Click for here for pdf version

Scarlet fever, once a feared disease that killed many thousands, today rarely leads to death and is easily treated by antibiotics. Tuberculosis, pneumonia, strep throat, gangrene…the list of bacterial infections that were once serious killers is long, and all can now be treated with what were once called ‘miracle drugs’, or antibiotics.

What are antibiotics?

Antibiotics are drugs that fight bacteria that cause infections. After the widespread use of antibiotics in the 1940s, medical care was transformed. They dramatically reduced illness and death from bacterial diseases.

Bacteria are found everywhere; inside our stomach, on our skin, in the food we eat, on surfaces we touch, and even in the air we breathe. Many types of bacteria are beneficial, such as the type that makes yogurt and those that help us digest food. There are also disease-causing bacteria, such as Streptococcus (responsible for strep throat and scarlet fever) and Mycobacterium tuberculosis (causes tuberculosis). However, many illnesses are caused by viruses and not bacteria. Viral infections cannot be treated by antibiotics.

When are antibiotics necessary to treat an infection?

Ultimately, your healthcare provider will decide, based on your symptoms and results from laboratory tests, whether you have a viral or bacterial infection and if antibiotics are needed.

Here are some common infections that may not require antibiotics.
Ear infections: There are several types and can be caused by either a virus or bacteria. Only the bacterial infections can be treated by antibiotics.

Sinus infections: Most children with thick and/or green mucus do not have a bacterial sinus infection. Mucus production is often the product of a viral infection. However, antibiotics may be needed for long-lasting or severe cases.

Cough or bronchitis: Children rarely need antibiotics for a cough or bronchitis.

Sore throat: Viruses cause most cases. Only one major type, strep throat, requires antibiotics, and this condition is diagnosed by a laboratory test.

Colds: These are caused by viruses and are not treatable with antibiotics.

What is antibiotic resistance?

Antibiotic resistance is the ability of bacteria or other microbes to resist the effect of an antibiotic. This occurs because germs constantly adapt to their environment. When antibiotics are used inappropriately, the weak bacteria are killed, while the stronger, more resistant ones survive and pass along their resistance to the next generation of bacteria. This problem is then compounded because once a bacterium has developed resistance to one antibiotic, it can easily develop resistance to another antibiotic. Bacteria that are resistant to multiple drugs are termed ‘superbugs’. In Canada, superbugs killed 8,000 hospital patients in 2005 and cost our health-care system an estimated $100 million (Taylor et al, 2006).

The chart below highlights the growing problem of antibiotic resistance.

What does antibiotic resistance have to do with my kitchen sponge?

There are several causes of antibiotic resistance, including overuse (prescribing an antibiotic for a viral infection), inappropriate use (misdiagnosis resulting in an inappropriate antibiotic being used), and misuse (not taking the prescription according to instructions or not finishing the prescription). All of these involve prescribed antibiotics. Other sources responsible for the development of resistant bacteria are products containing antibiotics, such as soap, cleaners, and kitchen sponges. These products contain the antibiotic triclosan.

Triclosan is an antimicrobial agent added to many products, including cleaning supplies, toys, and skin care and oral hygiene products. Bacteria respond to triclosan in a similar way as to prescribed antibiotics, and can in fact develop resistance to it. Aiello et al. (2004) found bacteria that can survive the low concentrations of triclosan already in our water supply. These resistant bacteria can then pass the resistance along, eventually making triclosan powerless. Triclosan gets into our water supply from antibacterial consumer products, such as soap and kitchen sponges.

True or False
Using antibacterial soaps stop people from getting sick.

False: Larson et al. (2004) found that there were no differences in the number of illness symptoms between households that used antibacterial products and those that did not. Using antibacterial soaps, sponges, and other products did nothing to reduce illnesses. This may be due to the fact that some of the most common illness, such as colds and flu, are viruses which are not affected by antibiotics.
 

What can I do to help prevent and reduce drug resistance?

Health Canada (2005) suggests several ways to use prescribed antibiotics safely and appropriately.

• Take medication as directed. Do not skip doses or stop taking a prescription part way through without first discussing it with your doctor. Even if you feel better, use the entire prescription as directed to make sure that all of the germs are destroyed.

• Do not share prescriptions with anyone else. Taking an inappropriate drug makes the resistance problem worse.

• Dispose of unused medication at the pharmacy. Flushing the drug down the toilet or sink means it ends up in our water supply, which can increase the drug resistance problem.

• When going to the doctor, do not always expect to get an antibiotic for treatment. This puts pressure on doctors to prescribe a drug that may not be necessary. Instead, talk with your doctor about what type of infection you have (viral or bacterial) and ask what else you can do to feel better sooner.

Keeping your hands clean, through regular washing with soap and water, is the single most effective way to prevent the spread of infection.

Other ways to help

• Wash your hands frequently with regular soap and water, for 15 to 20 seconds. This is the most effective way to prevent infection. Alcohol hand sanitizers are also good to use and do not have the same problems associated with products containing triclosan.

• Avoid the use of antibacterial soaps and other products. These products not only increase the possibility of creating resistant bacteria, they also kill ‘good bacteria’. To keep your kitchen sponge clean, microwave the damp sponge regularly, for 1-2 minutes. This will effectively sterilize it. Also, be sure to replace your sponge often.

• Cleaning with soap and water, or disinfecting surfaces with a water-vinegar or water-bleach solution, is sufficient to keep your home clean and free of harmful bacteria.

• Store, handle, and prepare food safely. When preparing food, be sure to wash all surfaces, including cutting boards and counter tops, with a mild bleach and water solution. For more information on food safety visit www.canfightbac.org.

Remember, most germs, bacteria or viruses, find their way into the body by way of your hands, usually by touching your eyes or nose.
 

Key References:

Aiello, A.E., Marshall, B., Levy, S.B., Della-Latta, P., & Larson, E. (2004). Relationship between triclosan and susceptibilities of bacteria isolated from hands in the community. Antimicrobial Agents and Chemotherapy, 48, 2973-2979.

Health Canada. (2005). Antibiotic Resistance. (Catalogue# H50-3/113-2004E-pdf). Ottawa, ON: Queens Printer. 

Larson, E.L., Lin, S.X., Gomez-Pichardo, C., & Della-Latta, P. (2004). Effect of antibacterial home cleaning and handwashing products on infectious disease symptoms. A randomized, double-blind trial. Annals of Internal Medicine, 140, 321-329.

Public Health Agency of Canada. (Feb. 1, 2005). Surveillance for Methicillin-Resistant Staphylococcus aureus in Canadian hospitals - A report update from the Canadian Nosocomial Infection Surveillance Program. Canada Communicable Disease Report, 31-03.

Taylor, G., Johnston, L, & Simor, A. (2006). Public reporting and inter-hospital comparison of health care-acquired infections. Association of Medical Microbiology and Infectious Diseases– Canada. Retrieved October 10, 2006 from http://www.chica.org/pdf/AMMIposition.pdf.