PROMPT: Describe your personal philosophy about how and when you have taken, or would take, antibiotics. What experiences or prior knowledge do you have that shaped that personal philosophy?
Having nearly 2 years of experience in healthcare, I have become quite familiar with drug-resistant organisms. I would say that due to the various classes I have taken in addition to the time I have spent working in hospitals, my personal philosophy on antibiotic usage is quite biased. Antibiotics are an incredible resource that have drastically improved the outcome for patients around the world. While it’s impossible to calculate an exact number of lives that have been saved since the creation of the first antibiotic in 1928, estimates put the number at 80-200 million or more. (1) However, with great power comes great responsibility. The misuse of antibiotics has lead to an epidemic of infections of strains of pathogenic bacteria which have developed resistance to nearly all antibiotics. (1) This is why strict adherence to proper use of antibiotics is serious.
It is important to note that antibiotics have an incredibly important role in healthcare and treating patients suffering from various infections. If your physician EVER prescribes an antibiotic, it is essential that you follow the specific instructions for the prescription. Additionally, even if you start feeling better, DO NOT STOP taking the antibiotics as prescribed. The premature discontinuation of antibiotic treatment can cause a relatively benign infection to come back as a much more serious, drug-resistant, infection. This contributes to the problems that lead to the few cons of antibiotic usage.
Antibiotics are a double-edged sword. While they have saved countless lives as previously stated, they have lead to the rise of deadly bacteria that we either struggle to or are no longer able to treat. Had antibiotics been used only in specific cases as needed, we would not be facing this epidemic we are in today. In 2009 alone, over 3,000,000kg of antibiotics were administered to humans. Even more surprisingly, 13,000,000,000kg of antibiotics were administered to US livestock. (2) Compared to the typical 125-1000mg dosage of antibiotics, it’s clear that antibiotics were over-used and overprescribed.
The 13 billion kilograms given to livestock was primarily given as preventative treatment, rather than for treating livestock afflicted by an infection. The farms raising the livestock do this to try to prevent an outbreak of infections that can wipe out an entire farm’s cattle due to the small shared spaces livestock are kept in at factory farms.
Bacteria replicate quickly, with a high chance of mutations occurring in their genome. These mutations can either lead to no change, be harmful, or be beneficial. Since bacteria replicate so quickly, one bacteria turns to two, which turns to four, then eight, 16, 32, 64… and so on. In a relatively short time, 1 bacteria can turn into a colony containing millions of bacteria. If even as many as 1 in 1000 bacteria have a serious mutation, the amount killed off due to harmful mutations is insignificant as the colony still has 99.9% of the bacteria living without mutations. However, if that mutation happens to lead to a beneficial change in the bacteria, especially if it leads to resistance to antibiotics, that 1 in 1000 becomes incredibly significant.
Now, take those millions of bacteria in the colony, and place them in a cow at a farm. The cow then receives antibiotics, which leads to the death of 99.9% of the bacteria. However, the remaining bacteria now have all the space they need to replicate and virtually 0 competition for nutrients. Not only this, but they are resistant to the antibiotic, so treating the cattle with the same antibiotics to try and treat the infection does nothing. The resistant pathogen is now free to colonize the host without being killed by antibiotics, and without competition from other microbes.
The 1 in 1000 number I used is not a scientifically based statistic, it was used to illustrate my argument. The real number is MUCH less frequent, but it is still significant when put in a real-world context. With 3 million kilograms of antibiotics being given to humans, and another 13 billion being given to livestock, it’s clear to see how even incredibly low rates of mutation can still end up with the development of drug resistance.
As I said before, with great power comes great responsibility. We are sitting on the edge of a bubble of an epidemic that is ready to burst. If we continue to use antibiotics haphazardly, we will ultimately run out of antibiotics to treat even common infections. Antibiotics have a critical role in healthcare and should 100% be taken as directed by a physician. However, we must improve the way they are used before we are stuck in a situation we can’t get ourselves out of.
- Ventola, C. L. 2015. The Antibiotic Resistance Crisis: Part 1: Causes and Threats. J Clin Pharm Ther 40(4), 277–283.
- Spellberg B, Bartlett JG, Gilbert DN. 2013. The future of antibiotics and resistance. N Engl J Med 368:299-302.
