Antibiotics are powerful medicines that treat infections caused by bacteria. Since their discovery in the 1930s, they have saved millions of lives. But antibiotics are not a cure-all, and there can be consequences if antibiotics are misused or overused.
Maxx Enzmann and Zack Nelson, infectious diseases pharmacists at HealthPartners, discuss the good and bad of antibiotics, and how antimicrobial stewardship can improve equity and help to keep patients and communities healthy. Listen to the episode or read the transcript.
“Very precious resources”
Zack says antibiotics are “one of the most profound medications in human history in terms of increasing life expectancy,” but also notes that we need to use these “very precious resources” wisely.
Antibiotics become less effective over time, both when they’re used appropriately and when they’re misused. Overuse can lead to antibiotic resistance, which is when bacteria develop the ability to defeat the antibiotics designed to treat them. Since antibiotic resistance is currently outpacing new antibiotic development, it’s important to use antibiotics only when necessary.
There are trade-offs with antibiotics
Many people believe that antibiotics are benign, and even if they don’t exactly help, they won’t hurt. They may view antibiotics as a preventive measure – for example, something to take just in case sniffles turn into a nasty sinus infection or if you feel a bladder infection coming on.
“That mindset really needs to change,” says Maxx. “There are a lot of consequences of unnecessary antibiotic use.” They include:
- Destroying good bacteria – “There’s a lot of bacteria in our bodies that do a lot of good things for us, and without them, we’re actually prone to certain diseases, maybe more infections,” says Maxx. For example, antibiotics can kill off the helpful bacteria in your digestive system, making it more likely that you’ll develop severe diarrhea from a C. difficile infection.
- Higher chance of chronic disease – Some research suggests that the use of antibiotics in childhood may increase the chance of getting chronic disease later in life. “I still think more data needs to come out about this, but there are definitely some warning signals out there,” says Maxx.
The importance of antimicrobial stewardship
As members of the Antimicrobial Stewardship Program (ASP) at HealthPartners, Zack and Maxx promote the best use of antibiotics and other antimicrobials, and develop guidelines for diagnosing and treating infections.
“We shouldn’t be treating your run-of-the-mill urinary tract infections, your run-of-the-mill pneumonias in eight different ways. We should be treating them in the evidence-based way,” says Zack.
Precision use of antimicrobials pays off in a big way. Not only do patients and the community stay healthier, but it also allows for more prudent use of supplies like IV fluid.
Improving equity in antibiotic safety across communities
Infectious disease specialists like Zack and Maxx have special training and experience in the best ways of managing infections. But this expertise is not always readily available – 90% of the counties in the U.S. have below-average or no access to an infection disease physician, according to one study.
“Like you wouldn’t treat cancer without an oncologist, serious infections need to be treated with people who have the requisite expertise to manage those,” says Zack.
The ASP program is working to reduce barriers to safe and effective antibiotic use across the community. Resources and guidelines are available to clinicians who may not have official training in infectious diseases. And there is also an infectious diseases pharmacist at HealthPartners who focuses on sites outside the metro area.
Zack says that by making treatment guidelines for infections visible and accessible to all the clinicians treating affected patients, “that’s going to make their care more equitable,” Zack says.
