Antibiotics — overprescribed and under-effective

By Brian Rotenberg

Why antibiotic resistance can be deadly

A version of this commentary appeared in the Ottawa Citizen, Windsor Star and Edmonton Journal 

Antibiotics — overprescribed and under-effectiveI am privileged to help patients deal with a variety of common disorders such as ear infections, pharyngitis and sinus inflammation.  People suffer a great deal from these problems, especially when they are in the acute phase.  I offer pain medication, ear or nasal rinses, gargles or decongestants, all of which work reasonably well. The overwhelming majority of these incredibly common infections are caused by viruses — that is, they will not respond to antibiotics — so I don’t routinely offer antibiotic treatments.  When patients hear they won’t be getting an antibiotic many become surprised and often upset.  I then spend time counseling them about why antibiotics are, in most cases, the wrong treatment choice.

Let us use sinusitis as an example to frame the discussion.  In 2013, according to Health Canada, almost five percent of the Canadian population was diagnosed with an acute sinus infection.  This represents almost two million Canadians.  Of these people, the same study reported that approximately 85 percent received an antibiotic prescription.  However, the disturbing part is that according to the modern Canadian Sinusitis Guidelines published in 2011, 98-99.5 percent of people with sinusitis actually have a viral infection without bacteria.  Therefore, the vast majority of people receiving the antibiotic not only didn’t need the therapy, but were actually treated incorrectly.

Antibiotics are a precious resource that, if used appropriately, can be life-saving and curative. However, the overuse (or “misuse” as some might say) of antibiotics in humans has led to the development of many types of antibiotic-resistant bacteria that fail to respond to these agents — and that can be deadly.

Antibiotic resistance is now a major global public health problem with serious societal costs. Since antibiotic resistance genes are shared between bacteria in our ecosystem, inappropriate use of antibiotics — even in a single individual — could potentially affect every living creature on earth.

In Canada we live in a blessed country where most acute infectious illnesses of the past have become rare enough to have faded from memory.  Most of our current health care dollars now go towards treating chronic conditions, many of which involve surgical treatments, such as hip and knee replacement to treat arthritis.  These surgeries simply could not happen if they carried a major infectious risk.

Having an implant get infected is devastating to a patient.  Imagine if your grandmother couldn’t have her hip replacement surgery because the risk of developing an antibiotic resistant infection was too high.  I don’t believe I’m exaggerating when I say this risk is a real possibility in our lifetime.

Modern society eschews disease, and nobody feels they have time anymore to be sick.  A reasonable level of tolerance for mild viral illness has largely been replaced by self-maximization of symptoms and requests for aggressive therapy, most commonly antibiotics. It is a rare patient who is satisfied with time honored and effective conservative measures — drink plenty of fluids, take some pain medication and wait a few days for it to get better.

More problematically, it is also becoming a rare doctor who will take the time to educate patients that in all likelihood their infection is viral, and won’t respond to antibiotics anyway.  Sometimes it is easier to just write a prescription.

Add to this the fact that pharmaceutical makers have been lackluster in developing newer antibiotics as the costs associated with drug development make such ventures very risky. You are more likely to see instead lifestyle medications such as cholesterol pills or blood pressure medications, which are far more lucrative for pharmaceutical firms.

And here’s a strange fact of history: did you know that most of the current types of antibiotics were discovered by scientific accident, and that the targeted research fostered by modern society has been notably unsuccessful in replicating the happy serendipity of our historical scientists?  When was the last time you heard of a new type of antibiotic being released for use by physicians?

It would be wonderful to see a willing wealthy philanthropist, or a strong government leader, partner with big pharma to set a financial motivator for antibiotic development.  Absent that though, society in general needs a reset for how antibiotics are regarded and used, and physicians in particular need to stop overprescribing them.

It really is ok to just be sick for a little while with a virus.

Dr. Brian Rotenberg is an advisor with EvidenceNetwork.ca and an Associate Professor in the Department of Otolaryngology — Head & Neck Surgery at Western University, London, Ontario.

July 2015

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