According to the
British Medical Association’s New Guide to Medicines and Drugs (1995), one prescription out of six is for antibiotics, and it is estimated by researchers such as Lappe that most of these are inappropriate and/or excessive, producing the perfect situation to encourage increased resistance.
Lappe discusses the frightening degree of resistance to antibiotics of Neisseria gonorrhoea, the organism responsible for gonorrhea, and makes the point that between 1986 and 1988 there was a 60 percent increase in resistance to penicillin, and that to cover this change tetracycline was introduced. This, too, quickly produced resistant strains, leading to the introduction of spectinomycin, which by 1988 had resulted in the first resistant strains (to it) being discovered. As a further twist in this never-ending game of catch-up, some hospital groups now use ever more powerful and expensive anti-gonorrhea cephalosporin antibiotics, such as ceftriaxone.
As Lappe sees it,
This ‘new’ (and expensive) therapeutic fix to a social problem may yet meet a similar fate. Unless antibiotic uses are coupled with sound health education about the hygienic measures needed to control the epidemic, no success in abating this epidemic is likely. Just such success has been charted in the gay community, where the widespread practice of ‘safe sex’ has led to an abatement of both AIDS and gonorrhoea in California.
This important insight of Lappe’s needs emphasis:
Unless causes are dealt with, antibiotics will fail in the long run – even if they are used sensibly.
If problems emerge from a lack of hygiene, then the ‘cure’ lies in better hygiene.
If causes lie in poor nutrition, then ‘cure’ lies in better nutrition.
If causes lie in poverty and social problems, then political and social action is needed – not the pumping of ever more antibiotics (or whatever) into the already sick population, an approach which simply masks the symptoms, ignores the causes and sets the scene for the infection explosion many now anticipate.
In the short term it makes sense to use antibiotics to save lives. But the antibiotics must be used sensibly, cautiously, appropriately and not haphazardly and excessively, as they are now.
Even when used correctly and appropriately (and remember, please, that Professors French and Phillips – quoted earlier in this chapter – believe that over 70 percent of antibiotics are ‘wrongly’ prescribed), serious long-term changes occur in our internal ecology when most antibiotics are taken, involving the friendly bacteria which keep us alive. This makes antibiotic use a potential health hazard even when prescribed and taken correctly and appropriately.
In the long term, underlying causes of ill-health have to be addressed both on a large scale by health authorities and government, and on an individual level by an acceptance of responsibility – by a recognition that each of us has the power to decide whether to maintain hygienic habits in our lives. Each of us can, if we wish, undertake to incorporate health-enhancing practices, rather than disease-causing ones, into our daily lives.
Many aspects of these health-promotion practices and immune-enhancing methods are discussed in later chapters.
What Happens in Hospitals?
Drugs, especially antibiotics, are widely used.
The presence of many different diseases and associated microorganisms offers a greater chance for cross-infection – infections being transferred from one person to another.
Highly specialized drugs, which may be new or only capable of being used under controlled conditions, are often used in hospitals only – so exposing bacteria to new substances to which they can start becoming resistant.
Antibiotics applied to the skin are widely used in hospitals and can lead to resistant strains rapidly emerging (this is something which has been observed when extensive use of antibiotics are involved in treating burns cases, for example).
It is common for people who spend time in the hospital – staff as well as patients – to become colonized with resistant bacteria, especially in their intestinal tracts (so allowing the bacteria to appear in their feces) and on the skin.
It is all too easy for staff to pass such resistant bacteria around as they touch patients, their beds or their food.
When catheters are used or injections given, previously harmless skin bacteria which may have been modified into disease-causing bacteria can enter through the broken skin, causing infection, sometimes extremely seriously, of the bloodstream.
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Unless scrupulous hygiene is observed, bacteria on the skin or in the feces can become the means whereby outbreaks of highly contagious resistant bacteria can take place in hospitals.
There exist (undetected by routine checks) highly infectious bacteria in hospital air-conditioning units, which can act to spread infection from ward to ward.
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Solutions lie in better hygiene and hospital organization, although to an extent the factors prevailing in these hothouses of disease management cannot easily be altered and solutions need to also involve patient and medical staff education as well as removal of the pressure exerted by drug manufacturers on those who prescribe the drugs.
Summary
Bacteria have developed resistance to antibiotics because of:
natural selection – genetic modification of the bacteria as they defend themselves from chemical assault
inappropriate and excessive use of antibiotics in food production, notably beef, milk and chickens
inappropriate and excessive use of antibiotics in treating humans – as discussed above
poor cooperation by patients (not completing courses of antibiotics, for example)
increased opportunities for cross-infections which allow resistant bacteria to transfer this characteristic to other bacteria, so spreading the pool of resistant microorganisms
increasing existence of unhygienic conditions where cross-infections
