The dangers of antibiotics

    These lifesaving drugs are being misused and might stop working if we don't take important precautions now

    Published: March 2014

    The drugs we have relied on for 70 years to fight bacterial infections—everything from infected cuts to potentially deadly pneumonia—are becoming powerless. Why? Because antibiotics are often misused by doctors, patients, and even people raising animals for meat. And that misuse, which includes prescribing or using those drugs incorrectly, breeds "superbugs"—dangerous antibiotic-resistant bacteria that can't be easily controlled.

    Too much of a good thing

    The problem often starts when we're sick. We ask our doctors for antibiotics to treat problems that the drugs simply don't work against, such as colds or the flu. Those illnesses are usually caused by viruses, not bacteria—and antibiotics don't work against viruses.

    Doctors, of course, know that the drugs don't work for viral infections. But they're often all too willing to comply. That's partly because they want to make their patients happy, and partly because doing so is faster than ordering tests to confirm the cause. And sometimes it's just easier than explaining why antibiotics aren't needed.

    Even when the drugs are necessary, doctors sometimes reach too quickly for "broad spectrum" ones that attack multiple bacteria types at once, when more targeted drugs would be less likely to breed resistance. The national Centers for Disease Control and Prevention estimates that more than half the antibiotics used in the U.S. are prescribed unnecessarily or used improperly.  

    The problem isn't limited to doctors' offices. Many of us now use antibacterial cleaning products in our homes. "They contain triclosan or other antibiotics," Urvashi Rangan, Ph.D., director of the Consumer Reports Center for Safety and Sustainability, said. "These products may promote resistance, and plain soap and water is enough to get most cleaning jobs done."

    Farms also pose a concern: About 80 percent of the antibiotics sold in the U.S. are fed to livestock to speed growth and prevent disease in healthy animals. But that breeds superbugs, which can spread in the environment, contaminate our food, and undermine the effectiveness of antibiotics.

    How resistance develops

    Every time you use an antibiotic it kills some—but not all—of the bacteria in your body. The survivors might mutate, modifying their genetic material so that they are no longer vulnerable to the drugs. The more often the drugs are used, the greater the chance that some will become resistant.

    Antibiotics also kill off some of the "good" bacteria that normally live in your intestines, which may allow resistant bacteria to fill the void. Those bacteria can then multiply and transfer their drug resistance to other bacteria, magnifying the problem.

    The superbug threat

    Superbugs pose serious concerns. Antibiotic-resistant infections, such as methicillin-resistant staphylococcus aureus, sicken at least 2 million Americans each year and kill 23,000, according to the CDC. Those infections can happen anywhere, but they're especially deadly when they occur in hospitals, nursing homes, or other health care centers.

    Compounding the crisis is that drugmakers are spending less time and money creating new antibiotics, even as more bacteria are becoming resistant to the older drugs.

    Alarmed by the situation, health leaders are working to change how we use antibiotics. For example, the CDC recently urged hospitals to prescribe and administer antibiotics more carefully and to track and prevent hospital-acquired infections more vigorously. The Food and Drug Administration wants the meat and poultry industry to cut back on the use of the drugs. And many medical organizations, as part of a program called Choosing Wisely, have highlighted situations in which the drugs are often overused (read "When You Think You Need Antibiotcs, But Probably Don't.")

    But experts say those efforts won't be successful unless patients take part by, for example, refusing antibiotics when they aren't necessary and taking steps to reduce their use at home.

    What you can do

    You can help protect yourself and others from antibiotic-resistant infections in two ways. First, take precautions to avoid infections in the first place. That reduces your need for antibiotics. Second, when you do need the drugs, use them properly. Both strategies are incorporated in the following steps, which you can take at home, in a doctor's office, and in a hospital.

    At home

    Keep hands clean. Washing up with soap and water for at least 20 seconds helps you avoid getting and spreading infections. Just be sure to avoid antibacterial hand soaps and body washes. There's no evidence that they work any better, and many contain chemicals, such as triclosan, that may promote resistance. The FDA recently proposed that the makers of those products prove that they are safe and more effective than ordinary soap. Watch our video on how to properly wash your hands.

    Use antibiotic creams sparingly. Even antibiotics applied to the skin can lead to resistant bacteria. So use over-the-counter antibiotic ointments containing bacitracin and neomycin only for cuts and scrapes that leave visible dirt behind. Wash all superficial wounds with soap and water.

    Consider purchasing meat labeled "no antibiotics" or "USDA organic." Consumer Reports' tests of turkey and chicken suggest that poultry raised without antibiotics may be slightly less likely to harbor resistant bacteria. More important, Rangan says, is that "buying meat raised without antibiotics supports farmers who keep animals off unnecessary drugs and helps preserve the effectiveness of antibiotics." Read about what labels to look for when shopping for meat.

    In the doctor's office

    Get vaccinated: Some shots prevent bacterial infections, such as diphtheria and whooping cough. Pneumonia can be viral or bacterial, and there are vaccines to prevent both. And while the flu is always viral, getting vaccinated makes it less likely that you'll get sick from it and ask your doctor for antibiotics unnecessarily.

    Don't insist on antibiotics. If your doctor says you don't have a bacterial infection, don't insist. Instead, ask about other ways to get relief.

    Fight it off on your own. If bacteria are the cause, ask if you might be able to beat the infection on your own. That's often possible, especially if symptoms are mild.

    Follow directions. Take the full course of your prescription, even if you feel better after a day or two. If treatment stops too soon, the antibiotic might not kill all the bacteria, some of which might re-infect you and become resistant to the drug.

    Don't use leftover drugs. Taking medications left over from a previous illness is a bad idea, because your current problem might not stem from a bacterial infection or the antibiotic might not be the right one for it. And don't use drugs prescribed for someone else, because they might not be the best choice for you.

    In the hospital

    Get screened for MRSA before surgery. A simple nasal swab can tell whether you carry low levels of MRSA and allow the hospital staff to take precautions, such as prescribing antibiotic nasal ointments and having you use special soap before your procedure.

    Say "no" if someone tries to shave you with a razor before surgery. Nicks can provide an opening for bacteria on your skin to enter your body.

    Insist on clean hands. If you don't see health care providers or visitors wash their hands, ask them to. And if your room is dirty, ask to have it cleaned. You can also bring bleach wipes to use on bed rails, doorknobs, and the TV remote.

    Ask every day if catheters or other tubes can be removed. They can lead to urinary-tract or bloodstream infections.

    Use Consumer Reports' hospital Ratings. We rate more than 4,000 U.S. hospitals on various measures, including several kinds of infections. And read more about how to stay safe in the hospital.

    Editor's Note:

    This article also appeared in the October 2013 issue of Consumer Reports on Health.

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