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Perspectives in Health Magazine |
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I entered medical school in the 1950s, about ten years after the appearance of the first antibiotics. I can still remember the feeling of euphoria over these "magic bullets" which we thought would put an end to infection. The medical arrogance that accompanied the ready availability of these life-saving drugs led many to forget the major advances that public health had wrought. We can now reflect and remember that the nearly half-a-century added to average life expectancy since 1700 is owed much less to antibiotics than to public health measures. Cleaner water, better sanitation, improved housing, public as well as medical awareness of the role of "germs" in causing disease--all these combined with improvements in diet account for the greatest increases in the human life span during the last three centuries. But the situation has changed dramatically over the past half century, and the alarm bells are now ringing, calling us to note that the problem of antibiotic resistance is with us and growing. Ever since antibiotics first became widely available in the 1940s, the disease-causing bacteria they are intended to fight have been developing resistance to them. The acceleration of this process in recent decades has led microbiologists to sound alarm bells that have by now focused widespread attention on the problem. Globally, first-line antibiotics are no longerw in effective in treating resistant strains of several of the world's most threatening infectious diseases, including tuberculosis, pneumonia, , and choleraand many sexually transmitted infections. Everywhere, the consequences of growing antibiotic resistance are no longer limited to hospital settings and immunocompromised patients, but are showing up in community-acquired infections as well, essentially as a manifestation of indiscriminate use. We think of antibiotics, rightly, as life-saving drugs whose discovery--like the earlier discovery of vaccines--revolutionized medicine. Yet it is important to remember that the nearly half-a-century added to average life expectancy since 1700 is owed much less to antibiotics than to public health measures. Cleaner water, better sanitation, improved housing, public as well as medical awareness of the role of "germs" in causing disease--all these combined with improvements in diet account for the greatest increases in the human life span during the last three centuries. To be sure, antibiotics are today an integral part of the public health panoramapractice, and they should be viewed as such. In many cases, Tthhey are public goods, with both individual and societal benefits, that must be managed essentially as nonrenewable resources. as such. Yet the public too often seems to view antibiotics more as private consumer goods, in many casesand as virtual cure-alls for any ailment that affects the upper respiratoryappears to be infectious, regardless of origin. system. Surveys carried out in the United States have found that a third to half of respondents are not aware that the secommonly used antibiotics drugs are effective only predominantly against bacterial illnesses, not against the common cold, flu orviral infections or allergies. But consumers are not the only problem; physicians play a contributing role as well. Doctors are well aware that when their patients take the time and effort to visit them, they are often not satisfied with "take two aspirin and call me in the morning." Those who want to maintain good patient relations too often give in to pressure and prescribe antibiotics, even when their better judgment tells them not to. This dynamic was surelymay very well have been at work late last year when panicky U.S. consumers threatened to deplete U.S. stocks of ciprofloxacin in New York and other areas during the anthrax bioterrorism scare. To educate the public and ease the burden of education for doctors, a new PAHO-sponsored public service announcement was recently launched throughout Latin America and the Caribbean. It explains that antibiotics are not appropriate for every illness and appeals to patients to accept that explanation from their doctors. Its educational function is especially important, since in many Latin American and Caribbean countries, antibiotics are easily purchased without a doctor's prescription. But judicious prescribing of antibiotics also requires that doctors themselves keep up to date about new antibiotics and treatment protocols, which are changing in response to growing antimicrobial resistance. The emergence of multidrug-resistant tuberculosis has shown how poor prescribing practices (along with patient noncompliance) can contribute greatly to the problem. A third target of this campaign must be the agriculture industry. In the United States, an estimated 40 percent of antibiotics produced are used for animals, the bulk of these in low doses for the purpose of promoting growth, not curing disease. Antibiotics used on crops (primarily fruit trees) leave resistance-promoting residues on our foodstuffs. These practices promote the growth of resistant bacteria and their spread throughout the food chain. The European Union has now banned the nontherapeutic use of antibiotics in agriculture, and U.S. and Canadian regulators are considering new controls in their countries. Latin American countries that have adopted these agricultural practices should consider similar measures. Pharmaceutical research will no doubtcertainly continue to produce important advances innew antimicrobial drugs, but we clearly cannot afford to place all our eggs in that one basket. We must use our arsenal of public health measures to prevent infection, reduce the spread of antibiotic resistance, and save the potency of existing drugs while we still can. We all have a role to play in protecting antibiotic effectiveness, and we ignore this at both our individual and collective peril. To your health,
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