus aureus infection. N Engl J Med 1999;340:517-23.
- Smith TL, Peasom ML, Wilcox KR et al. Emergence of vancomycin resistance in Staphylococcus aureus. N Engl J Med 1999;340:493-501.
- Hiramatsu K, Hanaki H, Ino T, et al. Methicillin-resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility. J Antimicorb Chemnother 1997;40:135-6.
- Roberts RB, de Lencastre A, Eisner W. et al. Molecular epidemiology of methicillin-resistant Staphylococcus aureus in 12 New York hospitals. J Infect Dis 1998;178:164-71.
- Wiener J, Quinn JP, Bradford PA, et al. Multiple antibiotic-resistant Klebsiell and Escherichia coli in nursing homes. JAMA 1999;281:517-23.
- Recommendations for preventing the spread of vancomycin resistance: recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR Morb Mortal Weekly Rep 1995;44(RR12):1-13.
- Interim guidelines for prevention and control of Staphylococcal infections associated with reduced susceptibility to vancomycin. MMWR Morb Mortal Weekly Rep 1997;46:626-8, 635.