Last week news hit that a strain of E. Coli resistant to colistin was found in a woman suffering from a bladder infection in Pennsylvania. This was notable as colistin is a last-resort antibiotic and these bacteria have become problematic in some areas of Europe and China, but until the announcement last week, it hadn’t been detected within the United States.

Headlines called the bacteria’s arrival a “nightmare” and “the end of the road” for antibiotics, describing a seemingly dire situation. Considering that children are particularly susceptible to infections of all sorts, these headlines concerned parents, but is the level of concern proportional to the risk? To get to the bottom I reached out to Mike Stevens, MD, MPH an infectious disease doctor, epidemiologist and head of an antibiotic stewardship program at an academic medical center.

Before we begin, a point of clarification: Several news outlets and blog posts have cited this bacteria as being Carbapenem-resistant Enterobacteriaceae (CRE) or belonging to that family. The findings in question are not related to CRE.

A reader has asked about the use of antibiotics to treat viral infections. She says she knows that antibiotics won’t help a virus like a cold or flu, but she doesn’t understand why.
Many common infections are due to viruses. Viruses and bacteria both can cause infections, but they’re different structurally. Antibiotics can kill or harm bacteria to help clear an infection from your body. Because, as I mentioned, viruses and bacteria are different structurally, antibiotics will only work against bacteria. If you have a viral infection it will not respond to an antibiotic, and they often resolve on their own. Some antibiotics target many bacteria, some only target a few, so not all antibiotics work against all bacterial infections.

Another reader would like to know how crucial antibiotics are to fighting bacterial infections. She cites the fact that previously her children had been given antibiotics for ear infections, however, her doctor now waits a few days before taking action and the infections clear up on their own.
Many ear infections are actually not caused by bacteria. For ear infections not caused by bacteria antibiotics will not be helpful. Your child’s physician can help determine if he or she has an infection that would benefit from an antibiotic.

How does antibiotic resistance develop?
When bacteria are exposed to antibiotics, but aren’t wiped out they can adapt and become resistant to those antibiotics and this is what we’re seeing now. When they become resistant, they change genetically and some bacteria can easily pass these resistant genes on to bacteria of the same kind or to completely different bacteria.

Antibiotic Resistance

Many are wondering how a bacteria that has seemingly remained an “over there” problem suddenly wound up “over here.”
We’re used to the idea that we live in a highly interconnected world, but that also means that drug resistance that arises in one country will almost inevitably travel to other parts of the world. Antibiotic resistance is a global issue and we need to work together to combat resistance.

Many headlines are calling the establishment of CRE in the United States as a “nightmare” and “the end of antibiotics.” Do you feel this is accurate?
For some pan-resistant bacteria [bacteria that are resistant to all antibiotics] we have already entered the “post antibiotic era.” You could also say this is similar to returning to the pre-antibiotic era. We need to work hard now to preserve the antibiotics we have, prevent the further spread of resistant bacteria and to create new antibiotics.

What is colistin and what does it mean for a bacteria to be resistant to it?
It means that this bacteria is resistant to colistin, an older antibiotic that’s considered one of the antibiotics of last resort. Colistin fell out of use in the 1970s due to its side effects, particularly significant kidney toxicity. Many gram-negative bacteria that are still otherwise completely drug resistant are still susceptible to colistin, which has lead to a revival in the drug’s use in these cases.

You mentioned a return to the pre-antibiotic era, what would this mean?
Antibiotics are miraculous drugs that revolutionized modern medicine, but for context they’ve been in widespread use for less than 100 years. In the pre-antibiotic era ‘simple’ infections could be deadly. We need to act now so that we can continue to benefit from antibiotics moving forward.

What is being recommended to prevent us from returning to the pre-antibiotic era?
This is best done by using antibiotics only when necessary. The best thing parents can do is learn about the safe and optimal use of antibiotics from a trusted source such as the CDC. Parents should ask their children’s physicians about when an antibiotic is indicated and when it’s not, and to avoid antibiotics when they are not medically indicated.

The Review on Antimicrobial Resistance report outlines 10 key focus areas for addressing the antibiotic resistance crisis. It’s estimated that failing to act now to properly steward antibiotics could lead to 10 million deaths per year by 2050 due to antibiotic resistance. We must act now.

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Categories: Infectious Disease + Vaccines, Policy, Politics, + Pop Health