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Bacteria bite back

January 19, 2004|by ANDREA ROWLAND

andrear@herald-mail.com

Your child gets a sore throat. You're sure it's strep so you take her to the doctor's office, where you ask for an antibiotic immediately - even though results of diagnostic tests to nail down the exact cause of the problem aren't yet ready.

It's a common scenario - and one that's fueling skyrocketing rates of antibiotic resistance in the United States.

Overuse and improper use of certain antibiotics, including penicillin and azithromycin, has spawned a new class of disease-causing bacteria - germs that resist traditional antibiotic treatments. Antibiotic resistance occurs when bacteria mutate in some way that reduces or eliminates the effectiveness of drugs designed to cure or prevent bacterial infections. The resistant bacteria survive and multiply - resulting in a longer illness and need for stronger antibiotics, according to the national Centers for Disease Control and Prevention.

Nearly all significant bacterial infections in the world are becoming resistant to the most commonly prescribed antibiotics, according to information on the CDC Web site at www.cdc.gov. Resistance thwarts treatment of such ailments as ear infections in children, sinusitis, urinary tract infections, pneumonia, septicemias and meningitis.

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Antibiotics are not effective against viral infections, including the flu, coughs, colds, bronchitis and most sore throats. Doctors cite diagnostic uncertainty, time pressure on physicians, and patient demand as the main reason for prescribing antibiotics inappropriately, according to the CDC.

Hagerstown physician Dino J. Delaportas said patients must stop expecting antibiotic treatment for all their ailments in order to help combat the resistance problem.

"The culture needs to change," he said. "Instead of telling your doctor, 'I need an antibiotic,' ask your doctor why you need an antibiotic."

It's been proven that the rate of antibiotic resistance decreases in communities where patients strictly limit their antibiotic use, Delaportas said.

Individuals at the highest risk for acquiring drug-resistant diseases include people hospitalized for serious illnesses, individuals with weak immune systems, children attending day-care facilities and elderly patients in nursing homes, he said.

Bacteria that are resistant to multiple drugs and can spread infections include pneumococcus, gonococcus, Mycobacterium tuberculosis, group A streptococci and E. coli, according to the National Foundation for Infectious Diseases at www.nfid.org on the Web.

Pneumococcal resistance to penicillin and other traditional antibiotics is of particular concern due to the prevalence of pneumoccocal infection, Delaportas said. The bacterium Streptococcus pneumoniae - which is spread from person to person by coughing, sneezing or close contact - is the most common cause of secondary bacterial infection for individuals diagnosed with the flu, he said.

Pneumococci also cause pneumonia, meningitis and ear infections - a major problem for young children in day-care settings, which Delaportas likened to a "cesspool of bacteria" where germs are passed back and forth between kids whose bodies haven't developed immunity to different types of pneumococci.

More than 7 million pneumococcal infections occur in the United States each year, and about 40,000 Americans die annually from such infections, the NFID Web site states.

Penicillin has been used to effectively treat pneumococcal pneumonia and other pneumococcal diseases since 1945, but antibiotic overuse and misuse has led to the gradual resistance of pneumococci to penicillin and other commonly used antibiotics.

A 2001-02 survey conducted as part of the Tracking Resistance in the United States Today (TRUST) surveillance program found that pneumococcal antibiotic resistance rates across the nation have steadily climbed from 1998 to 2002 for penicillin and azithromycin. The survey, which examined more than 7,600 cultures of Streptococcus pneumoniae from 239 U.S. hospital laboratories, found that pneumococcal isolates resistant to penicillin increased from 14.7 percent during the 1998-99 respiratory infection season to 18.4 percent during the 2001-02 season. Resistance to azithromycin jumped from 22.7 percent to 27.5 percent during the same time period, according to survey results outlined in the Dec. 2003 edition of the American Family Physician journal.

The article is posted on the American Academy of Family Physicians' Web site at www.aafp.org.

Newer antibiotics can treat pneumococcal infections, but such treatment is often more complicated and much more expensive than traditional treatment with penicillin, Delaportas said.

We're only hurting ourselves


In a nutshell, overuse of antibiotics jeopardizes the usefulness of essential drugs. Decreasing innappropriate use is the best way to combat the problem, health officials say. The Centers for Disease Control and Prevention at www.cdc.gov on the Web gives the following suggestions for helping to prevent antibiotic-resistant infections:

- Do not take an antibiotic for a viral infection such as a cold, a cough or the flu.

- Take an antibiotic exactly as the doctor tells you. Do not skip doses. Complete the prescribed course of treatment, even if you are feeling better.

- Discard any leftover medication once you have completed your prescribed course of treatment.

- Do not take antibiotics prescribed for someone else because the drugs may not be appropriate for your illness. Taking the wrong medicine may delay correct treatment and allow bacteria to multiply.

- Parents should not demand antibiotics when a health care provider has determined they are not needed.

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