The Truth About Antibiotics

Antibiotics have a reputation for being a cure-all. They’ve been prescribed for everything from cuts and scrapes to sore throats and gonorrhea, so it can be difficult to parse what, exactly, they fight. To make matters more confusing, phrases like “antibiotic resistance” and “post-antibiotic future” are increasingly popping up in the news cycle, painting a picture of a medically induced end of times.
In the 1920s, scientist Alexander Fleming realized that as an evolutionary tactic in their fight for resources, some bacteria produced chemicals to kill other kinds of bacteria. He believed those chemicals could be extracted and then used to fight infection in humans. So, when he first released penicillin in 1943, it was used to treat injured soldiers on the front lines of World War II — and it was lifesaving. Fleming was hailed a hero and antibiotics became one of the greatest medical breakthroughs in history. But, since the 1940s, much has changed in the way we use them. Ahead, we break down the common myths around antibiotic use and take a look at how years of (amoxicillin) pill popping has altered the medical landscape.

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Illustrated By Sydney Hass.
Antibiotics don’t kill viruses.

Today, we use antibiotics for strep throat, bronchitis, acne, staph infection, and tuberculosis, among other bacterial infections. On a side note, a common misconception is that antibiotics treat influenza, affectionately known as the flu. The flu is caused by a virus, not a bacterium, and your doctor should only recommend vaccines to prevent and antivirals to treat viral infections.

Fleming knew that antibiotics would not always be effective against bacteria. When he accepted the Nobel Prize, he said, “It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body.” Meaning, if infectious bacteria is not treated with enough antibiotics, it will grow resistant, rendering our antibiotics useless against infection. Few heeded his warning.

In the decades that followed, antibiotics proliferated. “In the early years, during the ‘50s, ‘60s, ‘70s, there were so many antibiotics coming on the market every year. There were literally new antibiotics appearing all the time. And, so one of the things that happened was, as doctors, we got a little cavalier about the way we use antibiotics,” says Dr. Solomon, Director of the Office of Antimicrobial Resistance at the Center for Disease Control and Prevention. Then in the 1980s, the pipeline of new antibiotics slowed to a trickle, but doctors didn’t immediately change the way they prescribed them.
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Overuse of antibiotics can make us sicker.

If you grew up in the '90s, you may remember taking a viscous, pink liquid called amoxicillin every time you got sick. Antibiotics were often prescribed without a thorough examination of whether or not an infection was bacterial. “We just got used to using antibiotics without worrying about it in every single case,” says Solomon. Even when antibiotic resistances developed, doctors expected a new stronger antibiotic was just months from being released.

Patients are not blameless either, often pressuring doctors to prescribe antibiotics unnecessarily and only taking them until they start to feel better. When patients don’t take all of their medication for a prescribed time period, bacteria are exposed to antibiotic levels too low to kill them, which allows them to develop and pass on resistant genes.

To use an example: My throat is killing me, so I go to my doctor and test positive for bronchitis. Doc prescribes me a Z-pack. Halfway through the prescription, I’m already feeling better so I stop taking the rest. The problem is, the bacteria in my system have only been weakened, not killed. “This is a stressful environment for bacteria. Those that survive the exposure to the low-dose antibiotics may even have an increase in their spontaneous mutations,” says Dr. Lawrence, citing a Boston University study. More spontaneous mutations means more opportunity for resistance to develop — in short what doesn’t kill bacteria only makes it stronger.

In 2013, the CDC reported that, annually, more than an estimated two million people in the United States get infections resistant to antibiotics, and at least 23,000 people die as a result.

We’re heading towards what some people have called the post-antibiotic era. Before antibiotics, people died of common infections. Much of the advances in modern medicine rely, in some way, on the power of antibiotics: “Cancer chemotherapy, the use of steroids for a variety of treatments...[surgeries to place] implantable devices and artificial hips. Antibiotics are critical to so many of the lifesaving and life-enhancing abilities we have today,” says Solomon. He notes that if we do not change the way we use antibiotics, all bacteria will evolve to become resistant.
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Ask your doctor, "Do I really need this?"

Solomon says one of the things that people can do to slow the evolution of resistant bacteria is to ask your doctor whether you really need antibiotics or if more testing is needed to find out whether your infection is bacterial or viral.

Just use plain old soap and water:

A lot of the work in dealing with bacteria and bacterial infections is preventing sickness in the first place. Make sure to wash your hands, your kitchen, your bathroom, and any other places where bacteria loves to hang out. When it comes to what cleaning products to use, think twice about using antibacterial soaps. According to the FDA, they are not proven to be more effective than simply using regular soap and water. And, since they use a low-dose antibiotic in their formulas, it's very likely they contribute to antibiotic resistance.

While it may at first seem tedious, it’s smart to read the labels of all the products you buy. Urvashi Rangan, Executive Director of Consumer Reports Food Safety and Sustainability Center, points out that she found Triclosan (a controversial antibiotic) in the minty toothpaste her son likes. She says antibiotics turn up in the most unlikely places, “Fruit trees can be treated with antibiotics. In pears, apples, nectarines — they’re used to treat fire blight [a disease that affects fruit trees].” But, farmers are not just using antibiotics to treat infection, they’re spraying trees with antibiotics to prevent them from getting sick, which only works in the short-term. Ultimately, using low-dose antibiotics builds resistance. “What we’re doing is not the long-term answer,” says Rangan.
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In the U.S., 80% of antibiotics produced are used on livestock.

The practice of using low-dose antibiotics to prevent disease is also common in animal-husbandry operations. In the U.S. today, 80% of all antibiotics produced are sold to the industrial agricultural community for use in livestock at low doses for growth promotion and disease prevention. Because most livestock farms are overcrowded and filthy, they provide the perfect environment for bacteria to flourish and evolve to be antibiotic resistant. Dr. Robert Lawrence, director of the Center for a Livable Future at Johns Hopkins, paints the picture best, “You have thousands of animals crowded together in filthy conditions, and you have them constantly exposed to low-dose antibiotics littered through the feed and the water.” He calls it the perfect storm for antibiotic-resistance development. What’s worse is that it doesn’t just affect farm animals, it affects you, too.

Farms workers often carry antibiotic resistant bacteria back to their families and then into their communities. And, as a recent Hopkins study proves, people without connections to industrial agriculture are being affected, too. The study examined a group of people in Pennsylvania who had been diagnosed with methicillin-resistant staph aureus (MRSA), “People who had no connection to industrial agriculture at all, except they happen to live relatively near to one of these so-called spray fields.” Having a high concentration of animals in a single area means a lot of animal waste that farms can’t get rid of fast enough. To relieve themselves of large quantities of waste, farmers spray the accumulated waste on crops as manure, over-saturating the fields and leading to waste run-off in groundwater and nearby waterways. This run-off often contains, you guessed it, antibiotic resistant microbes.

To give you a recent example of the kind of health problems this causes: The CDC reports that Foster Farms in California had high levels of a salmonella strain resistant to several classes of antibiotics in one of their slaughterhouses. The bacteria ended up sickening people in 23 states and was found on Costco’s rotisserie chickens, which reach temperatures of 180 degrees.
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Meatless Monday

Antibiotic resistance is scary stuff, but living in fear is not the answer. There are proactive steps you can take to make sure you aren’t a victim of bad farm practices. Dr. Lawrence says cutting back on your meat consumption is one way to avoid antibiotic-resistant bacteria in meat. “The Meatless Monday campaign is trying to introduce a very modest reduction. It encourages people to go without meat products for just one day per week to see if we can’t lower our risk for cardiovascular disease, some cancers, obesity, and type 2 diabetes,” says Lawrence. Since eating a lot of meat isn’t good for your health anyway, lowering meat consumption is a good habit to get into.

When you do eat meat, choose meat from animals not treated with antibiotics. The usual suspects — Whole Foods and Trader Joe's — offer antibiotic-free meat products, but you can also find antibiotic-free meat in your average supermarket. Applegate Farms, Nature’s Promise, Kirkland brand, and Greenway are all committed to delivering antibiotic-free foods.

Make sure to wash your vegetables and prepare them on a cutting board that hasn’t touched raw meat. Washing your fruits and vegetables with a scrub brush or with diluted vinegar is really effective at killing bacteria and getting rid of pesticide residue.

As a final note, Rangan says, “We don’t have an unlimited leash on antibiotics; we’re exploiting something that nature already does. Bacteria will evolve to resist things that try to kill it, and using antibiotics in low doses daily can only accelerate that process.” That is not to say we shouldn’t use antibiotics altogether; they can be a lifesaving tool. However, in order to keep them effective, we need to be mindful about the way we use and ingest antibacterials and antibiotics. If we aren’t, we risk entering an era without them.