Just a century ago, there was little that could be done to prevent the scourge of infectious diseases. At the turn of the 20th century, one in five children would not live to their fifth birthday. Two major medical discoveries, vaccines and antibiotics, changed that. Vaccines continue to prevent death and disease today, and antibiotics can now treat deadly bacterial infections.
For every new antibiotic that has been developed, though, resistance is soon detected. As incredible as antibiotics are at curing the sick and saving lives, they have come with the consequence of antimicrobial resistance: bacteria that develop resistance, potentially causing serious or even fatal illness.
Resistance to antibiotics is a key threat to our health. Antibiotics are frequently misused: They are prescribed for circumstances for which they are not indicated, sometimes the wrong drug or dose is prescribed, and very often, treatment continues for too long. The overuse of antibiotics leads directly to resistance. Antibiotics are the second most commonly used class of drugs in children.
Adults and children are frequently prescribed antibiotics for the "common cold," which is caused by viruses, not bacteria. Cold symptoms can last 10 to 14 days, yet many people who seek medical care might be given antibiotics when they're not needed. Antibiotics also can cause drug reactions. In one study, antibiotics were responsible for 19 percent of emergency room visits related to a drug reaction. Antibiotic-associated diarrhea caused by the bacteria Clostridium difficile, or C. diff, is linked to 250,000 infections and 14,000 deaths a year in the United States. Another major concern has been that most of the antibiotics produced are not for human use. Up to 70 percent of antibiotics are given to food-producing animals, primarily to promote growth, not to treat sickness.
Pediatric infectious disease specialists take care of the most vulnerable children and are constantly challenged by antibiotic-resistant infections. Some of these bacteria are resistant to most, if not all, antibiotics. Imagine yourself or your child with a life-threatening infection that cannot be treated effectively. This makes the possibility of treating common bacterial infections without antibiotics, like we did just 100 years ago, very real.
The goal of antibiotic treatment, when needed, is to use an antibiotic that targets only the bacteria you are trying to fight, rather than a broad-spectrum antibiotic. Patients must be monitored closely for side effects and appropriate length of therapy.
What lies ahead for all of us is worsening antibiotic resistance — unless we do something to stop it. All health care providers must strive to prescribe antibiotics for bacterial infections only, and all patients and caregivers need to trust and understand the importance of not always needing to receive an antibiotic.
Other measures to reduce resistance include prevention of infectious diseases. First and foremost, we need to focus on timely and appropriate hand washing. Second, the safest and most natural way to defend ourselves is by using our own immune response to prevent an infection rather than suffering the disease. This has been demonstrated repeatedly with vaccines we use to prevent such devastating diseases as pertussis, polio and pneumococcus. Hopefully, the development of other vaccines will curtail our need for more antibiotics.
Larger-scale efforts are under way as well. In September, President Barack Obama signed an executive order to combat antibiotic-resistant bacteria, including preventing the spread of resistant bacteria, improving national efforts for surveillance of antibiotic-resistant bacteria, developing new tests to rapidly identify resistant bacteria, and collaborating on antibiotic research and development. Many hospitals are launching antibiotic stewardship programs, bringing together infectious disease specialists and clinical pharmacists to monitor and guide antimicrobial therapy.
SHARPS (Sharing Antimicrobial Reports for Pediatric Stewardship), a major collaborative, is a group of 24 children's hospitals, including All Children's Hospital Johns Hopkins Medicine. SHARPS and many other medical organizations in the United States have partnered with the Centers for Disease Control and Prevention for Get Smart About Antibiotics Week, which begins Monday. (Learn more at cdc.gov/getsmart/week/index.html.) The goal of this annual event is to raise awareness of antibiotic resistance, and educate health care providers and the public about appropriate and safe use.
The efforts to date are only the start of what we can do as a nation to tackle this problem. We all need to be partners to reduce antibiotic resistance and other unintended consequences of inappropriate antibiotic use.
Dr. David M. Berman is a board-certified pediatric infectious disease specialist at All Children's Hospital Johns Hopkins Medicine, a member of SHARPS. He was recognized as the CDC's 2014 Immunization Champion for the State of Florida.