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Despite anthrax fears, overusing antibiotics can lead to bugs that are harder to kill

The image is unnerving: all around us, invisible to the eye, bacteria. Crawling around on our skin, in our guts, in our throats and lungs.

"We all live in a sea of bacteria," said Dr. Hugh Straley, associate medical director at Group Health Cooperative.

Most of the time, we coexist with our little friends. They don't hurt us; we don't hurt them. Sometimes they even help us — for example, in digesting food.

Sometimes, though, Bad Bugs come along. Some E. coli from the wrong side of the tracks. Some cocky pneumococci, looking for someone to play host organism. These guys, known as pathogens in the medical world, want to be in charge. Sometimes they can be killers, like Bacillus anthracis — anthrax.

And patients, aided and abetted by doctors, are inadvertently giving bad bugs the upper hand, warn experts, by using antibiotics in the wrong ways.

These days, antibiotics are on our minds. Ciprofloxacin (Cipro) and doxycycline (many brand names), touted as effective against the anthrax bacterium, have become hot sellers, as people stockpile them "in case." (One report had Cipro outselling Viagra. The headline is tempting: "Fear Trumps Hope of Sex," but that's another story.)

For health educators, the anthrax scare has provided what they call "a teachable moment." Roving bands of top doctors, health-plan administrators and public-health officials are insisting that we listen up: Don't take antibiotics when you don't need them!

As patients, we forget momentarily that most of the invaders reducing us to sniffly, achy, miserable human beings are viruses. We vaguely remember that viruses aren't harmed by antibiotics, which kill only bacteria, but we don't care. We plead with our doctors for relief. And doctors, besieged with patients like us, give in.

So we end up using antibiotics for the wrong reasons. Even if we use them for bacterial infections, sometimes we get the wrong antibiotic. Sometimes we take the pills just until we feel better, and forget the rest. And in all these cases, we help create resistant strains of bacteria by weeding out the weak. With no competition, the resilient strains thrive and multiply.

Bacteria — let's face it — may be smarter than we are. They adapt, mutate, learn new tricks. They arm themselves against certain antibiotics, borrow "resistance" genes from other bacterial cells, and figure out how to pump those nasty antibiotics right out of their little bacterial bodies.

Then they go on to wreak havoc somewhere else — possibly on someone in a weakened condition.

Medical experts say we're creating what some refer to as "an epidemic" of drug-resistant bacteria. For example, back between the late 1970s and late '80s, only .02 percent of pneumococcus strains (the most common bacterial cause of pneumonia and other illnesses) were resistant to penicillin. By the late '90s about 25 percent of the bug's strains were resistant, said Dr. Art Sprenkle, project medical director for the Washington Alliance Working for Antibiotic Education (AWARE). And more become resistant every day.

There are some folks around who remember life before antibiotics — a time when a common bacterial infection could, and did, kill people. Although discovered initially in 1896, then rediscovered by a Scottish physician, penicillin, the first antibiotic, didn't become widely available until 1943.

Four years later, microbes began appearing that could resist it.

Today, staphylococcus, a common bacterium often found in hospitals, has developed strains that can resist vancomycin, the last-ditch antibiotic. Little reported, the resultant deaths "should have sent shudders" through the medical community and the public, one expert wrote.

From a patient's point of view, the trend toward antibiotic resistance should be alarming. Every hour, two people in the U.S. die from complications related to antibiotic resistance, said Dr. Maxine Hayes, public-health officer for the Washington state Department of Health.

There are likely a number of reasons for the problem besides patients' overuse of drugs.

Some point to the proliferation of antibiotics used in food-producing plants and animals. Experts say this "sub-therapeutic" level of antibiotics in the food we eat constantly selects for resistant strains of bacteria.

Experts are also concerned about the routine use of hand lotions and other products containing antibacterial agents. Those products, too, promote the growth of resistant strains of bacteria.

Perhaps the most important thing patients can do is to remember this: Human beings have a miraculous system already in place to defeat viruses and most bacterial onslaughts. Think about what happens when you get a cut, or a cold, and don't use antibiotics.

(Right — you get better.)

Most patients with viruses who badger their doctors for antibiotics will get them, though the doctor knows the pills won't be effective.

"Doctors often feel the power they have is on their prescription pad," Straley concedes. With a persistent patient, "the majority of docs will cave in."

Local doctors will get a little help from AWARE, including prescribing guidelines for the most common illnesses for which antibiotics are prescribed — a sort of flow chart that will help sort out whether antibiotics are really needed.

They'll also receive a confidential "report card" comparing their antibiotic prescribing habits with their peers'.

Some diseases are a tough call. Ear infections in children are one of the most common causes of antibiotic prescriptions. Studies show, said Straley, that about 81 percent of children with acute ear infections get better without antibiotics. And 92 percent recover when given antibiotics. In other words, only about 11 percent are actually benefiting from antibiotics; nine out of 10 are getting the antibiotic needlessly.

It's often hard to tell, however, which screaming, unhappy child is the one in 10 who needs the drugs. But pediatricians, through education and dissemination of guidelines, have begun to cut down significantly on antibiotic use.

And sinus infections, too, can be troublesome. Most will clear up on their own, but some longer-term infections will need antibiotics.

Even when an antibiotic is warranted, urges Dr. Neil Barg, a specialist in infectious disease and epidemiology in Yakima, patients can help doctors do the right thing. "Don't get a fancy-schmancy quinalone antibiotic — Cipro, Levaquin, Tequin — don't accept that from the doctor if amoxicillin can do the job."

If patients can learn to recognize, even on a rudimentary level, what illnesses are caused by viruses and which ones are caused by bacteria, if they can start asking, "Do I really need that antibiotic?" says Straley, the whole community — if not the whole world — will benefit.