The existence of antibiotics to treat infections is a relatively new discovery. Fewer than 100 years ago, when someone contracted a bacterial infection, the options for treatment were very limited. Doctors would often recommend amputation of an affected limb to prevent the bacteria from spreading to the brain or other vital organs. When this was not an option, infections that we would consider harmless today could kill quickly and spread to others rapidly.
In 1928, the discovery of Penicillin, which is derived from a fungus that “kills” bacteria by weakening its cell walls, revolutionized healthcare. Soon it was followed in 1934 by Sulfa, which prevents to ability of bacteria to use the essential nutrient folate. These could be considered the greatest medical advancement in history. They helped turn the tides on our fight against bacteria.
According to data gathered by the CDC ( Centers for Disease Control ) the expected lifespan of those born in 1900 was 47 while those born in 2015 have a projected life expectancy of nearly 79. This dramatic increase in life expectancy is can be largely attributed to the discovery, availability and use of antibiotics.
Emergence of Antibiotic Resistant Bacteria
With the great benefits of the systematic antibiotic usage around the world, saving life and limb, also came the development, adaptation and spread of bacteria that were resistant to our methods of fighting bacteria.
How Did These Bacteria Develop?
After the discovery of this medical “miracle”, the medical community’s response was to prevent and treat bacteria where ever it might be found. This overuse, often times when harmful bacteria were not even a real concern, led to the rapid development of mutations. Some bacteria were only exposed to small amounts of antibiotics. Or they were exposed for a short period of time. Through this, the bacteria were able to survive. This is similar to the way that vaccines include small amounts of the virus from which they protect us, so that our own bodies can learn to fight the virus in a harmless and controlled environment.
The Bacteria Life Cycle
In the case of the bacteria, the minute exposure led to their better understanding how to fight back against antibiotics. Bacteria, much like humans, contain DNA, which they pass down to their “offspring”. Similarly to a human mother to child, passing on immune intelligence, so do these bacteria spread this knowledge during bacterial cell division, basically, a bacterium’s method of giving birth.
Staphylococcus aureus (Staph), a very common bacteria, which is present (and typically harmless) on the human skin, hair, noses and throats, demonstrates a resistance to important antibacterials, such as vancomycin ( common IV antibiotic ). And it has become the most frequent medical facility acquired pathogen. The term “pathogen” is a catch all for bacteria, virus and other microorganisms that cause illness.
Despite the similarities, between humans and bacteria, the bacteria life cycle is very different from the human life cycle. The resistant bacteria are able to reproduce quickly and many times in a short period of time, which allows them to adapt very, very quickly. This has led to a striking increase in death and serious illness from pathogens that are contracted after — and not before — a person is admitted into a medical facility, such as a hospital.
The Cost to Patients
These types of infections are incredibly costly. According to JAMA, a well-respected medical journal, the direct cost of these infections is $9.8 billion per year, with infections developing on the surgery site accounting for 1/3 of these infections. In individual cost, which is a bit easier for us to relate to, this amounts to about $46,000 per affected patient. That’s more than most people make annually in most regions of the country.
Despite great measures taken to prohibit the spread of these infections in facilities, the individuals who develop these infections in facilities are then able to spread the infection to hospital staff and other patients. These infections then leak out into the general community as visitors, staff and discharged patients go about their lives.
But in a “Catch 22”, these facilities through their usage of antimicrobials, antibacterials and other prevention measures, are actually furthering the development of new resistant bacteria.
Pharmaceutical Company Response
Almost, as soon as a pharmaceutical company can develop a new effective antibiotic, the bacteria adapt and become resistant. Significant time and money go into the development of new drugs. So this quick adaptation has made the development antibiotics not only not profitable, but a losing proposition as research investments cannot be recouped. Because pharmaceutical companies must make profits to exist, many companies can no longer afford to research antibiotics.
Who to Blame
While we can definitely look to the medical community responsible for managing antibiotics, we all hold a bit of the blame for the spread of antibiotic-resistant bacteria.
- Medical Professionals, including Dental, for many years prescribed antibiotics as a “just in case” measure rather than waiting to see if an infection developed against which antibiotics would be effective and the which the patient’s own immune system would not simply destroy. If a patient had a root canal, they might be prescribed antibiotics just in case an infection developed.
- Ordinary people did not finish their course of antibiotics after they felt better. This led to some bacteria surviving and being adapted. Most of us have done this at some point in our lives, completely unaware of the consequences.
- Patients who went to a doctor for a viral infection — over which antibiotics have no control — were given seemingly harmless antibiotics, as a “placebo”, so they would “feel better” when it was really their own immune systems making them better. If you have ever received antibiotics for the Flu or a Cold, both viruses, you have seen this first hand.
- The meat industry, in an effort to produce cheaper meat, treated animals with antibiotics to prevent infections before they could develop that might add to cost of treating animals who actually became sick.
- Over commercialization of antibacterial products for everyday use, when there is no proof that they are any more effective than hand-washing with regular soap and water.
This is a world wide challenge. The British Society of Antimicrobial Chemotherapy concluded in a review that dental professionals contributed to this spread as well. The American Dental Association, in a survey completed, identified among licensed dentists, a widespread:
- misunderstanding about best prescribing practices
- gross inappropriate prescribing, dosage, usage
- use of antibiotics as a bacteria preventative
Is There Hope?
Research completed in Oslo, Norway is promising. It does indicate that the adoption of “smarter” usage guidelines can reverse the direction that we are going. While the majority of the world was increasing usage, Norway was decreasing usage of antibiotics. And as a result they have little to no existence of the “superbugs” present throughout the rest of the antibiotic using world.
The US Medical Community’s Response
Based upon newer research, and an uphill battle against bacteria, the medical/dental community has revised its method for fighting bacteria to a “wait and see” approach.
The ADA (American Dental Association) issued its official stance that antibiotics are only to be used as a treatment when necessary and not as a preventative.
It is important to understand that antibiotics do not cure patients. They only help our own immune systems more effectively battle the infections by weakening the bacteria in such ways as those described above in the case of penicillin and sulfa.
Antibiotics are very rarely a substitute for a removal of an infected area through surgery ( i.e., removal of affected tooth, drainage of an abscess, scraping/removing necrotic flesh, etc.). 60% of infections can be resolved by the patient’s own immune system once the source of the infection is removed. If the infection has spread beyond a source that can be safely surgically removed, the two methods (minor surgery and antibacterials) may be used together.
It should be noted, that antibiotics do not prevent bacterial infection. In fact, they can even weaken your natural defenses. They destroy our bodies natural balance of microorganisms, primarily, “probiotics”, a “good” bacteria that live in the gut and help us properly break down and absorb nutrients. Without these vital nutrients, our immune systems are weakened, making the patient more susceptible not less.
What to Expect When You Visit Your Dentist
When you visit your dentist with symptoms of a bacterial infection, your dentist will:
- Examine the infection to determine if it is bacterial in nature.
- Evaluate the source of the infection to determine the best course of treatment, which may be allowing your own immune system to do its job. Or, if treatment is needed, then your doctor may drain, extract or cut away infected flesh to allow healthy flesh to take over.
- Consider if antibiotics are needed for the infection either as a stand alone or in conjunction with surgical intervention.
- Wait and see if needed.
Your dentist will not:
- Give you antibiotics as a preventative after a procedure or otherwise.
- Give you antibiotics, so you can “feel better”.
- Give you antibiotics if a minor surgery is a better and safer option for your type of infection.
- Give you antibiotics before your condition can be properly and extensively evaluated.
- Give you antibiotics for infections that your immune system should be able to handle effectively without intervention.
Through re-evaluating how antibiotics are used, we can work together to stop the effects of years of antibiotic misuse. Learning about antibiotic-resistance and educating others about the risks will help support the worldwide efforts to reverse this dangerous trend toward ineffectual tools to fight bacteria. Together we can save lives. If you have any question or concern call us or make an appointment to talk to one of our dental specialists.
- Why are doctors completely rethinking the way they prescribe antibiotics?
- Use and abuse of antibiotics