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 lifetimes.

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," Krieger added.

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.