Flu season will be upon us shortly, and the Infectious Disease Association of California (IDAC) expects an increase incidence of penicillin-resistant streptococcus pneumonia in Southern California this winter.
Streptococcus pneumonia is known to be a prime opportunist during flu season. It prays upon those unable to adequately deal with the flu, causing secondary bacterial superinfections that range from bronchitis and sinusitis to pneumonia and even meningitis. Some of those at risk include individuals with underlying heart or lung disease (including smokers or those with asthma), kidney disease, diabetes, blood disorders, HIV disease, people on cortisone for a variety of disorders, and those over 65 year old.
The day of miracle antibiotics as we know them, for relatively easy conquest of many infectious diseases, is over. Even as you read this, microbes are gaining an upper hand.
The streptococcus pneumonia organism (one of the most common causes of bacterial ear infections, as well as pneumonia and meningitis) has evolved (over the last 30 years) from being a very penicillin sensitive and easy to treat infection into an often resistant form, which is not only resistant to penicillin, but to numerous other antibiotics. In the real world of practical medicine, this phenomenon has been translated into treatment failures and many resultant deaths.
Drug resistance was relatively rare until the 1980ıs. Since then, however, it has increased approximately 1-2% per year (depending on geographic location, local habits of prescription and antibiotic use, etc.). And this is just in the U.S. In other countries, levels of 40% to almost 70% resistance have been reported.
This increase in resistance can be traced directly to the increased use of antibiotics. Indiscriminate use of antibiotics contribute to their loss of effectiveness over time.
The statistics are alarming. According to the Center for Disease Control & Prevention (CDC) in Atlanta, GA, there are approximately 12 million cases of ear infections per year. There are also 500,000 cases of pneumonia and approximately 40,000 deaths per year, all due to this organism. In the U.S., levels as high as 16% resistance to one or more of the antibiotics tested against pneumococcus have been found, including significant resistance to penicillin (7%), erthromycin (6%), as well as newer third generation antibiotics.
Again, indiscriminate use of antibiotics can induce resistance. Bacteria have an ability to resist antibiotics not only through mutation (along the lines of Darwinıs survival of the fittest through generations), but also through mechanisms that directly transfer genetic material (episomes) with inherent resistance between various other and often unrelated bacteria. This means that a pathogenic (disease producing) bacteria, generally susceptible to a given antibiotic, may acquire resistance and create treatment failures, even when never exposed to that drug previously. If this trend continues, doctors will not know which medications to use, nor when and how to use them, because results will be unpredictable.
Antibiotics are over prescribed and should be used judiciously. Antibiotics are only one type of ammunition in the war against an ever-changing and alert enemy. So, indiscriminate use of antibiotics wastes valuable bullets, both individually and on a global scale.
It is important that patients and their physicians use antibiotics carefully and appropriately to maximize antibiotic effectiveness over the long-term. If possible, use vaccination to prevent the need for antibiotic therapy. In the case of streptococcus pneumonia, there is a vaccine. If you are at risk, get it now, well-ahead of flu season.