What is the Importance of Appropriate Antibiotic Use?

Ever since the 20th century when antibiotics revolutionized medicine, these drugs have become powerful tools for doctors to treat various types of diseases and illnesses.

As effective as antibiotics are, they can just as easily be ineffective when misused or not taken properly. Bacteria are smarter than we give them credit for, and they’re adept at becoming resistant to various antibiotics. By knowing the proper use of antibiotics, you can help preserve their effectiveness and help combat bacterial infections in the future.

In this blog, we speak to Ana Garcia, APRN-CNP, a family nurse practitioner with INTEGRIS Health Medical Group NW Family Medicine, to learn about the proper use of antibiotics.

An overview of bacteria

It’s common for people to view the word “bacteria” in a negative light due to the health problems these single-celled microorganisms can cause. Bacteria play an important role in the ecosystem, though, and can be found both in nature and in the human body. Bacteria live on the skin and in our mouths, nose, throats, gut and reproductive organs.

Typically, these bacteria remain harmless and do their job of helping digest food, absorbing nutrients and breaking down toxins. But in some cases, bacteria can be pathogenic, meaning they produce disease by creating toxins or invading tissues and cells.

As an overview, bacteria can be gram-positive or gram-negative, which are phrases used to describe their structural makeup. Gram-positive bacteria lack an outer membrane but have a thicker layer of peptidoglycan, a substance made of sugars and amino acids that forms cell walls. Gram-negative bacteria, on the other hand, have an outer membrane made of lipids along with a thinner layer of peptidoglycan.

This additional outer membrane found in gram-negative bacteria makes it harder to treat because antibiotics have a more difficult time breaching the membrane and entering the cells.

Examples of gram-positive bacteria:

• Staphylococcus aureus
• Streptococcus pyogenes
• Enterococcus faecalis
• Bacillus anthracis
• Clostridium difficile
• Listeria monocytogenes
• Streptococcus pneumoniae
• Corynebacterium diphtheriae
• Staphylococcus epidermidis

Examples of gram-negative bacteria:

• Escherichia coli
• Salmonella enterica
• Pseudomonas aeruginosa
• Klebsiella pneumoniae
• Neisseria gonorrhoeae
• Helicobacter pylori
• Acinetobacter baumannii
• Vibrio cholerae
• Legionella pneumophila

What is antibiotic resistance?

When used properly, antibiotics are like powerful weapons that can fight against many diseases caused by bacteria, such as tuberculosis and pneumonia. But sometimes, when we use these antibiotics too much or when taken needlessly, bacteria can survive and learn how to protect themselves from antibiotics.

Antibiotic resistance occurs when bacteria can withstand the effects of antibiotics. As a result, the bacteria remain because medications are no longer effective in killing or inhibiting their growth. 

Antibiotic resistance is most common in premature babies, older adults, people with compromised immune systems and those who take long-term antibiotics.
One misconception about antibiotic resistance is that the human body becomes resistant to drugs. However, that isn’t the case. Instead, bacteria adapt and figure out how to destroy cells even in the presence of specific drugs.

“A common misconception is viral infections require treatment with antibiotics. However, viruses and bacteria are structurally different and require differing treatment modality. Proper use of antibiotics can be lifesaving. The ability for medical providers to use effective antibiotics for bacterial infections is an effective tool in treating patients,” says Garcia.

Types of antibiotic resistant infections

Whenever antibiotic resistance occurs, bacteria can cause severe infection because they spread and thrive without anything to slow them down. Here are common examples of infections that occur due to antibiotic misuse or overuse:

• Clostridioides difficile (C. diff): C. diff can cause severe gastrointestinal issues such as diarrhea and colon inflammation (colitis), and usually creates an infection after antibiotic use.
• Streptococcus pneumoniae: Also known as pneumococcus, it can cause pneumonia, meningitis and ear infections.
• Drug-resistant gonorrhea: These bacteria, known as neisseria gonorrhoeae, cause gonorrhea, a sexually transmitted infection that affects the female reproductive tract.
• Methicillin-resistant Staphylococcus aureus (MRSA): MRSA typically cause skin infections and may also lead to pneumonia. MRSA start as red bumps that develop into pus-filled masses called abscesses.
• Vancomycin-resistant enterococci: These bacteria are commonly found in the gastrointestinal tract and can become resistant to vancomycin, an antibiotic used to treat infections. Enterococci can cause infections in your blood, urinary tract and at incision sites after surgery.
• Carbapenem-resistant enterobacteriaceae (CRE): This group of bacteria, including E. coli and klebsiella pneumoniae, can be found in the digestive tract. The infections typically occur in patients in the hospital or nursing homes.
• Acinetobacter: This bacterium is typically found in water and soil and can live on surfaces in health care settings. Acinetobacter can cause pneumonia and infections in your blood.
• Pseudomonas: This bacterium can survive harsh environments and can cause infections in the lungs and urinary tract. It usually only causes infections in health care settings.
• Enterobacteriaceae:  This bacterium, which include E. coli and klebsiella, can be found in the intestines and can cause pneumonia, urinary tract infections and other blood infections. 

What causes antibiotic resistance?

Antibiotic resistance occurs due to natural selection. While antibiotics can kill most bacteria involved in an infection, some slip through the cracks by either acquiring genes that can withstand antibiotics or are able to genetically mutate. These surviving rogue bacteria then mate and transfer their traits to other bacteria. Eventually, the bacteria become resistant to certain antibiotics, rendering them useless when administered. 

• Selective pressure: The idea is that other bacteria are killed off in favor of antibiotic-resistant bacteria surviving.
• Mutation: Like any cells, bacteria can experience genetic mutations. Some bacteria have evolved to produce specific enzymes that prevent drugs from attaching to bacteria. In other cases, bacteria have developed membrane proteins that act as pumps to get rid of antibiotics that breach the cell wall.
• Gene transfer: Bacteria can also transfer genes via horizontal genetic transfer, meaning DNA with resistant genes can move seamlessly from one source to the other. The mutant bacteria take over and become resistant to certain antibiotics, rendering previously effective medications useless to humans.

Risk factors

Although bacteria can mutate over time on their own, there are behavioral factors that make this more likely to occur.

Inadequate use: Some people take antibiotics for the wrong reason. A common example is taking antibiotics for a viral infection such as the cold or flu. Since these illnesses are caused by a virus and not bacteria, antibiotics won’t work. Antibiotics should only be prescribed when necessary. Whenever an antibiotic is unnecessarily taken, the bacteria that survive can mutate and develop resistance due to overexposure.

Not finishing a prescription: Antibiotics are prescribed by a medical provider and distributed by a pharmacist for a reason – they determine the dose, frequency and length of antibiotic use. However, sometimes people miss doses or don’t finish treatment, two things that can allow bacteria to survive, multiply and mutate. For example, some people stop taking antibiotics when they feel better instead of taking the drugs as directed.

When should you take antibiotics?

Here are some key factors to keep in mind when deciding if antibiotics are the correct treatment option.

If the illness is caused by bacteria: Antibiotics won’t work against viruses or fungi, so determining the source of the illness is critical.

If the infection is severe: In some cases, the risk of taking antibiotics outweighs the benefits if the infection remains mild. But for more severe cases, antibiotics are prescribed to prevent complications.

If your doctor recommends antibiotics: Your doctor will perform the necessary tests and examinations to provide an accurate diagnosis. If they recommend antibiotics, take them as directed according to the instructions.

If you are otherwise healthy: Older adults with pre-existing health problems or those who are immunocompromised may not be the best candidates for antibiotics.

While developing antibiotic resistance can occur due to many reasons, understanding how to use antibiotics correctly is the most important thing you can do as a patient. When prescribed antibiotics, be sure to use them as directed by your provider. Don’t hesitate to reach out to your doctor or nurse if you have questions.

If you’re looking for a new primary care provider, Ana Garcia, APRN-CNP, is accepting new patients. Call to learn more or click here to schedule online.