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Sage Ross via Wikimedia Commons // CC BY-SA 3.0
Sage Ross via Wikimedia Commons // CC BY-SA 3.0

Why Leftover Antibiotics Are a Problem

Sage Ross via Wikimedia Commons // CC BY-SA 3.0
Sage Ross via Wikimedia Commons // CC BY-SA 3.0

Public health is a tricky, tricky beast. People don’t like being sick, but they also don’t like being told what to do. And in an age of bankruptcy-inducing medical bills, many people just can’t afford to see a doctor. Those three factors combined can lead to a dangerous choice: taking leftover antibiotics at the first sign of a cough or cold. One-quarter of participants in a recent study said they have, or would, self-prescribe antibiotics without getting a diagnosis first. The study results appear in the journal Antimicrobial Agents and Chemotherapy.

The more antibiotics we use, and the more irresponsibly we use them, the closer we push ourselves to an age of completely drug-resistant bacteria, in which today’s common, easily treated infections could once again become lethal.

Yet for all our concerns about the bacterial apocalypse, there’s been very little research into antibiotic misuse in American homes, and the studies that have been conducted focused on immigrants from Latin-American countries. To sample a broader range of people, scientists in Texas surveyed 400 patients in the waiting rooms of three walk-in clinics. Respondents were asked about their antibiotic use in the last year, how they got their antibiotics, and whether they would take, or had taken, the drugs without getting a diagnosis and prescription first.

At first blush, the results seemed promising. Just 5 percent of respondents (20 people) reported self-prescribing antibiotics in the last year. But 25 percent said they would self-prescribe, and 14 percent said they kept a supply of the drugs at home. And those are just people who admitted doing it, the authors say. "Respondents might deny practicing self-medication," they write, "especially if aware that this is inappropriate behavior and if interviewed in a health care setting."

People got their drugs from pharmacies, friends, family members, and in some cases even took their pets' antibiotics. But 74 percent of respondents’ medication stashes were left over from their own unfinished prescriptions.

All of this is bad news for three primary reasons. First, we are prescribed a certain number of antibiotic doses for a reason: to knock out every single bacterium that’s making us sick. You might start to feel better before your prescription runs out, but that doesn’t mean the harmful bacteria are all gone. When you start, but don’t complete, a course of antibiotics, the surviving pathogens are much more likely to become drug-resistant.

Second, unless you have a medical degree, you might very well be misreading your symptoms. A doctor visit and new prescription, when necessary, is the best way to ensure you’re not overlooking something more serious.

Third, antibiotics only work for bacterial infections, not viruses, and most of us don’t know whether our symptoms are being caused by bacteria or a virus. Corresponding author Larissa Grigoryan of Baylor College of Medicine said we’re far too eager to drug ourselves up. “The most common conditions patients reported self-treating with antibiotics were sore throat, runny nose, or cough,” she said in a press statement, “conditions that typically would get better without any antibiotic treatment."

And even if that illness is bacterial, it’s not like the drug your brother’s doctor prescribed for his skin infection can cure your UTI. “Lay people don't know which antibiotics cover which pathogens,” Grigoryan says, "and for how long should they use them."

The bottom line: Ease up on the antibiotics. If you think you have an infection, see a doctor. If that doctor doesn't prescribe you antibiotics, trust that they have a very good reason. (And for Pete’s sake, don’t swipe your dog’s medicine. Come on.)

Know of something you think we should cover? Email us at tips@mentalfloss.com.

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5 Ways a Post-Antibiotic Era Could Change Medicine
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For the first time ever, this month the United Nations General Assembly convened a high-level meeting on the topic of antibiotic resistance. At the meeting in Geneva, members committed to develop action plans to reduce antibiotic use.

The urgency for this rare meeting stems from news over the last few months, when we've seen the emergence of resistance to the antibiotic colistin in humans and pigs in the U.S. Colistin, an old drug, is one of our “last resort” antibiotics. Physicians have been reluctant to use it because it can be toxic, and because of their restraint, resistance to the drug hasn’t historically been much of an issue in people. But while its use was rare in the U.S., it was commonly used in agriculture in China. Resistance genes ended up on a plasmid (a piece of DNA that can “jump” between bacteria species) and due to travel and trade, is now in the U.S. This is alarming, as once resistance to an antibiotic evolves, we know it can spread very quickly.

Colistin resistance is far from our only problem. There are now many common bacteria already resistant to antibiotics or carrying a resistance gene that may jump between other bacterial species. Antibiotic resistance leads us to a cornucopia of abbreviations: MRSA, VRE, NDM-1: bacteria that are resistant to antibiotics (methicillin-resistant Staphylococcus aureus; vancomycin-resistant Enterococci) or carry a resistance gene that can jump between bacteria species (NDM-1), like the colistin resistance gene can (abbreviated MCR-1). Even gonorrhea infections are becoming untreatable. A report released earlier this year suggests that by 2050, antibiotic-resistant infections will kill more people each year than cancer.

The bottom line is that we’re losing our last effective antibiotics, and it will change the way medicine is administered in the future.

It can be hard to visualize the enormous impact antibiotic resistance will have, so here are five ways antibiotic resistance might change your life.

1. A SCRATCH COULD BECOME DEADLY.

Infectious disease journalist Maryn McKenna wrote about her great-uncle’s death at age 30, in 1938, five years before antibiotics became widely available. “Through one of the scrapes, an infection set in. After a few days, he developed an ache in one shoulder; two days later, a fever. His wife and the neighborhood doctor struggled for two weeks to take care of him, then flagged down a taxi and drove him fifteen miles to the hospital in my grandparents’ town. He was there one more week, shaking with chills and muttering through hallucinations, and then sinking into a coma as his organs failed. Desperate to save his life, the men from his firehouse lined up to give blood. Nothing worked.”

Though this was 80 years ago, this scenario could become common again. As the available drugs fail, any breach of the skin could once again result in a deadly, untreatable infection. Something as simple as gardening or getting a tattoo could be fatal.

2. MINOR ILLNESSES WON'T BE MINOR ANYMORE.

Infectious disease physician and researcher Eli Perencevich tells mental_floss, “The post-antibiotic era will be your sister or mother dying of a urinary tract infection or your brother dying of a simple appendicitis. But I can't offer a description of life cut short quite like Alfred Reinhart’s death."

As a medical student at Harvard, Reinhart had survived a bout of rheumatic fever at age 13, leaving him with a chance of developing rheumatic heart disease later in life. He was also concerned about the potential to develop a bacterial infection in his heart—which he tracked by keeping close watch on his own symptoms during his time in medical school. He meticulously documented his irregular heartbeats, heart murmurs, and faint skin rashes for months, telling his own doctors he was going to die. He continued to take notes on himself until two days before his death at age 24 from subacute bacterial endocarditis following rheumatic fever.

"Both conditions would be prevented or treated with antibiotics only a few short years later,” Perencevich says.

3. SURGERY WOULD BECOME NEARLY IMPOSSIBLE.

Even now, infections occur after 1 to 3 percent of surgeries. Most of these are still treatable with antibiotics, but about 3 percent still lead to death. Even surgeries many consider “routine” now could easily become complicated without antibiotics, such as Caesarean sections or knee replacements. Infectious disease physician Judy Stone tells mental_floss, “Joint replacements, which are now routine, would be enormously risky. Without effective antibiotics, 40 to 50 percent of patients undergoing hip replacement would develop infections, and approximately 30 percent would die.”

Something like a bone marrow or organ transplant, where the host’s immune system must be compromised to accept the new tissue, would no longer be possible at all; the risk of an untreatable infection would be too high. Stone notes this trend has already started. “I already regularly see men who develop sepsis following prostate biopsies," she says. "They are routinely given Cipro as antibiotic prophylaxis by their urologist, and the bacteria causing their bloodstream infections are now often resistant to Cipro.”

And “elective” surgeries, such as most cosmetic procedures? Forget about it.

4. ANTIBIOTICS COULD BE RATIONED OR ONLY AVAILABLE TO THOSE WITH MEANS.

It may sound far-fetched, but we’ve seen in recent months how easily critical medicines—EpiPens, insulin, treatments for HIV-associated infections, even acne creams—can quickly become financially out of reach. Because antibiotics are “community drugs”—use in anyone can affect how well they work in the whole population—as we find ourselves with fewer and fewer options available for treatment, the few remaining drugs may become strictly rationed—and expensive.

5. IT'S ALREADY HAPPENING.

In many developing countries, deaths from antibiotic-resistant infections are already far too common. In 2015, approximately 1.8 million people died of tuberculosis—in part because drugs weren’t available, and in part because their drugs did not work.

The grandfather of antibiotics, Alexander Fleming, famously predicted in his speech for the 1945 Nobel Prize in Physiology or Medicine, which he received for his discovery of penicillin, that in the future, penicillin might be misused and rendered ineffective. He was all too correct. By 1950, 40 percent of Staph bacteria found in hospitals were already resistant to penicillin.

Now, we have an almost impossible task ahead of us—to preserve the antibiotics we still have by using best prescribing practices in hospitals and clinics, reducing unnecessary use in livestock, and working to develop novel ones before it’s too late.

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Sick Ants Take Medicine, Too
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Humans aren’t the only animals who have learned to fight off infections with medicines. In a study that will be published in the journal Evolution, researchers from the University of Helsinki report that ants who come into contact with a harmful fungus then seek out foods that fight infection. 

The researchers observed 400 ants, some of whom had been exposed to a disease-causing fungus. All the ants had access to an eggy food the scientists had laced with hydrogen peroxide, a reactive oxygen species (better known as free radicals). Those who had been exposed to the dangerous pathogen took the peroxide-laced food, while uninfected ants didn’t go for it at all. 

Reactive oxygen species are harmful to healthy ants, but when the ant was already been exposed to the fungus, the cellular destruction associated with the fungus became a worthwhile trade off, since it also damaged the fungus cells. The fungus-exposed ants preferred the peroxide food before and after developing infections, and eating it increased their survival chances by 30 percent. 

[h/t: Scientific American]

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