Antibiotics- What Goes Wrong if not Used Properly

Antibiotics:

What Goes Wrong if not Used Properly

Antibiotics are the most popular prescriptions but the most poorly understood.

They do tremendous good, but when used inappropriately, they cause much more harm than people know.

And, by people we mean families and doctors.

In fact, so many doctors prescribe so many antibiotics inappropriately that the CDC a few years ago began looking into restricting the ability of doctors to prescribe them.

Most of us appreciate the tremendous power of antibiotics to help, but what is the story of how they can hurt?

What is an antibiotic?

An antibiotic is a medication that can kill bacteria without killing our own human cells.

The key word in that sentence is the word bacteria.  

Antibiotics kill bacteria, not other germs such as viruses, fungi, and parasites.

What is the difference between bacteria and other germs?

There are four types of germs that cause infections:  Bacteria, fungi, parasites, and viruses

Bacteria

Bacteria are single-celled organisms that live by eating nutrients in their environment, and in the case of bacteria that cause infections in us, by eating our cells.   When bacteria infect, their eating usually creates pus.  Bacterial infections not only feature pus, but higher fevers, and often more serious and feared infections, such as bacterial pneumonia, bacterial meningitis, and various abscesses.   

The most common and minor bacterial infections are the very familiar and usually harmless strep throat and ear infection.  Bacteria also cause urinary tract infections which also tend to be harmless.

Bacteria are killed by antibiotics, and can cure these infections.

Fungi

Fungi are also single-celled organisms but can grow in complex branching forms that join many fungal cells together.  Healthy people do not get internal fungal infections normally.  For most healthy people the only fungal infections are surface infections and include ringworm, yeast infections, and oral yeast infections in infants (thrush).  These infections involve the fungi only eating dead cells that line the outer levels of the skin and mouth.  They create scaly rashes, fuzzy white plaques in babies' mouths, red rashes in the diaper area, but not pus.

Fungi are not killed by antibiotics, and antibiotics cannot cure these infections.

But there are other medications, related to antibiotics, called anti-fungals that can cure these infections.

Parasites

Parasites are single-celled organisms that are more complex cells.  Like fungi, in healthy people, most parasitic infections take place on the outside of the body.  Keep in mind the inside hollow tube of our gut is outside our body.  Think about what happens if you swallow a penny, you pass it through your gut and poop it out, and so it never enters your body.   The most common parasites that cause infections are lice, pinworms, and giardia.  Each of these never really enter our body, our bloodstream.

Parasites are not killed by antibiotics, and antibiotics cannot cure these infections.

But there are other medications, related to antibiotics, called anti-parasitics that can cure these infections.

Viruses

Viruses are a totally different type of germ than any of the above three.  All the germs listed above are made our of different types of cells that live on their own, and live by eating material and/or cells around them.  Like all animals and plants they eat, reproduce, and eat and reproduce.

But viruses are so, so different.   A virus is a bit of genetic material inside a coating of protein.  That's it.  Viruses never eat.  And without a cell to infect, they cannot reproduce, ever.

The way viruses work is very simple, and is described as a two step process:

1.  Their protein coat contains codes that allow the virus to enter their target cell.

2.  Once they have cracked the code to get in, the genetic material in the virus takes over the DNA in the target cell, forcing it to make all new viruses, and tons of them.   

Together, these two steps lead one virus to create millions more, usually popping the cell and leading to millions more cells getting infected and destroyed.

That's the incredible biology of viruses.  But there are some other very important points to be made about them:

1.  In infants, children, adolescents, and young adults, viruses cause the overwhelming majority of infections. 

Think about the main viral infections we experience:  colds, flus, stomach flus, viral fevers and rashes.  About 70-90% of all fevers in childhood are due to viruses.

2.  These most common viral infections are miserable, but harmless.  Everyone gets viral infections, no exceptions.  And in a healthy population of young people, such as we have in the US, viral infections come and go without causing any permanent harm.  Consider the most common viral infection- the common cold.  If it does not lead to any complications, such as bacterial pneumonia, and remains a cold, essentially everyone recovers without any harm long term at all.

3.  All viral infections often cause aches, pains, fever, and lots of inflammation and mucus, but not pus.  Again think about viral colds, they cause aches, pains, fever, and lots of mucus, but no pus.  The runny nose always starts with clear mucus and ends with yellow and white mucus, but there is no pus.

And, in regard to antibiotics, they are useless against viruses, they simply do not kill them, or even slow them down.  They do nothing to viruses or the infections they cause.

Of all the germs listed above, we have the fewest medications for viruses.  A tiny number of viruses have some medications that can kill them, such as the antiviral medication acyclovir to kill the herpes virus.  There are no such medications whatsoever that have any impact on the viruses that cause the common cold and stomach flus.  There are some medications that kill the influenza virus, but they have limited impact and can cause seizures in children.

But when it comes to the antibiotics, they have no impact on viruses at all.

What's the big deal about using an antibiotic in a viral infection?

The big deal is that right now, about 23,000 Americans die every year from the use of antibiotics used for viral infections.   This is comparable to the number of Americans who die every year from guns and cars (about 30,000 each).

Many people wonder, it's one thing to use an antibiotic for a viral infection knowing it won't work.  But how could using an antibiotic that doesn't work lead to harm, particularly someone dying?

The way that happens is explained in one word:  resistance.

This brings us back to bacteria.  Every time we use an antibiotic, remember that's a medicine whose only purpose is to kill bacteria, the clever bacteria get another chance to find a way to neutralize the antibiotic.

Consider what was once the most common antibiotic ever used:  penicillin.   After many years of use, all but one bacteria have figured out how to not be killed by penicillin.   The only exception is the strep germ of strep throat fame, it has never failed to be killed by penicillin, but so many bacteria in our mouths neutralize penicillin, that the strep germ can at times be protected.

So each use of antibiotics gives bacteria a chance to evolve a way to neutralize them.   The other part of the story of resistance comes in another key word: volume.

If doctors and families only used antibiotics to kill viruses a total of once a year, bacteria could learn to neutralize them, but it would be extremely unlikely.  But consider of millions of people take antibiotics every day when they only have a viral infection, now unlikely turns to certain.   And that is precisely what happens.

So many millions of people have colds and so many of them get antibiotics, that bacteria have millions and millions of chances to learn resistance, chances they should never have.

The result is that we are experiencing a dramatic epidemic of bacteria learning to laugh at all our antibiotics, creating germs that can infect us that cannot be killed or cured, opening the door to a huge rise in dangerous infections that cannot be treated.  This is how use of antibiotics for colds is right now killing 23,000 of us a year.

The example of viral pink eye

Few completely harmless infections cause more fear and anxiety than viral pink eye.   Pink eye is condition in which our eyes get red, make extra tear or mucus, and become uncomfortable.  There are three main causes of pink eye:

1.  Viral pink eye- this is exceedingly common during cold season.  Viral pink eye is in fact, the manifestation of a cold in the eye.  Just like colds in the nose cause the lining of the nose to get swollen and sore, and make loads of mucus, colds in the eye cause the lining of the nose to turn red (hence "pink eye") and make lots of tears and mucus.   In the morning the mucus can accumulate from overnight and cause the eyes to be swollen shut and matted with dried mucus, but there is no pus. There is no drug that can help or treat viral pink eye.  Antibiotic eye drops have no impact on viral pink eye.

2.  Allergic pink eye- this is exceedingly common during allergy seasons.  Allergic pink eye is like hay fever in the nose.  In both cases there is itch and mucus.  Red, itchy eyes, with some mucus during allergy seasons associated with nasal hay fever troubles is most likely allergic pink eye.  This form is treatable with antihistamine, by oral route or eyedrop.

3.  Bacterial pink eye- this is the least common form of pink eye, and the only one with pus.  Bacterial pink eye causes lots of pus, not just mucus, to form, usually overflowing the eye.  It is the only form of pink eye that antibiotic eye drops do anything at all.

Now, here it gets very interesting and worrisome.  It has been determined that if we use topical antibiotics for children with a cold in the eye, we will be giving millions of people antibiotics that have no benefit, and it has been shown that very dangerous bacteria, like MRSA, start to appear.

MRSA is a form of a dangerous bacteria, Staph, that can no longer be killed easily with common, or most, antibiotics.  Now imagine, if doctors and families agree to the use of antibiotics for simple viral pink eye, the nation becomes exposed to potentially deadly bacteria.

BOTTOM LINES

1.  Antibiotics are medicines that kill bacteria.

2.  Antibiotics do not kill any viruses, cure no illnesses caused by viruses, help no one with a viral infection in any way.

3..  The vast majority of infections in infancy and childhood are caused by viruses, including pink eye.

4.   Not only is the use of antibiotics in viral infections useless, but it causes about 23,000 Americans to die every year for no reason aside from our misguided habits.

Putting it all together, this is why we at Advanced Pediatrics will always let you know when it is clear that your child's infection is a virus, and will explain why use of antibiotics is not only not helpful, but could end up hurting someone we all care about.  We also appreciate that when any child is ill, the need for a solution is urgent and pressing, but we know that families ultimately want to avoid treatments that do no good and cause real harm.  Perhaps one day we will have a medicine that kills and cures the common viruses, safely and effectively.

To your health, 

Dr. Arthur Lavin

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