Our patients are suffering the effects of antibiotic overuse
Mary’s manicured fingernails made an audible scraping noise as she scratched incessantly at the unquenchable itch on her back. The discomfort had begun yesterday, and Mary had noticed an angry-looking red patch on her skin that morning. A knowledgeable nurse, she quickly sought my opinion.
Feeling like a nagging parent, I gently admonished, “Don’t scratch,” as I asked medical history questions: Any major medical problems? Taking any medications? Recent travel, camping, exposures to new environments, foods, pets?
Mary had been diagnosed with Type 2 diabetes a few years ago, and the condition had recently worsened. Her diabetes specialist had hospitalized her and started her on insulin. Her blood sugars had improved with the new regimen, she insisted, but like many patients with diabetes, she was still at risk of having a serious skin infection.
I listened with concern, worried about whether her immune system was working optimally to fight off infection, and then examined the affected skin. There were no pus-filled bumps, and though I couldn’t rule out an early case of shingles -- a reactivation of the chicken-pox virus, varicella-zoster -- an allergic reaction or eczema was a more likely possibility.
I recommended topical and oral anti-allergy drugs and agreed to see Mary again in 24 hours to monitor her progress.
The rash was worse the next day. The red bumps had become darker and were now randomly scattered over a larger patch. I recommended an antiviral medication to cover the possibility of evolving shingles and pledged to remain alert for potential signs of bacterial secondary infection that might need an antibiotic.
Mary’s rash continued to worsen, despite aggressive antiviral and then antibiotic therapy. She should have been improving. Why wasn’t she?
The answer came from the lab. Cultures from the lesions showed that the rash was caused by methicillin-resistant staphylococcus aureus (MRSA), an organism -- found in hospitals and the community -- that is resistant to many or all of the antibiotics commonly prescribed for skin infections.
This strain of staph is just one of a growing number of resistant bacteria that have developed when a small proportion of bacteria survive treatment with a specific antibiotic and then reproduce. They gradually become a greater and greater proportion of the bacterial population, until a formerly effective antibiotic no longer can destroy the majority of the bacteria and help fight the infection.
The end result is that we are rapidly running out of effective antibiotics for some bacterial infections. Pharmaceutical companies are racing to develop new antibiotics, but their success in staying ahead of resilient bacteria is not guaranteed.
We doctors have to do our part by avoiding the inappropriate or excessive use of antibiotics and by selecting necessary antibiotics carefully. No longer do we have the luxury of blithely agreeing to a patient’s request for an antibiotic when the patient clearly has a cold or flu virus -- or when a bacterial infection is likely to improve on its own.
Some people become carriers of MRSA and spread it to others without showing any symptoms themselves. The risk of getting an MRSA infection outside the hospital can be reduced by not sharing personal items with others, avoiding touching infected skin, and cleaning surfaces -- such as athletic equipment and toilets -- before touching them.
MRSA strains outside the hospital usually tend to cause milder infections that can often get better without antibiotics in healthy people. Because MRSA symptoms may mimic other skin infections, it’s wise for anyone with a rash that doesn’t quickly resolve, or that grows or spreads, to consult a healthcare provider.
Mary’s case of MRSA was more typical of the strains found in hospitals -- not only resistant to almost every antibiotic currently available but, when coupled with her underlying diabetes and challenged immune system, also having the potential to spread to her internal organs and endanger her life.
Mary went back into the hospital and, under the guidance of an infectious disease specialist, received weeks of intravenous therapy with the “magic bullet” antibiotic vancomycin. She’s feeling much better these days.
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Dr. Linda Reid Chassiakos is director of the Klotz Student Health Center at Cal State Northridge and a clinical assistant professor of
pediatrics at UCLA.
