January 15, 2021 by John Fernandez
Antibiotics: Join the Fight Against Resistance
The antibiotic drugs we have depended on for decades to fight serious infections are losing their superpowers, thanks to strains of bacteria that have adapted to resist them. Both the World Health Organization and the U.S. Centers for Disease Control and Prevention (CDC) recognize antibiotic resistance as one of the most urgent global threats to the public’s health.
The U.S. sees more than 2.8 million cases of antibiotic-resistant infections each year, directly linked to more than 35,000 deaths, and those numbers are rising. At the root of this crisis is years of widespread — and often irresponsible – use of these wonder drugs.
“One of the things that we say is that the more you use antibiotics, the more you lose antibiotics because we pressure the organisms to become resistant the more we use them,” said Timothy Gauthier, Pharm. D., manger of the antimicrobial stewardship clinical program at Baptist Health South Florida.
Gauthier and fellow Baptist Health clinical pharmacist Jefferson Cua, Pharm. D., sounded the alarm about the danger of antibiotic resistance in a recent episode of the Baptist HealthTalk podcast, hosted by Jonathan Fialkow, M.D., deputy medical director, chief of cardiology and a certified lipid specialist at Miami Cardiac & Vascular Institute and chief population health officer at Baptist Health.
They discussed issues including antibiotic side effects and obstacles to developing new antibiotics, along with information about how the public can join Baptist Health to battle antibiotic resistance. Selected questions and answers from the conversation are below.
Dr. Fialkow: “What are antibiotics and what do they specifically treat? How do they work?”
Timothy Gauthier: “Antibiotics are special because they’re not like other drugs. Antibiotics treat bacteria, they kill bacteria, they target bacteria. Whereas a lot of the other drugs we use, they target cells in our body. And so, when we use an antibiotic, it impacts bacteria rather than impacting our cells to maybe reduce our blood pressure or reduce our cholesterol. And so, we’ve tried to pick the right bug for the right drug, depending upon what infection we’re talking about.”
Dr. Fialkow: “So, let’s talk about what bacterial illnesses antibiotics work against versus things like viruses.”
Jefferson Cua: “If we look at a bacteria and a virus, they have different components. And so sometimes the targets that antibiotics try to attack are not on the virus. And so, using antibiotics for viral infections is not going to be effective. A lot of our common infections that we see in our outpatient and also inpatient population, they’re going to be a common cold and most of them are due to respiratory viruses.”
Dr. Fialkow: “We’re currently observing Antibiotic Awareness Week. What is it and why is it certainly something very cogent in current times?”
Timothy Gauthier: “U.S. Antibiotic Awareness Week is an annual observance that always happens November 18th through 24th and it highlights the steps that everyone can take to provide antibiotic prescribing and use that is rational. Antibiotics can save lives and are critical tools for treating a number of common, of more serious infections that can lead to very serious infections like sepsis. It’s okay to use antibiotics when you need to, but when you don’t need antibiotics, we do not want to give them because there can be consequences.”
Dr. Fialkow: “Jefferson, let’s talk about the concept of antibiotic resistance. Let’s dive a little deeper into that.”
Jefferson Cua: ”Antibiotic resistance basically refers to when the antibiotics we use for certain bugs, all of a sudden, the bugs outsmart the antibiotics and what used to work for them no longer is going to work. And that happens usually if we give antibiotics to people who don’t need it, if patients are on it for a long period of time, or if we’re not dosing the antibiotic correctly.
Dr. Fialkow: So when we use antibiotics, especially if we don’t use the proper doses or we use them where they don’t belong, there will be some bacteria that will survive an antibiotic and maybe adapt to no longer being sensitive to that antibiotic. And the issue is we are now getting bacteria that don’t respond to antibiotics, leaving people at risk for worsening infections that we can’t really help.”
Jefferson Cua: “Correct.”
Dr. Fialkow: “Why can’t we just develop new antibiotics?”
Timothy Gauthier: “That’s an excellent question. If you think about an antibiotic, it’s kind of a miracle drug in a way, because most antibiotics cure infections, rather than treating the symptoms of a disease for a long period of time. So the return on investment for a pharmaceutical company isn’t near what it is for developing a new heart medication or a new lipid lowering medication. There used to be about 20 pharmaceutical companies engaged in research for new antibiotics and that is down to about three currently.
“And so pharma is not putting money into it because they’re not seeing money come out of it. And there are organizations that have been developed in order to facilitate drug development, but unfortunately it’s not going very well. In fact, no new approved classes of antibiotics have been discovered since 1962.”
Dr. Fialkow: “There’s a lot of exploration now on antibiotic use killing healthy bacteria; the idea that taking antibiotics without the proper indications or for the full count can actually kill healthy bacteria and leave you with other types of medical problems. That’s something you’re comfortable talking about?”
Timothy Gauthier: “Yeah, absolutely. So there’s something called your microbiome and your microbiome is what bacteria live on and inside your body and it’s perfectly normal to have bacteria and fungi actually living within your GI cavity, within your mouth, the genital-urinary area and on your skin….Every time we expose ourselves to an antibacterial or an antifungal medication, that drug is going to kill a certain number of those bugs and that can have long-term implications and it can have short-term implications.
“But I think the take home message is you don’t want to take antibiotics if you don’t need to, because they can be harmful.”
Dr. Fialkow: “Which also further supports the fact that we, as people in the community and a population, have to be stewards of taking antibiotics appropriately. Jefferson, what are we doing at Baptist to fight anti-microbial resistance?”
Jefferson Cua: “So, I am part of the team called the Antimicrobial Stewardship Program here. We make sure that we are using our antibiotics judiciously. So just making sure that all the right patients are getting their antibiotics … making sure that everyone’s completing their courses appropriately. We work closely with our providers just to make sure that our doses are optimized, the correct drugs are being used based on the labs that we get every day.”
Dr. Fialkow: “So, a precision approach.”
Jefferson Cua: “Exactly.”
Dr. Fialkow: “What can we in the community do?”
Timothy Gauthier: “I think a really important take-home is that when it comes to appropriate and safe antibiotic use, it’s really a team sport. It’s engaging with the prescriber, with the patient or the family member to understand what’s going on, what is the complaint that’s currently ongoing and what diagnosis goes along with that complaint? And then pharmacists can be involved to help pick the right drug after the prescriber has made that diagnosis.
“When it comes to antibiotics and patients who are requesting antibiotics, sometimes it’s better to focus on the specific symptom or complaint that is at hand, rather than asking for an intervention. So, let the physician make the call on when antibiotics are indicated.”