Antibiotic Resistance: A Personal View

The medical community has, in recent years, stirred public fear of disease by championing the concept of antibiotic resistance. The principal is based on evolution (and, by the way, is direct and demonstrable evidence that evolution is a valid concept), in which bacteria are exposed to antibiotics. The pathogens adapt through natural selection and become resistant to antibiotics.

Scientists and physicians are eager to claim that this is a result of the overuse of antibiotics. While this may be true to some degree, nothing in biology happens in a vacuum.

I know I am not a researcher, and I don’t want to sound like a million other rubes who start topics with, “All I know is…” Think of this as an observational element to consider as part of the big picture.

My own experience with the creation of antibiotic resistance happened in October 1986, somewhat early in the season for upper respiratory infections. My girlfriend and I both came down with it at the same time. The symptoms were very general, including a very sore throat that became a dry, hacking cough in two or three days. The cough was hard enough that I pulled a muscle in my abdomen. It woke me up several times a night. I kept hoping the cough would abate on its own, but after ten days with no improvement at all, I went to a doc-in-the-box, since I didn’t have a physician at the time.

The doctor who saw me spent little time examining me. She glanced at my chart and asked, “So you have the crud, huh?”

She wrote a prescription for seven days of erythromycin, a small, pale, pink and white pill that resembled a bird egg and smelled faintly sweet. I started taking them exactly as directed, and in a couple of days, my cough was almost gone. I continued taking the erythromycin exactly as directed, even though they hurt my stomach. At the end of the seven days, I thought I was well.

A couple of days after I was out of medication, the sore throat returned, and the next day I was coughing again.

This is an antibiotic called cephalexin, brand name Keflex. I took this drug as a child, when the pathogen community was less resistance to it. In 1989, I experienced a serious allergic reaction to penicillin, so I avoid all drugs in that range, including cephalexin.
This is an antibiotic called cephalexin, brand name Keflex. I took this drug as a child, when the pathogen community was less resistance to it. In 1989, I experienced a serious allergic reaction to penicillin, so I avoid all drugs in that range, including cephalexin.

I went back to the doc-in-the-box and was given another seven day course of erythromycin. The same thing happened. I felt better soon enough, but at the end of the course, my symptoms returned.

My third visit to the doc was like the first two, with the exception of me asking, “Are you sure you can’t give me two weeks of erythromycin?”

The answer was no, a week should be enough to do the job.

When my symptoms returned yet again, this time in December, I’d been sick off and on for a couple of months. My girlfriend’s best friend was a nurse, and at my behest she held back some erythromycin that was slated to be destroyed (since it had been prescribed for someone else who was later switched to a different drug), three weeks worth.

Finally, by New Year’s Eve, I was really done being sick.

This story is almost a lesson in how to deliberately create antibiotic-resistant pathogens: attack them with a medication that doesn’t kill them all, leaving the stronger, better adapted ones behind. Allow them to grow. Attack them again, killing the weaker ones of that generation, leaving the stronger, better adapted ones behind. Allow them to grow. Repeat.

The core point of this story, then, has to be that in cases like this, physicians are lazy and inattentive, and live in something of a vacuum. There was virtually no doctor-patient relationship, and no effort to follow my progress. Lastly, the doc-in-the-box didn’t really listen to anything I said. She had already assumed that either I didn’t need antibiotics at all, or that the pathogen I had was the same she’d seen in other cases.

Before you eagerly point out that surely this must have been one bad doctor, let me say that this experience was repeated time and again until I got married and Abby and I found a good physician and saw only him. I would venture to guess that many people have similar stories of doctors who don’t have the time or energy or devotion to actually do their jobs well.

So, fair readers, my advice is this:

  • Be an aggressive advocate for thorough treatment.
  • Find a decent doctor and establish a relationship with them.
  • Always take all your medication exactly as directed.
  • Know your body and learn how to communicate what’s wrong with it.
  • Be aware that no doctors are perfect. If Ann Kelley had sought a second opinion in 2009, she might be alive today.

In conclusion, I believe that the misuse, particularly the negligence and apathy of the medical community, is a significant factor in the development of antibiotic resistance.

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2 Comments

  1. Maybe it’s just a run of bad luck, but…

    In my (fortunately limited) experience with doctors, they remind me quite a bit of public defenders you might meet at a local courthouse — in that they seem to have good intentions (and excellent training!) but rarely get around to doing their actual jobs thoroughly.

    Some of the worse examples would be the doctors that treated both my grandmothers (one still living) over the last couple of decades. Both of them had to change physicians multiple times over the course of the years due to misdiagnoses, prescriptions for the wrong drugs (or wrong amounts) — sometimes due to the misdiagnoses, and perhaps most disturbing: a general unwillingness to listen to the patient, and in some cases outright disbelief of the patient. (“You couldn’t have experienced that; it’s impossible”, one of them said in response to a report of side effects.)

    So I counted my family very fortunate that my wife found an excellent doctor for our two recent pregnancies, and a pediatrician that is at least tolerable.

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