Planning Antibiotic Use…The Road ahead

Doctors often find it difficult to decide whether to use antibiotics. patients demand it or buy it over the counter. The result…the serious threat of antibiotic resistance !!

We’re in the middle of an antibiotic crisis that public health experts have been warning about for years. While antibiotics are a miracle of modern medicine, they’re being over used and abused — 30% of prescriptions are unnecessary, a new study found and yet doctors continue to prescribe them inappropriately and the agricultural industry relies on them to keep animals plump. Such overuse is leading to smarter bacteria that are evolving into super bugs that can resist nearly every antibiotic drug available today.

To avoid a world of rampant, untreatable bacterial infections, experts say cutting back on unnecessary use of antibiotics is critical. That includes prescribing the drugs only for bacterial infections, against which they work, and not for viral infections. But because people with bacterial infections—people with cold symptoms, say—tend to feel similarly to those with viral infections—with flu symptoms—many doctors still prescribe the drugs for both.

According to the Centers for Disease Control, about a third of the 154 million prescriptions that doctors write for antibiotics are unnecessary, and likely do more harm in terms of promoting bacterial resistance, than good in treating infections. The reasons for that include patients who demand drugs to treat their symptoms, even if they aren’t caused by bacteria, doctors who are too pressed for time to educate their patients about the difference between bacterial and viral infections, and a better-safe-than-sorry mentality to protect hospitalized patients, from dangerous, potentially fatal infections like sepsis.

Thus, 30% of antibiotics prescriptions are not needed. Now scientists have come up with a promising way to help physicians decide when the drugs are needed.

Scientists at Stanford University and Cincinnati Children’s Hospital Medical Center report on a blood test that can distinguish between bacterial and viral infections. The test looks at the proteins made by seven genes; in the presence of bacteria, four of the genes become more active, while in the presence of viruses, three of them churn out more proteins. By measuring this, the test can tell with reliable certainty whether an infection is caused by a bacteria or virus. (See the accompanying picture)

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We didn’t really have a good test where we could say to a patient “ Look, you don’t have an infection so we can safely withhold antibiotics ”.

This panel of seven genes may change that, but it will take a few years before it becomes reliable enough to use in the clinic. Further, at this point of time, the test also takes four to six hours — too long when the patient might be suffering from sepsis, which can progress quickly within hours.

The goal is to perfect the technology to scan the blood for the seven genes’ profile in about an hour. A test like this or similar ones will help to reduce the crazy over use of antibiotics that is threatening not just medicine but whole parts of our society based on our inability to treat certain infections.