Are Antibiotics Becoming Ineffective?
by Jennifer Wider, MD
(Washington DC, 2/19/04): Having a urinary tract infection (UTI) is never
pleasant, but women may have new reason to worry about these everyday ailments.
Current research shows that infection with antibiotic resistant bacteria is
becomingly increasingly common in the United States.
It used to be that women
experienced burning during urination, visited the doctor and received a prescription
for antibiotics. No more thought was given to the matter. Antibiotics have emerged
as therapeutic leaders in the fight against bacterial infections over the last
fifty years. Prescriptions were filled without full attention being paid to
the potential consequences.
The medical community now
faces new challenges. With the overuse and misuse of these drugs, some bacteria
have evolved to become resistant to the medication, resulting in treatment failure
and the need for a new approach.
The resistance of bacteria
to certain antibiotics has caught the attention of major medical organizations
and government agencies including the Food and Drug Administration (FDA). It
is of particular concern to physicians, who treat UTIs, which are one of the
most common bacterial infections.
There are several types
of UTIs, but the most common by far is called uncomplicated acute cystitis.
It occurs predominantly in young, sexually active women and occurs rarely in
men. Close to one-third of all women will have at least one diagnosed UTI by
the age of 24, according to a 2002 study in The American Journal of Medicine.
Roughly forty to fifty percent of women will have at least one UTI during their
Women at an increased risk
for UTIs include those who engage in frequent sexual intercourse, have many
sexual partners, and frequently use a diaphragm or spermicide. Other known risk
factors include diabetes, recent antibiotic use and estrogen deficiency (most
commonly from drugs or menopause).
Many female patients are unaware of the growing resistance to antibiotics and
doctors often don't mention it. Certain types of bacteria have become more resistant
than others. Across the United States, physicians are seeing increased resistance
of E. coli, the most common UTI bacteria, to the commonly used antibiotics,
including trimethoprim/sulfamethoxazole , ampicillin and cephalosporins, Richard
Colgan, assistant professor of Family Medicine at the University of Maryland
School of Medicine, said.
Different regions in the
country report varying rates of resistance and it is up to the physician to
be aware of the patterns in their locale.
" Practitioners can
get this data by contacting their local departments of microbiology in the hospitals
where they practice," Colgan said.
The increase in antibiotic resistant bacteria is "most likely due to the
overuse of antibiotics for infections overall, especially respiratory, skin
and soft tissue and urinary infections," Thomas Hooton, M.D., p rofessor
of medicine at the University of Washington in Seattle, said . "The more
antibiotics used, the greater the risk for resistance."
In many cases, the misuse
or overuse of antibiotics by human beings can be blamed, but the use of antibiotics
in the animal population must be looked at as well.
"Farmers use tons
of potent antibiotics for purposes of promoting growth and preventing infections
in overcrowded populations of animals on factory farms," John N. Krieger,
M.D., professor of urology at the University of Washington in Seattle, said.
As antibiotic resistance
has increased, the governments of several countries have intervened. "Some
European countries have limited agricultural antibiotics to animals with diseases
only," Krieger said. Experts in the United States have initiated dialogues
between the medical community and the government to explore these issues. "I
support the experts who would prefer to limit the agricultural indications,"
It isn't an easy decision
for farmers, in light of recent mad cow disease and bird flu virus scares. Most
consumers want the comfort of knowing their food is disease free, but few probably
recognize the dangers of treating healthy animals. Taking antibiotics for illnesses,
which do not necessitate their use, and consuming animal products treated with
antibiotics will increase the chance of bacterial resistance. Minimizing exposure
to antibiotics when possible is the surest way to ensure the medication's effectiveness.
Women need to become familiar
with the signs and symptoms of a UTI in order to recognize when an antibiotic
will be helpful.
" If she notes urinary
frequency, urgency, hesitancy, discomfort with urination, plus-or-minus a fever,
or with lower back pain, she may have a bladder infection that may be helped
by an antibiotic," Colgan said. If an antibiotic is prescribed, completing
the entire course is vital to the protection against bacterial resistance.
The Society for Women's
Health Research is the nation's only not-for-profit organization
whose sole mission is to improve the health of women through research. Founded
in 1990, the Society brought to national attention the need for the appropriate
inclusion of women in major medical research studies and the resulting need
for more information about conditions affecting women. The Society advocates
increased funding for research on women's health, encourages the study of sex
differences that may affect the prevention, diagnosis and treatment of disease,
and promotes the inclusion of women in medical research studies. Dr. Donnica
Moore has been a member of the Society since 1990 and is a past member of its
Board of Directors.
Created: 2/19/2004  - Jennifer Wider, M.D.
Reviewed: 2/23/2004  - Donnica Moore, M.D.