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Antibiotic Prescription

Story at-a-glance -

  • From 2010 to 2011, 262 million people received prescriptions for antibiotics from their physicians—of these, about 30 percent were unnecessary
  • Antibiotics prescriptions for acute respiratory conditions were most often inappropriately prescribed
  • Children aged 2 years and younger were the most frequent recipients of antibiotics prescriptions

Many Prescribed Antibiotics Are Unnecessary and Cause Damage

May 17, 2016 | 29,466 views

By Dr. Mercola

Despite warnings that we’re quickly approaching a post-antibiotics era in which bacterial infections once easily cured by the drugs become resistant and life threatening, doctors are still prescribing too many antibiotics.

The finding comes from the U.S. Centers for Disease Control and Prevention (CDC), which found 262 million people received prescriptions for antibiotics from their physicians from 2010 to 2011. Of these, about 30 percent were unnecessary.

The report, which was published in JAMA, assessed data from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) to estimate the current rate of U.S. antibiotic prescriptions.1

A group of experts then determined whether the antibiotic prescriptions were appropriate based on national guidelines. There were an estimated 506 antibiotic prescriptions per 1,000 population annually, but only 353 of those were appropriately prescribed.2 The researchers wrote:

“Collectively, across all conditions, an estimated 30% of outpatient, oral antibiotic prescriptions may have been inappropriate.”

A 15-Percent Reduction in Antibiotic Use Recommended to Combat Antibiotic-Resistant Bacteria

The White House National Action Plan for Combating Antibiotic-Resistant Bacteria set a goal to reduce at least half of inappropriate antibiotic prescriptions by 2020. In order to meet this goal, the JAMA report found a 15 percent reduction in antibiotics use is needed.

According to the report, antibiotics prescriptions for acute respiratory conditions were most often inappropriately prescribed, and children aged 2 years and younger were the most frequent recipients of antibiotics prescriptions.

Across all age groups, such drugs were most often prescribed for sinusitis, ear infections and inflammation of the throat (pharyngitis). As for why so many unnecessary antibiotics are being prescribed, sometimes doctors do it to appease their patients.

Other times they may be misguided in when the drug’s risks outweigh their benefits. According to the study, “no data suggest worse outcomes … in low-prescribing regions due to undertreatment.”3 Meanwhile, there’s still a great deal of misunderstanding among the public.

A 2015 World Health Organization (WHO) survey found, for instance that one-third of people surveyed believed you should stop taking antibiotics when you start to feel better as opposed to finishing the entire course.4 Stopping early can lead to resistant bugs by allowing stronger bacteria to survive and thrive.

Further, 64 percent of those surveyed believed antibiotics could be used to treat influenza and colds, both of which are caused by viruses, which cannot be killed by antibiotics. As WHO reported, there are also misconceptions about who is at risk of drug-resistant infections:5

“Two thirds (66%) of respondents believe that individuals are not at risk of a drug-resistant infection if they personally take their antibiotics as prescribed.

Nearly half (44%) of people surveyed think antibiotic resistance is only a problem for people who take antibiotics regularly. In fact, anyone, of any age, in any country can get an antibiotic-resistant infection.”

Antibiotic-Resistant Superbugs Kill Millions Every Year in the US Alone

In the U.S., at least 2 million people are infected with antibiotic-resistant bacteria every year, and at least 23,000 die as a result.6 This is already a staggering number, but the problem is slated to get worse.

A 2015 report commissioned by U.K. Prime Minister David Cameron estimated that by 2050 antibiotic resistance will have killed 300 million people, with the annual global death toll reaching 10 million, and the global cost for treatment reaching $100 trillion.

By the year 2030, antibiotic-resistant disease — if left to spiral out of control — is expected to have killed 100 million.7 The problem is that antibiotic’s primary target — bacteria — is smart. Even under the best circumstances, bacteria can eventually adapt to resist and overpower once-effective antibiotics.

In recent decades, however, the overuse and misuse of antibiotics has greatly sped up this process, and we’re now seeing what it’s like to live in a post-antibiotic era.

For instance, from 2013 to 2014, cases of antibiotic-resistant gonorrhea doubled, with rates reaching 0.8 percent. WHO already recognizes drug-resistant gonorrhea as "an emergency," with several countries, including Australia, France, Japan, Norway, Sweden, and the United Kingdom, experiencing increasing infections.

Further, up to 50 percent of pathogens that cause surgical site infections, and 25 percent of those that cause infections following chemotherapy, are already resistant to common antibiotics.8

If antibiotic effectiveness drops by another 10 percent, it could result in 40,000 more infections and 2,100 additional deaths following surgery and chemotherapy each year.

Antibiotics Disrupt Your Gut Bacteria by Creating an Oxygen-Rich Environment

In your gut, beneficial microbes grow in an anaerobic (no oxygen) environment while pathogenic bacteria like salmonella need oxygen to thrive.

One way antibiotics may promote disease is by creating an oxygen-rich environment that favors that growth of pathogens, according to a recent study published in Cell Host & Microbe.9

The study involved the antibiotic streptomycin, which first reduces populations of beneficial microbes in your gut. Among them are Clostridia, which help break down fiber into an organic acid called butyrate.

Cells lining your gut use butyrate as an energy source, but if Clostridia, and thereby butyrate, are reduced, the cells ferment glucose to lactate for energy, and this is what causes an increase in oxygen.

Study author Andreas Bäumler, professor of medical immunology and microbiology at the University of California-Davis, told Medical News Today, "In essence, antibiotics enabled pathogens in the gut to breathe."10

In addition, by killing off the bacteria in your gut, antibiotics have a detrimental effect on your overall immune system, as about 80 percent of your immune system resides in your gastrointestinal tract.

Research published in MBio even found just one course of antibiotics negatively alters your microbiome for up to a year.11 This is precisely why it’s crucial to only use antibiotics when absolutely necessary.

And when you do use them, be sure to “reseed” your gut with beneficial bacteria, either in the form of a probiotics supplement or fermented foods. If you don’t, your immune function, and more, can remain compromised for some time.

Antibiotics in Sewage Sludge

The use of antibiotics is concerning not only on an individual level but on a much larger scale as well.

For instance, in studies of sewage sludge from municipal wastewater treatment plants, which allow researchers to get an idea of chemical exposures on a citywide basis, antibiotics (and other pharmaceuticals) are often apparent. As noted in Environmental Health Perspectives:12

“ … it was becoming clear that … contaminants of emerging concern — those chemicals that are being detected for the first time or in increasing amounts — tend to elude treatment and remain in treated water and sewage sludge, returning to the environment and in some cases accumulating in living organisms, including humans.”

Antibiotics Carry Risks, Including Sudden Cardiac Death

Part of the problem with antibiotics' overuse and misuse is that some people, including even some physicians, assume it can’t hurt to take a course just in case. But many people aren’t aware that antibiotics have a risk of serious side effects.

Macrolide antibiotics (azithromycin (Zithromax), clarithromycin (Biaxin), quinolone, and erythromycin), for instance, increase your risk of sudden cardiac death. In a meta-analysis of nearly 21 million people, the drugs were linked to a small but significant increase in the heart risk.

For every 1 million treatment courses, the use of macrolide antibiotics resulted in an additional 36 sudden cardiac deaths.13 Macrolides are widely used in the treatment of bronchitis, pneumonia, ear infections, and sexually transmitted diseases. Past research has also highlighted their risk of side effects. Azithromycin, for instance, increases your chances of dying from a cardiovascular event by a whopping 250 percent within the first five days of usage compared to taking amoxicillin.14

Industrial Agriculture Is One of the Worst Offenders

While reducing unnecessary use of antibiotics in humans is important, one of the worst offenders is industrial agriculture. Eighty percent of the antibiotics used in the U.S. are used by industrial agriculture for purposes of growth promotion and preventing diseases that would otherwise make their concentrated animal feeding operations (CAFOs) unviable.

In 2011, the Infectious Diseases Society of America (IDSA) issued a policy paper that recommended significant reductions in the use of antibiotics for growth promotion in agriculture.15 In 2015, the federal Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria was created. Part of its role is to evaluate the implementation of the National Strategy for Combating Antibiotic-Resistant Bacteria.

One of the latter’s goals is to slow the emergence of resistant bacteria, which will require “judicious use” of the drugs. According to the National Strategy, “Judicious use of antibiotics in healthcare and agricultural settings is essential to slow the emergence of resistance and extend the useful lifetime of effective antibiotics.”16

By 2020, the plan calls for the elimination of the use of medically important antibiotics for growth promotion in food-producing animals. It also calls for veterinary oversight for use of medically important antibiotics in the feed or water of food-producing animals. But is this going far — and fast — enough?

The U.S. Food and Drug Administration (FDA) has asked drug companies to remove indications for “feed efficiency” and “weight gain” from the labels of their antibiotic products. They also require veterinarians to oversee any addition of these drugs to animal feed and water.

However, no benchmarks have been set to reduce antibiotic use on CAFOs, and there is no system in place to collect data on how agricultural antibiotics are being used. Without any baseline data, monitoring any process toward reduction will be difficult it not impossible.

As it stands, CAFOs remain hotbeds for breeding antibiotic-resistant bacteria because of the continuous feeding of low doses of antibiotics to the animals, which allows pathogens to survive, adapt, and eventually, thrive.

How to Avoid Becoming Another Victim to Antibiotic-Resistant Disease

You can help yourself and your community by purchasing only antibiotic-free meats and other foods and using antibiotics only when absolutely necessary. This is an important step that I urge everyone to take, even though ultimately the problem of antibiotic-resistance needs to be stemmed on a global level. That said, your lifestyle choices are the most critical factors in determining the health of your immune system, which determines your ability to resist infections.

The stronger your immune defenses, the less chance a microbe — antibiotic-resistant or otherwise — will have of gaining a foothold in some part of your body. Below are some basic strategies for supercharging your immune system. You may also want to download my free special report about how to protect yourself from super germs.

Optimize your diet. Avoid foods that tax your immune system such as synthetic trans fats, fried foods, processed foods, sugar and grains; reduce carbohydrates (sugar, grains, fructose) and protein, replacing them with high-quality fats. Fifty to 70 percent of your total intake should be fat.

Most of your diet should be fresh, whole foods, like organic vegetables and grass-pastured meats and dairy, and beneficial fats, such as butter and fermented dairy from grass-pastured animals, cheese, egg yolks, and avocados. A great portion of your immune system resides in your GI tract, which depends on a healthy, balanced gut flora.

One of the best ways to support this is by incorporating naturally fermented foods into your diet, working up to 4 to 6 ounces per day. One large serving of several ounces of fermented foods can supply you with around 10 trillion beneficial bacteria, which is about 10 percent of the population of your gut. You can take a high-quality probiotic supplement, but the actual fermented foods offer the greatest benefit.

Exercise regularly. Exercise improves the circulation of immune cells in your blood. The better these cells circulate, the more efficient your immune system is at locating and eliminating pathogens in your body. Make sure your fitness plan incorporates weight training, high-intensity exercises, stretching and core work.

Get plenty of restorative sleep. Recent research shows sleep deprivation has the same effect on your immune system as physical stress or disease, which is why you may feel ill after a sleepless night.

Have good stress-busting outlets. High levels of stress hormones can diminish your immunity, so be sure you’re implementing some sort of stress management. Meditation, prayer, yoga, and Emotional Freedom Techniques (EFT) are all excellent strategies for managing stress, but you’ll have to find what works best for you.

Optimize your vitamin D levels. Studies have shown that inadequate vitamin D can increase your risk for MRSA and other infections, which can likely be extended to other superbugs. Your best source of vitamin D is through exposing your skin to the sun or using a safe tanning bed. Monitor your vitamin D levels to confirm they’re in the therapeutic range, 50-70 ng/ml. If you can’t get UV exposure, consider taking an oral vitamin D supplement.

In addition to the basic lifestyle measures listed above, there are natural agents that science has shown to be naturally antibacterial. The following deserve special mention.

Vitamin C. Vitamin C’s role in preventing and treating infectious disease is well established. Intravenous vitamin C is an option, but if you don’t have access to a practitioner who can administer it, liposomal vitamin C is the most potent oral form.

For more information on vitamin C, listen to my interview with Dr. Ronald Hunninghake, an internationally recognized vitamin C expert. If you choose to use supplement vitamin C, liposomal C seems to be the best form to use.

Garlic. Garlic is a powerful antibacterial, antiviral and antifungal. It can stimulate your immune system, help wounds heal, and kill antibiotic-resistant bacteria (including MRSA and multi-drug resistant tuberculosis), plus has shown more than 100 other health promoting properties. 17 For highest potency, the garlic should be eaten fresh and raw (chopped or smashed.)

Olive leaf extract. In vitro studies show olive leaf extract is effective against Klebsiella, a gram-negative bacteria, inhibiting its replication, in addition to being toxic to other pathogenic microbes.

Manuka honey. Manuka honey, made from the flowers and pollen of the Manuka bush, has been shown to be more effective than antibiotics in the treatment of serious, hard-to-heal skin infections. Clinical trials have found Manuka honey can effectively eradicate more than 250 clinical strains of bacteria, including resistant varieties such as MRSA.

Tea tree oil. Tea tree oil is a natural antiseptic proven to kill many bacterial strains (including MRSA).18

Colloidal silver. Colloidal silver has been regarded as an effective natural antibiotic for centuries, and recent research shows it can even help eradicate antibiotic-resistant pathogens. If you are interested in this treatment, make sure you read the latest guidelines for safe usage of colloidal silver as there are risks with using it improperly.

Copper. Replacing fixtures with certain copper alloys can help kill bacteria, even superbugs. Installing copper faucets, light switches, toilet seats and push plates in germ-infested areas such as hospitals and nursing homes could potentially save thousands of lives each year.

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