Doctors are supposed to know the difference between a bacterial infection and a viral infection. When they don’t — and they start prescribing antibiotics for viruses, including the common cold or the flu — there’s trouble in store.
Antibiotics won’t cure a virus because they’re not designed to – but that’s only part of the problem. Over time, physicians over-prescribing antibiotics also creates antibiotic “resistance,” making deadly bacteria stronger and more resistant to treatment.
The result is “Superbugs,” bacteria powerful enough to kill their unsuspecting victims.
India is the poster child for what happens when antibiotics are so readily available over the counter that consumers can misuse them at will to try to treat common afflictions.
Last July, reports surfaced of an epidemic of Superbugs in the country’s major hospitals. Newborns are especially vulnerable, with 16 per 1,000 live births subject to sepsis.
About a third of those babies die because available antibiotics that should work against sepsis have failed, according to a study published in the British medical journal BMJ.
India’s hospitals have begun taking extra precautions, with medical personnel required to engage in additional sanitary precautions including regular hand-washing.
But the same sanitation method was employed in past years and the Superbugs have since returned, suggesting that they’ve grown even stronger in the interim.
Superbugs from India are also highly mobile. They’ve been detected as far away as Antarctica, and they’re spreading. Part of the problem is the phenomenon of “horizontal gene transfer,” which allows Superbugs to spread from one species to another with impunity.
Health experts say India’s lax laws have allowed Superbugs to flourish. In addition to a lack of prescription control, rural farmers over-rely on antibiotics to try to protect their chickens and other farm animals from dying from disease, which threatens their livelihoods.
But poor sanitation, especially in hospitals, is the most salient issue. Invasive surgery and the use of catheters that are not properly sterilized lead to unnecessary bacterial infections, which have become stronger and more difficult to combat over time.
Many observers had assumed that the conditions giving rise to Superbugs were largely a developing world problem, and might be contained with strong outside medical intervention, including support from abroad.
But a report published this week in BMJ confirms what some have long suspected: Superbugs may soon infest the United States as well.
The report, based on a review of some 25,000 patient hospital visits and millions of antibiotic prescriptions issued in recent years, found that well over 40% of those prescriptions had been issued in error — for illnesses for which they were not the appropriate treatment.
How could this happen?
In theory, the distinction between a bacterial and viral infection is fairly clear. They are both caused by microorganisms but they operate somewhat differently. Bacterial infections are harmful cells while viral infections cause harm by damaging existing cells.
The two conditions are often contagious, but they produce quite different maladies that must be fought in different ways.
Tuberculosis, Lyme disease, and gonorrhea are examples of bacterial infections. By contrast, the common cold or the flu is a virus. You stop the virus by shoring up the healthy cells. You stop bacterial infection by going after the harmful organisms. It’s a subtle but critical difference
But there is room for confusion because some viral infections can also lead to bacterial infection, especially if the viral infection is prolonged. A good example is a sinus infection that develops on top of a cold. The cold medicine, while providing sinus relief, may not prevent an actual sinus infection, which requires antibiotics for treatment.
Still, why would highly-trained doctors confuse the two types of infection and the distinct health problems they cause?
The reason, in part, is an increase in American doctors and nurses with weak training who are sloppy in their methods and also poorly supervised. The larger problem may be demands from patients for quick fixes, including antibiotics that seem to promise them rapid healing but that aren’t always useful.
In fact, medical personnel may know that they are over-prescribing expensive antibiotics but they can charge their patients and also discharge them more quickly. Too often, revenue and cost issues come to override basic public health considerations.
Public health systems are not powerless to counteract these problems. In 2014, India instituted more stringent controls on over-the-counter sales and began imposing stiff fines on violators.
But it takes more than mere awareness of the problem or even punitive measures to address it fully. When the CDC sounded the alarm back in 2013, it noted that immune-compromised elderly patients in nursing homes and hospitals were the sub-group most at risk. Many observers concluded that the problem might be containable with targeted interventions.
But if anything the problem has spread far and wide since then. Already, tens of thousands of people are dying annually because of Superbugs, people who should have been treated and cured, according to public estimates.
So watch out: It probably won’t be long before a Superbug problem affects your local public hospital and spreads out to your community. The next big epidemic in American won’t be due to exotic causes like the Avian flu or the West Nile virus; it will be our public health system’s inability to treat patients effectively for the most common of domestic infections.