The advent of penicillin use in 1928 was a turning point in medical history and marked the first time physicians could cure deadly infectious diseases. Antibiotics greatly reduced illness and death from infectious diseases. However, these drugs have been used so widely and for so long that the bacteria these drugs are designed to kill have adapted to them, making the drugs less effective. Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections.[i]
Antibiotic resistance has been called one of the world’s most pressing public health problems. In response, in March 2015 the White House announced the National Action Plan for Combating Antibiotic-Resistant Bacteria, which was developed by an inter-agency task force and doubled the amount of Federal funding for combating and preventing antibiotic resistance to more than $1.2 billion.[ii]
Understanding Antibiotic Resistance
Every time a person takes antibiotics, sensitive bacteria are killed, but resistant ones may be left to grow and multiply.[iii] Bacteria can develop ways to fight off antibiotics by:
- preventing antibiotics from reaching their target cells (e.g., changing the permeability of cell walls or pumping the drugs out of the cells);
- changing the structure of target cells or entirely replacing them;
- or producing enzymes that destroy antibiotics.
When bacteria undergo these changes, they no longer respond (are susceptible) to antibiotics, hence they are resistant.[iv]
As more and more antibiotics are used globally, the resistance to common antibiotics worsen. We all contribute to infections becoming tougher to treat because we pass around antibiotic-resistant infections.[ii] Repeated and improper uses of antibiotics are the primary causes of the increase in drug-resistant bacteria.[ii] When antibiotics do not work, infections often last longer, cause more severe illness, require more doctor visits or extended hospital stays, and involve more expensive and toxic medications.[ii]
Treating the Older Patient
Infectious diseases that are typically treated with antibiotics account for one-third of deaths in older adults.[v] Urinary tract infections (UTIs) are the most common infection in this population, but pneumonia is the most deadly. An estimated 90 percent of deaths resulting from pneumonia occur in people 65 years and older.[vi]
Community acquired bacterial pneumonia (CABP)—pneumonia not caught in a hospital or institutional setting—is the most frequently treated infectious disease in the U.S. and one of the most serious[vii]; In the US, an estimated 5 to 10 million cases of CABP are diagnosed annually and as many as 1.1 million patients are hospitalized each year.[viii]
Older adults are at greater risk for pneumonia as well as its more severe complications than younger people.[ix] Rebounding from a severe infection takes a toll on older adults. Many who survive pneumonia experience a significant multi-symptom illness with long recovery periods to regain their baseline health and productivity.[x]
Macrolides, like azithromycin or clarithromycin, are antibiotics that are used to treat respiratory tract infections. Even though many strains of Streptococcus pneumoniae, the primary cause of pneumonia, are resistant to most macrolides, this class of antibiotic remains among the most commonly prescribed class of antibacterial drugs for pneumonia. Fluoroquinolones have also seen a swell in resistance develop since they have been widely overprescribed. The increasing prevalence of resistance to penicillin and other drugs among pneumococci has considerably complicated the empirical treatment of community-acquired pneumonia and other infections.[xi]
New antibiotics are being developed, though.[xii] One of these, solithromycin, has the potential to treat pneumococcal pneumonia, including antibiotic resistant cases of the disease, and is being studied for both oral and intravenous administration.
As important as knowing when to treat is recognizing when antibiotics won’t work. Many other common infections in older adults, such as flu, herpes zoster (shingles) and chronic colonization with MRSA are not treatable with antibiotics.
Protect Yourself and Your Community
You can prevent the spread of disease in your family and in your community by getting vaccinated against the most common infections. Not only does vaccination protect the patient, but it also protects those people who cannot be vaccinated (for many reasons) and are vulnerable to illness. Vaccines are available for the flu, pneumonia, and herpes zoster (shingles).
Because we know that bacteria will figure out a way to become resistant to any antibiotic we develop, we must maintain careful antibiotic stewardship and only take these drugs when absolutely necessary. You should always take them as prescribed and complete the whole course. Antibiotics don’t work for every ailment, and there are a lot of side effects that may occur, such as diarrhea and nausea.
Here are some other ways you can protect your health and help protect and prolong the effectiveness of our antibiotic supply:
- Always practice good hygiene, like washing your hands and coughing/sneezing into your elbow.
- Stay home when you are sick, especially if you will be around babies or people with compromised immune systems.
- Educate others and make sure you and your loved ones are following doctor’s advice.
Elizabeth Cerceo, MD, FACP, is an Assistant Professor at the Division of Hospital Medicine and the Associate Program Director of the Internal Medicine Residency at Cooper Medical School of Rowan University.
[i] Antibiotic Resistance (http://www.cdc.gov/drugresistance) [ii] The White House (https://www.whitehouse.gov/the-press-office/2015/03/27/fact-sheet-obama-administration-releases-national-action-plan-combat-ant) [iii] Get Smart: Know When Antibiotics Work (http://www.cdc.gov/getsmart/community/about/fast-facts.html) [iv] How Antibiotic Resistance Happens (http://www.pewtrusts.org/~/media/legacy/uploadedfiles/phg/content_level_pages/issue_briefs/antibioticresistancepdf.pdf) [v], [vi] Common Infectious in Older Adults (http://www.aafp.org/afp/2001/0115/p257.html) [vii] Cempra Investor Information Sheet (http://www.cempra.com/CEMP%20-%20fact%20sheet%20FINAL%2012%208%202014.pdf) [viii] Freeman MK. US Pharmacist. 2013 [ix] Community-acquired pneumonia in elderly patients (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2917114) [x] Observational longitudinal study of symptom burden and time for recovery from community-acquired pneumoniareported by older adults surveyed nationwide using the CAP Burden of Illness Questionnaire (http://www.ncbi.nlm.nih.gov/pubmed/26257528) [xi] Treatment of drug-resistant pneumococcal pneumonia (http://www.ncbi.nlm.nih.gov/pubmed/12127352) [xii] Race Against Time to Develop New Antibiotics (http://www.who.int/bulletin/volumes/89/2/11-030211/en/)