"You don't want to take antibiotics without a physician's advice," says Stuart Levy, M.D., director of the Center for Adaptation Genetics and Drug Resistance at Tufts University. "Don't stockpile them. Don't beg for them. You don't take antibiotics for the common cold."
Taking antibiotics — whether necessary or not — affects the individual and, potentially, others in the community. It changes the mix of microorganisms living in the gut and on the skin, killing sensitive bacteria and giving drug-resistant germs a chance to take hold.
For example, research suggests that taking commonly prescribed antibiotics increases a person's own risk of harboring or being infected with MRSA. Recent or current treatment with antibiotics is the single biggest risk factor for infection with Clostridium difficile — C. diff — drug-resistant bacteria found mostly in health care facilities that can cause severe diarrhea. Conservative estimates link this bacteria to at least 14,000 American deaths a year.
Like any bacteria, resistant bugs can also be passed to household members and others. One study found that family members of an individual taking antibiotics for acne were more likely to have drug-resistant acne germs on their skin.
The CDC estimates that in hospitals, nearly half of all antibiotic prescriptions are inappropriate. "Antibiotics are sometimes given when they are not needed — for example, sometimes patients are admitted to the hospital with a diagnosis of pneumonia and started on antibiotics, but it turns out they have heart failure," according to Arjun Srinivasan, M.D., medical director of the CDC's Get Smart for Healthcare educational program on antibiotic use.
Many hospitals have implemented "stewardship" programs to cut inappropriate antibiotic use and reduce drug-resistant bacteria in the hospital. Studies show well-run programs can have a real effect.
Animals take antibiotics too
Human medicine isn't the only area where antibiotics are too liberally applied. Many cattle, pigs and poultry are given antibiotics, not just to treat illnesses but also to prevent the spread of disease when large populations are kept in confined spaces, and, most controversially, to promote faster growth. Often these drugs are the same as or very similar to those used to treat people.
"It isn't the people or the animals that become drug-resistant," says Gail Hansen, a veterinarian and senior officer of the Pew Campaign on Human Health and Industrial Farming. "It's the bacteria. And we're sharing the bacteria."
One way of sharing the superbugs is by eating contaminated meat. Last year, 136 people in 34 states got sick and one person died after eating ground turkey carrying a strain of salmonella resistant to multiple antibiotics. Farms themselves may also spread the bacteria. Most of the bacteria end up outside the animal, as "poop," Hansen says. "Where does that poop go? It goes in the water. It goes into the soil. The soil dries and it gets aerosolized. Everybody's downwind or downstream from someone else. There's also person-to-animal contact, so farmers and workers and their families can be exposed. It gets all over pretty fast."
It's not clear how much agriculture contributes to antibiotic resistance. But the U.S. Food and Drug Administration recently issued new guidelines that call for a halt to "production uses" of antibiotics in food animals — to enhance growth, for example. Increasingly, experts in antibiotic resistance see the problem as one that's multifaceted, global - and growing.
"Resistance is produced and amplified by the misuse of antibiotics," says Levy. "There are lives being lost. And the solution is to get … antibiotics out of the environment as best we can."
Katharine Greider is a freelance writer in New York who reports on health and science.
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