LITTLE CURRENT—A crisis is growing in the medical field that endangers the chief weapon available in a doctor’s toolkit in combating disease. Antibiotics have saved countless lives since the discovery of penicillin, with hundreds of variants being created since. Antibiotics target the diseases behind most of the world’s pandemics, rendering many of the illnesses that struck terror into the lives of our grandparents relatively innocuous today, but at the same time lending aid to the development of a public complacency toward infections and injuries that would have been unthinkable to previous generations. But poorly used antibiotics are leading to the creation of superbugs that are resistant to those drugs and the weapons in a doctor’s toolkit are dwindling at an alarming rate.
Although the issue is becoming more critical with each passing year, the issue is nothing new to the medical community. Even the discoverer of the first antibiotic sounded the alarm shortly after announcing his discovery.
“It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them,” said Sir Alexander Fleming, the biologist credited with the 1928 discovery of penicillin. “There is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.”
Since the first doses of penicillin were released to protect the wounded on the battlefield in 1943, countless patients suffering from infections have inadvertently added to the problem by not completing their dose of medication, allowing too many organisms to survive and build immunity to the drugs.
Health writer Maryn McKenna noted in her article ‘Imagining the Post-Anti-Biotics Future’ that Dr. Fleming’s predictions proved all-too-quickly true. “Penicillin-resistant staph emerged in 1940, while the drug was still being given to only a few patients,” she wrote. “Tetracycline was introduced in 1950 and tetracycline-resistant Shigella emerged in 1959; erythromycin came on the market in 1953 and erythromycin-resistant strep appeared in 1968. As antibiotics became more affordable and their use increased, bacteria developed defenses more quickly. Methicillin arrived in 1960 and Methicillin resistance arrived in 1962; levofloxacin in 1996 and the first resistant cases the same year; Linezolid in 2000 and resistance to it in 2001; Daptomycin in 2003 and the first signs of resistance in 2004.”
The accelerated buildup of resistance has meant that pharmaceutical companies are beginning to shy away from the creation of new antibiotics as the resistance has been building too quickly to recoup the heavy investments required to develop them. A less charitable interpretation might suggest that there is no incentive to invest in costly new antibiotic drug development as companies focus on everyday drugs that will produce steady and dependable profits.
The Manitoulin Health Centre has developed a policy regime for identifying which antibiotic is resisted by which strain of organism.
“Through our regional affiliation we are running an antibiogram program,” said MHC CEO Derek Graham. “This profiles the organisms that have been discovered in patients in the region and have been isolated.”
The program will document the sensitivity patterns of different organisms to antibiotics. “Different antibiotics respond differently,” said Mr. Graham. “Take basic strep throat. Some antibiotics will work on acute strep, some don’t.”
The antibiogram is part of the Antibiotic Stewardship program instituted formally by the MHC recently and gives front line physicians a good idea of what tool to use in combating an infectious organism.
“For every organism class there will be a percentage that are susceptible and a percentage that will not be susceptible,” said Mr. Graham.
Doctors use a number of strategies to combat the buildup of resistance to antibiotics, noted Mr. Graham. That includes making sure that a patient’s issue is being caused by a bacteria and not a by a virus. Antibiotics do not work on viruses.
“The Antibiotic Stewardship program is formalizing and standardizing something that we have been doing for a number of years,” said MHC Nursing Manager Mary Lynn Wright. “This is a program within the hospital for admitted patients. There are a set number of antibiotics in the hospital, we chart what they are used for and for what length of time.”
A laboratory in Sudbury handles the efficacy of antibiotics, she noted. “They do our bacteriological testing and they create the chart.”
Although the issue of a buildup of antibacterial resistant organisms is not handled at the board of directors, it is definitely on the radar of the Ministry of Health and the Ontario Medical Association, said Mr. Graham. “And it is very much on the radar of our laboratory director.”
Individuals can help prevent the buildup of resistant bacteria by the simple expedient of taking all of the medicine that is prescribed by the doctor. Too often patients will begin to feel relief from the symptoms of the bacteria and they will stop taking their prescriptions, but not cure the infection. “The survivors are usually the more resistant organisms,” said Mr. Graham.
Simply put, if you go to your doctor for medical advice and treatment, it is a good idea to follow through on their advice and treatment. Half measures not only simply will not do, they are slowly but surely bringing us back to a pre-World War One world where a simple scratch can kill.
