Marian University’s college of Osteopathic Medicine is fairly new; the first-ever class of students graduated earlier this month. Part of its mission is training future doctors to think about treating the whole body.
“So, no matter what field the physician goes into, they’re trained to think as a primary care physician and they’re trained to think about what’s best for the whole body,” says Assistant Professor David Raskin.
This is especially important when it comes to prescribing antibiotics, which are used to treat bacterial infections. They’re among the most commonly prescribed drugs used in human medicine and they’re commonly perceived to be harmless.
Dr. Amy Beth Kressel is the medical director of infection prevention and antimicrobial stewardship at the Sidney and Lois Eskenazi Hospital. She says in the short term, antibiotics are mostly harmless. However, long term, it’s a different story. That’s because the more we use antibiotics, the more the bacteria are finding ways to resist.
“Bacteria like to share,” Kressel says. “Bacteria have various mechanisms to share resistance genes, so they can swap genes. So, again, by using antibiotics we have increased the prevalence of resistance.”
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Photo: Lindsey Wright
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Photo: Steve Burns
According to the Centers for Disease Control at least 23,000 people in the United States die each year due to infections that are resistant to antibiotic treatments. And Kressel says it can be even worse in countries that have fewer regulations.
Our guts, for example, are full of bacteria. Some are good, and some are bad. Once someone takes an antibiotic, it clears the gut of most bacteria, including the good kind. But some resistant bacteria remain and develop resistance to the antibiotic over time.
So, bacteria that cause some serious infections are now becoming more difficult to treat.
One example is methicillin-resistant Staphylococcus aureus, better known as MRSA, a common skin infection that seriously impacts about 90,000 Americans each year.
“MRSA is either the earliest or one of the earliest examples we have of a common, very important bacterial infection that became resistant to a common and very effective antibiotic,” Kressel says.
Although MRSA is just one example of the problem at hand, Kressel calls it the poster child for antibiotic resistance. Health providers have had to find other drugs to treat it.
The problem is largely one of our own making. Around half of antibiotic use is considered unnecessary. Antibiotics kill bacteria, not viruses, which means an antibiotic prescription for a cold or the flu isn’t going to do any good.
However, if a patient is sick, sometimes they just want to be treated and they don’t fully understand the consequences. Kressel says that can ultimately put pressure on a physician.
“So, if I’m in the office and somebody has a cold and they’re insisting on an antibiotic, I might feel pressure to give them an antibiotic and I might say, ‘I don’t think they need an antibiotic, but oh, it’s OK, no harm,” Kressel says. “But maybe a year later that same patient is going to have a urinary tract infection that is more difficult to treat.”
Even with the best practices, like only using antibiotics when absolutely necessary, Kressel says antibiotic resistance won’t go away. So, the key is how to slow the problem down. Kressel says it takes awareness, education, and a conversation.
“They are powerful, wonderful drugs when used right and absolutely lifesaving, limb saving, we cannot not use them,” she says. “We have to make sure we can continue to use them.”
That’s why at Marian, Raskin says students are learning about the topic from start to finish while they’re in school.
“When they learn about just the basics of bacteria, we hit basic bacterial structures and basic bacterial physiology, so that when we get to the pharmaceuticals, the drugs, the antibiotics, they’ll understand what those antibiotics will do to the bacteria,” Raskin says.
He says the best way to educate the public about medicine is to properly educate physicians first.
“We do try to make sure they’re trained in the right way before they’re out in the field, so this is something they’ve experienced, they’ve been trained in before they even start,” Raskin says. “So, it’s not that we have to correct behavior once they’re active physicians, but they will have learned the right way.”
Congress approved an incentive package five years ago in hopes of encouraging more manufacturers to develop new drugs. But it’s still difficult for drug companies to get a big return on their investment, and critics question putting money into new drugs when we should be focusing on prevention and proper antibiotic use.