Consider these depressing facts. The Union of Concerned Scientists has found that 70 percent of all antibiotics in the US are being fed to livestock as nontherapeutic agents, in the absence of disease, some 24.6 million pounds annually, up about 50 percent from 1985 to 2001. Amazingly, more antibiotics were fed to animals in North Carolina alone in a year than were administered to the nation's entire human population. Cattle, swine, and poultry are routinely given antibiotics throughout their lives. About 13.5 million pounds of antibiotics prohibited in the European Union are used for nontherapeutic purposes every year by US livestock producers. The US government has not regulated agribusiness sufficiently in this area.
You may have heard about MRSA. MRSA stands for methicillin-resistant Staphylococcus aureus. This infection can be fatal because it is resistant to the broad-spectrum antibiotics commonly used to treat it. We need to really worry about it, which means we must worry about the improper use of antibiotics.
The proportion of health-care facility-associated staph infections that are due to MRSA rapidly increased from 2 percent in intensive-care units in 1974 to 64 percent in 2004. MRSA is thought to cause about 59 percent of all skin and soft tissue infections. Invasive and serious MRSA infections occur in approximately 94,000 people each year and are associated with about 19,000 deaths, reportedly more deaths than caused by AIDS per year. Of fatal MRSA infections about 86 percent are related to health care facilities. A study of 11 emergency rooms across the country found that almost 60 percent of skin abscesses tested was caused by MRSA.
The Infectious Diseases Society of America has declared antibiotic resistance a "public health crisis." It has been estimated that more than 70 percent of the bacteria that cause health care infections have resistance to at least one or more antibiotic drugs.
Now consider this. Five out of 90 samples of retail pork in Louisiana tested positive for MRSA according to a study published last year. Another study of retail meats in the Washington , D.C. , area found MRSA in one out of 300 pork samples, a far lower but still troubling percentage. Research by Peter Davies of the University of Minnesota suggests that 25 percent to 39 percent of American pigs carry MRSA. By now you may be starting to think that perhaps following kosher rules not to eat pork may be smart.
How has this happened? Seems reasonable to believe that this has resulted from the incredible excessive use of antibiotics in animal feedstocks. Listen to Robert Martin who led a Pew Commission on industrial farming that examined antibiotic use: "We don't give antibiotics to healthy humans. So why give them to healthy animals just so we can keep them in crowded and unsanitary conditions?"
If the Obama administration really wants to do something useful about improving public health and reducing national health care spending, then it will have the Agriculture Department take strong steps to stop widespread use of antibiotics in animal feedstocks. And it will also have the Health and Human Services Department work harder to inform both physicians and citizens about the unnecessary use of antibiotics for many common ailments, such as ear infections in children and bad colds in adults.
In a Dutch study of 2,975 children, it was found that 88 percent of children with acute ear inflammation did not need antibiotics. Other studies in the U.S. and Scandinavia came to similar conclusions.
More generally, most antibiotic prescriptions in the US are for acute respiratory infections (ARIs), such as the common cold, coughs and the flue, and over half of these prescriptions for ARIs provide no direct benefit to patients. Why? Because ARIs are predominately viral rather than bacterial infections. Yet doctors keep prescribing them for ARIs. For most common situations, this is what is now known: there is a 1 in 4000 chance that an antibiotic will prevent a serious complication far, far less than 1 percent, and a 5 to25 percent chance that it will cause diarrhea. Worse, there is a 1 in 1000 chance that you will require a visit to the emergency room because of a bad reaction to the antibiotic. In other words, the risks are greater than the benefits for most people.
No real surprise that t he Center for Disease Control estimates that of the 235 million doses of antibiotics given each year to people, between 20 and 50 percent of them are unnecessary. That excessive use makes money for pharmaceutical companies and gives doctors something easy to do to placate patients, but it is profoundly dangerous for everyone. Like use in animals, the excessive use in people contributes to the evolution of fatal superbugs.
Here is yet another negative effect of excessive antibiotic use. Antibiotics just don't kill bad bacteria; they also kill good bacteria necessary for good health. Among the more important beneficial bacteria are lactobacillus acidophilus and bifidobacterium bifidus. They help protect the body against infection. When they are depleted the human body can lose a sound immune system, raising the risk of infections by fungi, bacteria, viruses and parasites. Another effect can be the overgrowth of yeast in the body and a yeast infection can also suppress immunity, which may lead to repeated infections.
Most of us have encountered common adverse but relatively mild effects of taking an antibiotic, notably diarrhea or constipation, because of the impact of antibiotics on good bacteria in the body. We have to take actions afterwards to restore our healthy bacteria by, for example, eating probiotic foods for some days or weeks.
So, what should we do? As patients we need to have the courage to question when our doctor prescribes an antibiotic to treat something that bothers us. Is it really necessary? Will it actually solve my problem? Are there reasonable alternatives? Do the benefits justify the short and longer term risks? And we need to express support for politicians willing to take strong actions to curb excessive antibiotics use in animals and humans.