Antibiotic Resistance: Causes and Consequences

7808465302_c3b85c86c4_zImage by Iqbal Osman via Flickr (Creative Commons License)

Each year, about 2 million people in the United States become infected with bacteria that are resistant to antibiotics, and more than 20,000 people die from these infections, according to the Centers for Disease Control. Antibiotic resistance occurs when bacteria are no longer killed by the antibiotics that doctors use to treat infection. Recently, President Obama has proposed doubling government funding to address this serious problem.  

Although there are many factors that contribute to this problem, we have learned that overuse of antibiotics can facilitate the development of resistance in bacteria.  The way this works is straightforward: Antibiotics will kill susceptible bacteria, but bacteria that have mutations that allow them to survive in the presence of these drugs will then have an advantage, and can multiply and spread.  (Interestingly, most of the antibiotics in this country—70 percent—are used in animals. Still, the antibiotics unnecessarily prescribed to humans do their part in increasing the resistance that makes these drugs ineffective.)

We certainly would benefit if researchers could develop new antibiotics and new treatments for infection.  But is there anything that doctors and patients can do about the problem of antibiotic resistance? The answer is yes. Although antibiotics continue to be life-saving drugs when used judiciously, there is no question that the inappropriate use of these drugs can be reduced. 

Take, for instance, viral infections. Patients with infections that are caused by viruses will not benefit from taking antibiotics—for antibiotics treat bacterial infections exclusively.

The most common types of viral infection seen by doctors are upper respiratory infections, such as bronchitis or sinusitis. Patients with acute bronchitis will complain of cough that may be productive of phlegm. But even though acute bronchitis is almost always caused by viruses, about 60 to 90 percent of patients with bronchitis who see a doctor will be given a prescription for an antibiotic. The majority of these prescriptions are unnecessary.

Similarly, patients with sinusitis (who may complain of headache, runny nose, nasal congestion, post-nasal drip) also are likely to be suffering from a viral illness. Bacterial sinusitis can develop after a viral sinus infection, but only in a small minority (generally less than 2 percent) of patients.

Patients with bronchitis or sinusitis caused by a viral infection will benefit from rest, increased fluid intake, and over-the-counter medications that can make them feel more comfortable.  For these patients, the immune system will fight off the infection within approximately a week without any specific treatment.    

So why are patients with viral infection given a prescription for an antibiotic? There are many reasons. First of all, many patients and doctors mistakenly believe that early treatment with an antibiotic will shorten the course of illness. For some patients and doctors, there is an expectation that a prescription will be written at the conclusion of a doctor’s visit.  Unfortunately, some doctors find it easier and more time-efficient to prescribe an antibiotic than taking the time to explain to the patient why he or she does not need one.

Whatever the reason for the unnecessary prescribing of antibiotics, we can do better. Since approximately three-quarters of all antibiotic prescriptions written by doctors are for the treatment of upper respiratory infections (most of which are viral), it is clear that patients and doctors could do more to limit the use of these drugs and therefore reduce the problem of antibiotic resistance. Limiting unnecessary antibiotic use can also reduce the potential for adverse side effects for some patients who take them.

As always, it is important to discuss your underlying medical condition and your symptoms with your doctor, because there are illnesses that do require prompt treatment with antibiotics.  But in many instances, avoiding antibiotics will not only save you a trip to the pharmacy but can also increase the chances that an antibiotic will help you when you really need it!


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