Preserving antibiotics like battling climate change: reduce resistance footprint

Experts worried about the growing problem of antibiotic resistance are hoping a concept made familiar by the fight against climate change will help them reduce inappropriate use of the critical drugs.

They think urging people to consider their "resistance footprint" may help patients and prescribing doctors get their heads around the notion that every time anyone uses antibiotics unnecessarily or inappropriately, it helps drive the development of resistant bacteria.

Those resistant bugs aren't just a danger to the individual taking the antibiotic. They are a threat to family members, friends and strangers, now and into future generations.

"If you take a heart pill, if you take a blood pressure pill, if you take a diabetes pill, that pill affects you and only you," explained Dr. Andrew Simor, head of microbiology at Toronto's Sunnybrook Health Sciences Centre.

"(But) you take an antibiotic and there's the potential for it to affect an entire community or a larger population - not just you taking the pill."

Simor and several other infectious diseases specialists warn about the dangers of antibiotic resistance in a series of articles published Tuesday in the Canadian Medical Association Journal.

The notion of the resistance footprint was advanced in an analysis by Dr. David Patrick, director of communicable disease epidemiology at the British Columbia Centre for Disease Control, and Dr. James Hutchinson, of Memorial University in St. John's, N.L.

In an interview, Patrick said he doesn't think people contemplate the broader consequences when they ask for antibiotics to treat their sinusitis or a child's ear infection.

"I don't think people think that way," he said from Vancouver.

"But I think people have digested the carbon footprint idea - that for my benefit of running the chain saw so I can cut more trees down for my industry or for my benefit of transporting food, there's a price to be paid. Which may not be paid exactly by me. It may be paid by people in the Maldives."

"There is a direct corollary with the overuse of antibiotics."

It's known that people seek - and doctors prescribe - antibiotics to treat viral infections against which the drugs have no power.

"The majority of outpatient (antibiotic) prescribing is for the acute respiratory conditions pharyngitis, sinusitis and acute bronchitis, as well as for otitis media (inner ear infections)," Patrick and Hutchinson wrote. "These syndromes are almost entirely caused by viruses."

So the drugs don't cure the ailment. But they do expose the bacteria living in the person's gastric tract or on the skin to what is called selective pressure.

The bugs susceptible to the antibiotic die off, leaving those that are resistant to flourish and potentially spread. It's the microbial version of survival of the fittest.

The rise of antibiotic resistance makes it increasingly difficult to treat infections. And it puts many of the advances of modern day medicine in jeopardy.

"There's a risk with surgery, there's a risk with a whole host of scenarios. Cancer patients on treatment who become immunosuppressed are at risk of very serious infections," said Simor.

"And again, infections in the community that we've all been accustomed to be able to treat relatively easily, you run the risk of these organisms becoming so resistant that they become untreatable - analogous to the situation we were in before antibiotics were available."

Society cannot assume the pharmaceutical equivalent of the cavalry will ride to the rescue. Antibiotics are not a big money maker for drug companies. Consequently there isn't much in the development pipeline. And the economic downturn isn't likely to help, Simor said.

Even if there were more drugs in development, Patrick believes it is time society starts taking a more sustainable approach to antibiotic use.

"Irrespective of whether there was a lot in the pipeline or a little bit, stewarding the value of what we already have is an imperative," he said.

"Even if you weren't looking at the fiscal crunch, you need to think of things environmentally to a degree and say: 'OK, what in terms of the value of what we have now can we preserve into the future so that our kids can still use them?"'