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Why Should We Care About Antibiotic Resistance? A Q&A with George Liu, MD, PhD

In (fairly) recent history, it’s safe to say that one of the most revolutionary additions to the world of health care has been antibiotics. Designed to attack bacterial infections, antibiotics have made countless ailments that were once serious — or even fatal — simple and quick to overcome. However, with ease and efficacy has also come overuse, which, combined with bacteria’s natural ability to evolve, has led to an alarming problem: many types of bacteria are starting to outsmart antibiotics. What exactly does that mean for us as a society, and for the future of health care?

We asked George Liu, MD, PhD, chief of the Division of Infectious Diseases at Rady Children’s Hospital-San Diego and a lauded antibiotic-resistant bacteria researcher, to weigh in on this complex and quickly growing threat to public health.

What is antibiotic resistance and why is it such an important public health issue?

Antibiotics are one of mankind’s most important discoveries.  They allow us to survive serious bacterial infections. When bacteria become resistant to an antibiotic, it means that the antibiotic can no longer kill that bacteria. If the bacteria develops resistance to all antibiotics, it means that we could be back to where we were a century ago, being at the mercy of pathogens and not surviving even routine infections. The impact on public health would be devastating.

How does antibiotic resistance happen?

Bacteria are constantly evolving. When challenged with an antibiotic, the bacteria will find any way they can to survive. That could happen if bacteria acquire mutations that allow them to evade an antibiotic’s killing mechanisms.  More commonly, some bacteria have developed ways to escape or neutralize certain antibiotics, and have passed those strategies on to other types of bacteria through DNA. Because bacteria adapt so well to their environments, experts agree that it’s only a matter of time before they become resistant to all antibiotics that are available.

Are certain types of bacteria more susceptible to becoming resistant?

Yes, some bacteria mutate more easily or are better at transferring antibiotic resistance genes.  Therefore, it just takes exposure to some antibiotics to trigger resistance in those microbes. It is worth noting that when we take antibiotics, the drugs act not only on the pathogen causing our infection, but also on the billions of good or bad bacteria that live in our nose, mouth or gut, potentially making them resistant to that antibiotic. Some of those antibiotic-resistant bacteria from any part of our body could come back and infect us when our immune system weakens.

What actions can we take as a society in order to help reduce resistance?

Antibiotic resistance happens when we consume lots of antibiotics. Antibiotics, when taken appropriately, help us recover from infections more quickly. However, antibiotics are often prescribed inappropriately — e.g., for viral infections, when bacteria play no role. If doctors and patients avoid using antibiotics unnecessarily, we could make a big dent in our fight against resistance. When antibiotics are prescribed, they should be as specific to an infection as possible. This minimizes their effects on all bacteria in our systems.

Aside from antibiotic resistance, what are other potential adverse effects of taking antibiotics?

Antibiotics were once thought to be relatively harmless.  However, recent studies of the bacteria in our gut (the gut microbiome) have unveiled quite a few surprises on how antibiotic use could have long-term, adverse consequences on our health. For example, emerging evidence now suggests that disrupting  our gut microbiome with antibiotics that attack a wide range of bacteria may  make us more obese, modify our immune system and the course of diseases, and  affect behavior. While fully verifying these findings requires additional research, including in larger human trials, doctors and patients must now carefully consider if an antibiotic is truly necessary.

What systems does Rady Children’s have in place to properly prescribe antibiotics?

We have an antimicrobial stewardship team that provides day-to-day guidance on proper use of antibiotics. They study patterns of antibiotic resistance in patients’ bacteria tested at our labs, which which helps guide physicians on their choice of antibiotics. The team also restricts the use of some overly broad antibiotics, audits and provides feedback on how physicians prescribe antibiotics, and publishes guidelines on the most appropriate antibiotics to give for common infections.

What are some illnesses many people think need antibiotics, but don’t and should not be treated with them?

Viral illnesses often mimic bacterial infections and can make the patients feel miserable, prompting them to seek antibiotics. However, antibiotics have no effect on viruses, and in fact could have adverse effects as discussed. Doctors are routinely taught to distinguish between bacterial and viral illnesses to reduce inappropriate prescription of antibiotics. The American Academy of Pediatrics has also published guidelines on when antibiotics are appropriate for common infections such as upper respiratory infections, sinusitis and ear infections.

Is there any promising research in place for methods, medications, etc., that may counteract resistance or provide new treatments for bacterial infections?

Recently, there has been a greater emphasis on researching new ways to combat antibiotic resistance, including vaccines against multi-drug-resistant bacteria, new antibiotics and innovative approaches that use both antibiotics and immune-boosting drugs.  At Rady Children’s, we will be introducing the use of fecal — poop — transplantation to treat antibiotic-resistant C. difficile infections. This type of infection causes severe, even fatal, diarrhea.

Also at Rady Children’s, researchers are partnering with colleagues at the University of California San Diego School of Medicine Department of Pediatrics in industry-leading exploration into antibiotic resistance.  For example, the Department of Pediatrics’ Dr. Victor Nizet started the Collaborative to Halt Antibiotic-Resistant Microbes, or CHARM, study. CHARM is a research and educational program that has brought together experts from different specialties and from all across the globe over a shared mission: to promote discussion and collaboration around this highly important research area, and to accelerate the pace of innovative research against drug-resistant bacteria.