We live in a time when world views are clashing and colliding everywhere. Evidence of this is all around us-religious views, political views, lifestyles-the list goes on and on. One such collision occurs in the way we view public health. One view, developed early in the 20th century, holds that since bacteria are the cause of disease, the way to eliminate disease is to eradicate bacteria. Sanitation became the founding principle of public health efforts And great strides were made by this approach. The other view of public health has a broader environmental perspective, one derived from observing the environmental effects of our behavior and its eventual health effects. Nothing illustrates this collision more clearly than our overuse of antibiotics and antibacterials.
After the discovery of penicillin, doctors began relying on a wide array of antibiotics for everything. Even when the disease was not treatable with antibiotics, they were often prescribed “just in case” or to prevent secondary infections. Antibiotics are pharmaceuticals that interfere with the life cycle of bacteria so that they can’t multiply and therefore simply die out. When we take antibiotics we often begin to feel better, sometimes within hours of our first dose. The problem is that overuse can negatively impact our overall health and over-prescribing them has resulted in the development of bacteria that no longer respond to antibiotics. Additionally, taking antibiotics unnecessarily presents risk of adverse reactions. Frequent and inappropriate use of antibiotics selects for strains of bacteria that can resist treatment. These resistant bacteria require treatment by higher doses of medicine or stronger antibiotics. Doctors have even discovered bacteria that are resistant to some of the most powerful antibiotics available today.
Antimicrobials, chemicals designed to prevent the spread of disease organisms to noninfected individuals, add to the problem of increasing resistance. An example is triclosan, added to many household hand soaps. Overuse has created a critical situation in which we are in danger of losing our ability to control disease. Antibiotics and antimicrobials kill pathogens and non-pathogens alike, creating an opportunity for resistant bacteria to grow and prosper without competition. Increasing numbers of resistant disease organisms leave us increasingly vulnerable to diseases that can’t be controlled with antibiotics. The bacteria with the ability to survive antibacterial soaps reproduce, making bacteria as a unit more powerful. Some fear that after years of killing off weak bacteria, all that will be left are the powerful bacteria that we cannot kill.
When we take antibiotics, we excrete the unabsorbed portion, and when we use antibacterial soaps, they go to wastewater treatment facilities from where they wash into rivers and lakes. Studies have shown that introduction by these routes has changed the antibiotic susceptibility of the microorganisms in those environments. Microorganisms are essential to our very existence. They are ubiquitous, found in common environments such as soil, water, and air as well as exotic locales and they have very specific jobs. They are responsible for recycling nutrients in our soil and purifying our water. Microbial populations have been shown to change due to exposure to antibiotics and antimicrobial agents, and we are seeing a rise in antibiotic resistance all around the world. Some diseases that were previously susceptible to a variety of antibiotics now demonstrate untreatable strains. According to the Center for Disease Control (CDC), approximately 70% of infections that people get while hospitalized are now resistant to at least one antibiotic. Resistance to antibiotics is rapidly outpacing our ability to synthesize new drugs. While only a very small proportion of bacteria in our lives can potentially harm us, we are losing our arsenal to treat these rare infections.
Dr. Timothy LaPara and his colleagues at the University of Minnesota have studied antibiotic-resistant bacteria in wastewater treatment facilities and have concluded that the problem is much worse than imagined. Resistant bacteria are released in higher numbers than anticipated and are not sufficiently inactivated during effluent disinfection. Dr. LaPara recommends using antibiotics only for people or animals with bacterial infections and seriously reducing or eliminating the use of antibacterials.
This overuse of a good thing has helped create a critical situation in which we are in danger of losing our ability to control disease. Increasing numbers of resistant disease organisms leave us increasingly vulnerable to diseases that can’t be controlled with antibiotics. Working together, we can help reverse this trend.
Municipal Wastewater Treatment: A NovelOpportunity to Slow the Proliferation of Antibiotic-Resistant Bacteria, cura.umn.edu
The Antibiotic Paradox: How the Misuse of Antibiotics Destroys Their Curative Powers, Stuart B. Levy, Harper Collins, 2002.