Antibiotics can save lives and treat people with common as well as serious infections, but it is estimated that at least 28 percent of antibiotics are unnecessarily prescribed. Improperly prescribed or used, antibiotics can cause side effects and contribute to antibiotic resistance, an urgent threat to the public’s health. November 18 through 24 is dedicated to focusing on the dangers of antibiotics and how they are contributing to one of the biggest public health challenges of modern times.
What Is Antibiotic Resistance?
Antibiotic resistance occurs when germs like bacteria and fungi develop the ability to kill off the drugs that are designed to kill them, causing germs to continue to grow. Infections caused by antibiotic-resistant germs are difficult or impossible to treat. As a result, antibiotic-resistant infections can lead to extended hospital stays, additional follow-up visits, and costly and even life-threatening alternatives.
Each year, at least 2.8 million Americans are infected with antibiotic-resistant bacteria or fungi, with 35,000 people dying as a result. If antibiotics lose their ability to kill bacteria or fungi, they no longer are effective in treating infections, putting the public health at risk.
How Antibiotics Work
Bacteria are one-celled organisms, and humans have billions living within their bodies. Most are harmless or even beneficial, such as those that break down the nutrients in food. Others are dangerous and cause illness. Bacteria are responsible for many illnesses, including ear infections, strep throat, and urinary tract infections (UTIs). Antibiotics work by either killing bacteria outright (called bactericidal antibiotics) or blocking bacterial growth or reproduction (called bacteriostatic antibiotics). Penicillin, which was invented in 1928 but did not reach widespread use until the mid-1940s, acts in this way.
Viruses are even smaller than bacteria and can cause illness when they enter the healthy cells in the body. They can lead to relatively minor illnesses, such as the common cold or the flu, or to life-threatening illnesses, such as smallpox, measles, hepatitis, AIDS, and COVID-19. Drugs called antivirals, which inhibit a virus’s ability to reproduce, can treat a narrow range of organisms and are used in fighting HIV, herpes, and hepatitis B and C, for instance.
Antibiotics are ineffective against viruses. If given when they are not needed, they can cause side effects and lead to the even greater problem of antibiotic resistance.
Commonly Prescribed Antibiotics
Many antibiotics have become available since Alexander Fleming’s discovery of penicillin in 1928. Even penicillin comes in several forms, including ampicillin and amoxicillin. Other commonly prescribed antibiotics include: 
- Aminoglycosides (gentamicin and tobramycin): used to treat serious infections and infections that are difficult to treat, including sepsis
- Cephalosporins (cephalexin): often used to treat UTIs, skin infections, respiratory infections, bacterial meningitis, and sepsis
- Fluoroquinolones (ciprofloxacin, levofloxacin, and ofloxacin): broad-spectrum antibiotics for use on respiratory infections and UTIs
- Macrolides (erythromycin, clarithromycin, azithromycin): often used to treat lung and chest infections
- Sulfonamides (cotrimoxazole and trimethoprim): used to treat UTIs, bronchitis, eye and ear infections, pneumonia, and bacterial meningitis
- Tetracyclines (tetracycline and doxycycline): often used to treat acne and rosacea
The Causes of Antibiotic Resistance
When an antibiotic is used to treat a bacterial illness, symptoms may improve but a few bacterial survivors that did not die from the drug may be left behind. The next time the same drug is used for the illness, it may not work as effectively or at all since the drug-resistant bacteria that were not killed from the prior use of antibiotics have now multiplied. This can lead to superbugs.
The National Institutes of Health cites the following as reasons for antibiotic resistance:
- Overuse: There is a direct relationship between antibiotic overuse and strains of resistant bacteria.
- Inappropriate prescribing: Studies have shown that the need for a drug, the choice of drug, or the duration of the prescribed use of a drug are incorrect 30 to 50 percent of the time.
- Extensive agricultural use: An estimated 80 percent of the antibiotics sold in the United States are used in animals to promote growth or prevent infection. Additionally, antibiotics have been used since the 1950s to control bacterial diseases in crops.
- Availability of few new antibiotics: Economic obstacles have slowed the development of new antibiotics by pharmaceutical companies. Of the 18 largest pharmaceutical companies, 15 no longer produce antibiotics because they are sold at relatively low cost and, therefore, are not as lucrative as many other drugs, such as chemotherapy. Also, funding cuts in academia have curtailed research into producing new antibiotics.
- Regulatory barriers: Obtaining regulatory approval has proven difficult for pharmaceutical companies.
Why Antibiotic Resistance Is a Threat
The major reason antibiotic resistance is a threat is that commonly used antibiotics are becoming less effective in treating infections. As a result, doctors will have to turn to more powerful antibiotics that pose greater risks to patients. In addition, the following may result: 
- Sepsis: Almost any infection can lead to sepsis, which is the body’s extreme response to an infection. Sepsis can cause tissue damage, organ failure, and death. More than 1.7 million adults develop sepsis annually and nearly 270,000 Americans die as a result of it.
- Surgery complications: Antibiotic resistance can prevent the effective treatment of surgical infections, especially those commonly acquired in hospital settings, such as C. diff (Clostridium difficile) and MRSA (Methicillin-resistant Staphylococcus aureus).
- Worsening of weakened immune systems: People with chronic conditions, such as diabetes, are at an increased risk for infections. Without effective antibiotics, common infections are difficult to combat.
- Organ transplant infections: People needing organ transplants must undergo complex surgeries. They also receive medicine to suppress the immune system, increasing the risk of infection and the need for antibiotics that can kill those infections.
- Increase in infections for dialysis patients: Patients needing dialysis treatment for advanced kidney disease are at risk of developing life-threatening infections, which is the second leading cause of death in these patients.
- Infections during cancer care: Because chemotherapy weakens the body’s immune response, chemo patients are at risk for developing infections during treatment.
What Can Be Done to Fight Antibiotic Resistance?
The U.S. Food and Drug Administration (FDA) is working to fight antibiotic resistance in the following ways:
- Approval of new antibiotics
- Labeling regulations addressing proper use of antibiotics
- Promoting public awareness
- Encouraging the development of new antibiotics
Everyone can do their part in fighting antibiotic resistance by: 
- Taking antibiotics as prescribed
- Not skipping doses
- Not saving antibiotics
- Not taking antibiotics prescribed for someone else
- Practicing healthy habits such as getting vaccines, washing hands, keeping wounds clean, and treating chronic conditions, such as diabetes
- Not requesting antibiotics when your health-care provider diagnosis a virus
- Letting health-care providers know at the time of treatment if you have traveled outside the country
- Talking with your health-care professional about when an antibiotic is appropriate and how to take it
- Being aware of a drug’s side effects and reporting problems to the physician in charge
Herrick Library Resources on Antibiotics
The following books and DVDs can be requested and checked out of Herrick Library via curbside pickup:
- Hunting the Nightmare Bacteria: The Rise of the Deadly Drug-Resistant Bacteria: PBS’s Frontline reporter David Hoffman investigates the alarming rise of untreatable infections in hospitals and communities worldwide.
- Missing Microbes: How the Overuse of Antibiotics Is Fueling Our Modern Plagues, by Martin Blaser: Dr. Blaser provides scientific evidence of how humans’ overreliance on medical advances, including antibiotics, threaten the extinction of healthy microorganisms, which is leading to severe health consequences.
- The Perfect Predator: A Scientist’s Race to Save Her Husband from a Deadly Superbug, by Steffanie Strathdee and Thomas Patterson: When her husband becomes ill with one of the world’s most dangerous antibiotic-resistant bacteria, fellow UC San Diego researcher Strathdee must seek help from the FDA, medical researchers, and the U.S. Navy to find the right virus (the so-called perfect predator) to kill the lethal bacteria ravaging Patterson’s body.
- Superbug: The Fatal Menace of MRSA, by Maryn McKenna: This book investigates the drug-resistant superbug MRSA and how it has become a threat to humankind.
- What You Must Know About the Hidden Dangers of Antibiotics, by Jay Cohen: This book explores how six popular antibiotics can destroy people’s health.
The following magazines have featured articles on antibiotic resistance and can be read via Flipster:
- Diabetes Self-Management
- Discover
- Men’s Health
- Prevention
- Women’s Health
Sources: Center for Biological Diversity, Lawsuit Challenges Trump Administration’s Refusal to Release Public Documents on Expanded Use of Antibiotics as Pesticides, https://biologicaldiversity.org/w/news/press-releases/lawsuit-challenges-trump-administrations-refusal-release-public-documents-expanded-use-antibiotics-pesticides-2019-09-05/; Centers for Disease Control and Prevention (CDC), Antibiotic/Antimicrobial Resistance (AR/AMR), https://www.cdc.gov/drugresistance/about.html and https://www.cdc.gov/drugresistance/about/5-things-to-know.html; CDC, Sepsis, https://www.cdc.gov/sepsis/clinicaltools/index.html; CDC, U.S. Antibiotic Awareness Week, https://www.cdc.gov/antibiotic-use/week/get-involved.html#:~:text=USAAW%20is%20an%20annual%20observance,that%20can%20lead%20to%20sepsis; Diabetes Self-Management, Antibiotics and Diabetes: Do the Two Mix?, 5/10/18, https://www.diabetesselfmanagement.com/blog/antibiotics-and-diabetes-do-the-two-mix/; Food and Drug Administration, Combating Antibiotic Resistance, https://www.fda.gov/consumers/consumer-updates/combating-antibiotic-resistance; Harvard Health Publishing, Drug-Resistant Bacteria a Growing Health Problem, https://www.health.harvard.edu/blog/drug-resistant-bacteria-a-growing-health-problem-201309176677; The National Academies, Infectious Disease, Vaccines & Medicines: Antibiotics & Antivirals, http://needtoknow.nas.edu/id/prevention/vaccines-medicines/antibiotics-and-antivirals/#:~:text=Antibiotics%20don’t%20work%20against,a%20virus’s%20ability%20to%20reproduce; U.S. National Library of Medicine, National Institutes of Health, The Antibiotic Resistance Crisis, Part 1: Causes and Threats, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/; U.S. National Library of Medicine, National Institutes of Health, Antibiotic Use in Plant Agriculture, https://pubmed.ncbi.nlm.nih.gov/12147767/#:~:text=Antibiotics%20have%20been%20used%20since,0.5%25%20of%20total%20antibiotic%20use
Graphics: CDC, https://www.cdc.gov/antibiotic-use/week/toolkit.html; Harvard Health Publishing, https://www.health.harvard.edu/staying-healthy/antibiotics-part-of-the-cure-or-part-of-the-problem; World Health Organization, https://www.who.int/campaigns/world-antimicrobial-awareness-week/2020/campaign-materials
