Beware of the Bewildering Bug

As of January 1, 2017, the U.S. Food and Drug Administration (FDA) has implemented new regulations concerning the use of antibiotics in livestock feed. Prior to this date, farmers could add antibiotics to water and feed to promote livestock growth in addition to treating infectious disease. This indiscriminate and widespread use of antibiotics also consumed by humans has contributed to the emergence of antimicrobial resistance in many bacterial species. The more bacteria are exposed to antibiotics, the more likely a strain will undergo a mutation that results in that strain becoming resistant to the antibiotic, rendering the therapeutic agent useless. The resistant strain then grows unimpeded and spreads to other hosts until eventually the resistant strain becomes the dominant form and treatment options are diminished.

Under the new regulations, the use of antibiotics strictly to promote growth are prohibited. Livestock owners are now required to obtain a "veterinarian feed directive" (the agricultural equivalent of a doctor's prescription) from a licensed vet to add antibiotics to feed or water to treat or prevent infectious diseases. While this new regulation will decrease use of antibiotics to some extent, the latter allowance represents a major loophole. In human patients, antibiotics are rarely used in a preventive fashion. Examples include persons with a history of heart valve disease who are given antibiotics prior to a dental procedure because bacteria in the mouth can enter the bloodstream and then cause damage to the vulnerable valves, or individuals who have had their spleen removed, and are at high risk of certain bacterial diseases, take antibiotics daily to prevent infection. But under the new FDA regulation, use of antibiotics to prevent disease in livestock can be implemented broadly, thus, preventing the emergence of antibiotic resistant strains will be limited compared to a practice of administering antibiotics only for treatment of infectious diseases.

One of the first significant antibiotic-resistant pathogens to humans was methicillin-resistant Staph aureaus (MRSA), which commonly causes painful skin infections, but may also spread into the bloodstream leading to sepsis, an often fatal condition marked by dangerously low blood pressure and vital organ failure, or pneumonia. MRSA has been developing resistance to other antibiotics, thus limiting therapeutic options. Many types of bacteria are now resistant to one or more antibiotics, making infections difficult to treat. Penicillin, the first mass produced and widely used antibiotic, is now ineffective against most bacterial strains. During my Master's of Public Health degree program, my senior project was on the treatment of Multi-Drug Resistant Tuberculosis, and my area of concentration was the epidemiology of infectious diseases. To further educate readers about the dangers and dynamics of indiscriminate antibody use, here is a passage from my book: The Lost Son: A Rock 'n' Roll Road to Redemption:

A mother brings her screaming child into a doctor’s office and frantically states that he/she has a fever, cough, runny nose, etc. The physician diagnoses an upper respiratory infection and explains to the mother that her tot has a viral illness that will run its course with or without antibiotics. The mother, while unsuccessfully attempting to still her ill child, refuses this course of action. She did not take off work, arrange child care for her other kids, and trudge to the doctor’s office to sit in the waiting room for nearly an hour, only to be advised to simply give the child “Tylenol and plenty of fluids.” She demands an antibiotic. While the physician knows full well that an antibiotic will have little or no effect on the progress of the illness, and in fact, could lead to side effects, or even worse, development of a drug-resistant strain, the hour is getting late, ten more patients remain to be seen in the office, and he or she has yet to check up on a patient who was admitted to the hospital earlier in the day. Rather than explain the cold, hard pathophysiology of upper respiratory infections or the very real dangers of antibiotic resistance, the physician does the easy thing: writes out a prescription for an antibiotic and sends the mother home satisfied. Considering that this scenario plays out hundreds of times every day in this country alone, it should not be a surprise that antibiotic resistance is growing.

I defer to the wisdom of veterinarians and FDA experts concerning the regulation of antibiotic use in livestock feed, but as for humans, I plead to all: Be smart, get educated, and reserve the use of antibiotic treatment for infections when they are absolutely necessary, otherwise bacteria may develop resistance to yet another antibiotic, scratching one more cure off the list and leading to the emergence of superbugs with no available treatment and inevitable death to the infected.

#antibiotics #infectiousdisease #antimicrobialresistance #MRSA #epidemiology #superbug #TheLostSon

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© 2017 by Peter McNeela.