Taking Antibiotics: When is That Useful?

Antibiotics help when nothing works. Why the medication works less and less and what can be done about it.

Twenty-three thousand. That was the number the C.D.C. used a few weeks ago to sound the alarm. This is because so many people die in the United States every year because they have become infected with resistant bacteria – pathogens against which no antibiotics are effective. In Germany, the figures are similarly alarming: Staphylococcus aureus germs, the so-called MRSA pathogens, which are immune to certain antibiotics, infect more than 100,000 people in Germany alone every year, and more than 10,000 die from them. There are also other germs, some of which are even less sensitive: The ESBL pathogen, for example, which caused several deaths in the premature infant ward of a Bremen clinic two years ago.

And the danger is growing: in the last five years alone, the proportion of resistant bacteria in German hospitals has increased by 50 to 200 per cent, depending on the type of germ, according to a list published by the Federal Ministry of Health in September. According to a study by the Aachen Tumor Center, 6.4 million people in Germany already carry such germs – most of them fortunately without becoming seriously ill. But they can become a deadly danger especially for people with a weak immune system, for chronically ill, elderly or very young patients.

The fact that bacteria virtually learn to deal with the medical weapons we use against them cannot be avoided in itself. The pathogens multiply so rapidly that new characteristics are constantly emerging, including a particular resistance. What is new, however, is that resistances are increasing so quickly and massively because the use of antibiotics has become increasingly excessive.

Problem 1: Factory farming

Where animals vegetate in confined spaces, drugs are used to prevent epidemics – not only when the first cases of disease actually occur, but often as a preventive measure. However, it is precisely this that favours the selection of resistant germs in particular. A broiler chicken, for example, is given antibiotics for an average of ten days during its 39-day life. The problem has worsened in recent years. In 2011, the pharmaceutical companies delivered twice as many antibiotics to veterinarians as in 2005 – namely 1.7 million kilograms. A quantity that puts Germany in a sadly leading position in Europe. This means that 40 times more antibiotics are used in animal husbandry than in human medicine as a whole.

No wonder, then, that resistant germs are repeatedly detected in meat. Every second chicken meat sample tested last year by the German Federation for the Environment and Nature Conservation (BUND) was contaminated with them. And other types of meat are also often affected. For us consumers, however, the danger does not lie in getting infected while eating – at least not if the meat is properly cooked through. It is more dangerous if the germs are spread by knives, chopping boards or hands. That is why you should follow a few simple rules when handling meat (see box on page 3). Nevertheless, kitchen hygiene alone cannot solve the problem: The resistant germs also spread via the air we breathe and drinking water.

We can counteract this by buying meat, eggs and dairy products from organic farms. Because organic farmers use antibiotics less frequently, e.g. only in acute cases of illness. Denmark and the Netherlands show that improvements can also be made in factory farming: There the use of antibiotics has been drastically reduced by hygiene measures in the stables. Unfortunately, we are still a long way from achieving this: an amendment to the Medicines Act, which was approved by the Bundesrat in July, only stipulates that companies must report the use of the medicines in future.

Problem 2: Frivolous doctors

Even in doctors’ surgeries antibiotics are used quickly and with pleasure. And it is by no means the patients who press for a prescription: According to a survey by the Robert Koch Institute, only one in ten patients expect a prescription for an antibiotic when they have a cold. And almost 80 percent of this already small group said that they would accept it if the doctor did not want to prescribe one.

Nevertheless, antibiotics are still prescribed – by the way, more by the family doctor than by the ENT specialist – for colds, coughs, sore throats and bronchitis. And thus against diseases in which not bacteria but viruses are to blame for 70 percent – and antibiotics do not help here. If you really need one (e.g. in cases of high fever, pneumonia and other serious infections), there is one rule you should follow: take the medicine as long as prescribed. If you stop too early, you will unintentionally contribute to the best possible reproduction of the particularly insensitive bacteria.

By the way, modern broad-spectrum antibiotics are often prescribed for minor infections such as cystitis. There are also well-tried methods for this purpose: The Drug Commission of the German Medical Association, for example, recalls the 30-year-old antibiotic Fosfomycin, which was almost forgotten after patent protection expired due to lack of advertising. Compared to newer drugs, it causes less resistance; in addition, it is effective against the most common pathogens of bladder infections with a single dose. By the way: Whether you have bacteria in your bladder at all can also be determined with a urine test from the pharmacy (approx. 6 euros).

Problem 3: Hospitals

However, most resistant germs are still found in hospitals. In Germany, almost one in five of some bacterial species is already such a problem germ. Some experts are therefore calling for every patient to be examined for the dangerous germs before they are admitted to hospital. The isolation of infected patients and meticulous hygiene can at least stem the spread of the pathogens.

After the sad events at the Bremen premature infant ward (where negligent lack of cleanliness was detected), the German states now prescribe in so-called hygiene regulations what exactly hospitals must observe in order to prevent infections. In addition, specially trained hygiene specialists must also be employed – albeit only until the end of 2016.

A look across the state borders again shows how great the effect of such measures, together with restrictions on the use of antiobiotics, is. In France, Portugal, Spain, Italy or Great Britain, for example, 25 to 50 percent of hospital germs are resistant – in other words, even more than in Germany. In Dutch and Scandinavian hospitals, on the other hand, there are only around one to five percent resistant pathogens thanks to the restrictive use of antibiotics and strict hygiene.

What is the solution?

In order to regain the upper hand in the fight against the dangerous pathogens, more effective weapons, i.e. new drugs, would of course also be important in the end. However, the development of antibiotics is a long and expensive process and is hardly worthwhile for the pharmaceutical industry. That is why there are increasing calls for politicians to make the pharmaceutical companies more accountable in this respect. However, it would be naive to trust that such measures will be decided and implemented quickly.

It therefore remains all the more important to keep a tight rein on the weapons we have at our disposal today. So if the family doctor pulls out the prescription pad at the next sinusitis, you better wave goodbye: In the meantime, several international studies have shown that antibiotics – although prescribed in up to 90 percent of cases – are superfluous here. Nasal spray and painkillers are just as effective in combating the symptoms.