Good Germs, Bad Germs by Jessica Snyder Sachs

Author:Jessica Snyder Sachs
Language: eng
Format: mobi
Publisher: Farrar, Straus and Giroux
Published: 2011-04-17T21:00:00+00:00

PRESERVING ANTIBIOTICS: LESS IS MORE

While doctors and patients clamor for newer and more powerful antibiotics, it’s clear that we’re still not using our existing drugs responsibly. We know, for example, that the less we use them, the longer they will remain effective. But two decades of hectoring physicians to curb “antibiotic abuse” has produced limited results. A key point of contention is the stubbornly persistent practice of keeping healthy but infection-prone patients on prophylactic, or preventive, antibiotics, for months to years on end—something known to breed drug resistance into patients’ microflora and even that of their housemates.8 In 1999 the American Academy of Pediatrics began actively discouraging its members from the habit of giving ear-infection-prone babies and preschoolers daily amoxicillin. Yet it remains common for dermatologists to prescribe long-term antibiotics to ease teenagers through their acneprone years, and gynecologists often do the same with women predisposed to urinary tract infections.9

Add to this the growing popularity of using antibiotics for their anti-inflammatory effects in treating nonbacterial diseases such as asthma, rheumatoid arthritis, and even obsessive-compulsive disorder.10 The popularity of this approach took a jump in the 1990s with the discovery that several classes of antibiotics, including tetracyclines and macrolides, somehow dampen the inflammatory activity of the immune system’s soldier cells.11 But because antibiotics don’t cure the underlying cause of these disorders, their effectiveness depends on continual, even lifelong use.

Cardiologists, in turn, have expressed great interest in using antibiotics to treat atherosclerosis, or clogging of the arteries, which we now know to be an inflammatory disease. The inflammation may stem from trace amounts of bacteria that stray from the mouth and respiratory tract and end up, in dormant form, in the lining of our blood vessels.12 No one knows why some people’s immune systems ignore these otherwise harmless bacteria while others respond with artery-clogging inflammation. Regardless, many cardiologists began putting their patients on antibiotics in the 1990s, with the hope of curing heart disease.13 The practice largely stopped in 2005, when two large studies showed that the drugs neither eliminated the bacteria nor reduced the risk of heart attack.14 However, these studies left open the possibility that longer courses of more powerful antibiotics might produce the desired effect. Should such an effective regimen be found—and several companies are betting their profit margins on finding one—the result could be tens of millions of middle-aged men and women on antibiotics in the United States alone.15

Scientists concerned with drug resistance warn that such increasingly widespread use will have dire consequences. But most physicians bristle at the idea of being limited in what they can prescribe to whom. In the short term, relieving one patient’s socially crippling acne or reducing another’s risk of heart attack tends to trump the seemingly distant threat of fostering dangerous drug resistance—at least until a doctor begins losing patients to the kind of unstoppable bacterial infections that now kill more than fourteen thousand Americans a year.16

Doctors may well feel unfairly blamed for antibiotic “abuse” when their prescriptions account for less than half the tonnage sold each year.

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