While the opioid addiction epidemic, mental health concerns and cancer prevention are health topics that are often in the news headlines, one health issue receiving attention recently is the increase in antibiotic-resistant strains of bacteria, often referred to as “superbugs.” Superbugs are becoming more prevalent as they adapt to the over-prescription of antibiotics.
According to the Centers for Disease Control and Prevention, one in three antibiotic prescriptions is likely unnecessary. Thanks to Missouri legislation that was passed and signed into law in June 2016, hospitals and ambulatory surgical centers in the state, excluding mental health facilities, are to establish an “antibiotic stewardship program” to evaluate the use of antibiotics, especially antibiotics that are the last line of defense against hard-to-cure, antibiotic-resistant infections. In response to the legislation, Fitzgibbon Hospital has formed a committee to educate staff and the public about the appropriate usage of antibiotics. Committee members include Fitzgibbon Hospitalist Jared Romney, D.O., Gina Glisson, R.N.; Jill DeWeese, R.N./B.S.N., CIC; and Ryan Wetzel, PharmD.
A goal of the committee is to educate the public and help change the expectation that a prescription for antibiotics is the best course of treatment.
“We have bacteria that no longer respond
s to antibiotic medications,” said DeWeese, who serves as infection preventionist at Fitzgibbon Hospital. “That is due to the overuse of antibiotics. We also saw a nationwide rise in bacterial infections from C.diff spores. This occurs when a patient has been on antibiotics for a long time, and the normal bacteria in the gut, which helps in digestion, are also destroyed. The body loses its ability to fight off the C.diff bacteria. This is being called ‘deadly diarrhea.’ Deadly diarrhea is an infection in the digestive, or GI, tract. Patients normally can fight bacteria entering the GI tract without antibiotics because of the healthy bacteria and the presence of stomach acid. However, in individuals whose healthy bacteria in the gut has been decreased due to overuse of antibiotics, their ability to fight off this bacteria is diminished.”
Another factor that inhibits the patient’s ability to fight this deadly diarrhea is the use of medications to decrease stomach acid, according to Glisson, coordinator of Quality Improvement for Fitzgibbon Hospital.
According to the CDC, more than 453,000 cases of Clostridium difficile Infection (C. diff) occur each year in the United States, resulting in 29,000 deaths. C. diff infects humans and other animals. It can cause diarrhea and potentially fatal inflammation of the colon.
“Proton-pump inhibitor (PPI) medications such as Prilosec, Nexium, Prevacid, etc, are designed to lower the amount of stomach acid and are used to treat GERD, or gastrointestinal reflux disease. The challenge, however, is that the presence of stomach acid does kill some of the C. diff bacteria before it reaches the small intestine. If you have less stomach acid, there is a greater risk of there being more C. diff bacteria in the gut over the long term,” said Wetzel, director of Fitzgibbon Hospital’s pharmacy.
“Taking antibiotics while on these types of PPI medications creates a ‘perfect storm’ for C. diff, because you have less good bacteria in the gut, paired with less stomach acid to impact the presence of the C. diff bacteria,” said DeWeese.
The key to effective antibiotic use is to know when the symptoms are actually caused by bacteria which can and do respond to antibiotics.
“About 80 percent of upper respiratory infections are viral, not bacterial. Antibiotics are not going to help someone with a viral upper respiratory infection,” said Wetzel. “When you receive an antibiotic prescription for a viral upper respiratory infection, you are needlessly affecting the good bacteria that are naturally contained in your gut. Another condition that frequently receives treatment with antibiotics is urinary tract infection (UTI). If the positive UTI just showed up in a urine culture, and you do not have any symptoms, that doesn’t mean you need to have an antibiotic to treat it.”
“Another area where we have seen over-prescription of antibiotics is with kids. Frequently a child will get a sore throat, and parents take them to the doctor and request an antibiotic. But truthfully, unless they have Streptococcus (Strep throat) bacteria, they don’t need to be on an antibiotic,” said DeWeese. “We also have learned that ear infections are not typically caused by bacteria, so there is no need to have an antibiotic prescription for ear infections. Managing the pain associated with the earache may be enough.”
Patients should understand that there are various ways of treating common ailments, and the expectations of receiving an antibiotic prescription can actually do more harm than good, in some cases. In the case of a sore throat, for example, a rapid strep test should be used to confirm the existence of bacteria before an antibiotic is indicated. Doctors frequently perform the strep test to confirm their diagnosis and prior to writing out the prescription. The Fitzgibbon Hospital committee’s goal is to educate the community about this important trip to the doctor and to help change the expectations of patients regarding antibiotics. The trip to the provider is vitally important in determining the best method of treatment, which may not always be a prescription for antibiotics.
If you do not have a primary care provider, Marshall Family Practice inside the Fitzgibbon Medical Clinic is taking new patients. Call (660) 886-7800 to make an appointment.