Op-Ed

Survival tips in the age of drug-resistant bacteria

Kentucky is ground zero for antibiotic prescribing. This map shows zip code level rates for antibiotics prescribed per 1,000 fee-for-service Medicare beneficiaries with Part D coverage in 2016.
Kentucky is ground zero for antibiotic prescribing. This map shows zip code level rates for antibiotics prescribed per 1,000 fee-for-service Medicare beneficiaries with Part D coverage in 2016. Source: Centers for Medicare and Medicaid Services

There is a war going on, reminiscent of a zombie apocalypse. The insidious agent is spread easily between people, a bite is not required. It does not turn its captors into mindless killing drones but instead, when they least expect it, they are slowly eaten from the inside out. The apocalypse is called drug-resistant bacteria and, so far, modern medicine is failing miserably at stopping it.

Some projections estimate the death toll each year will reach tens of millions worldwide, surpassing cancer and heart disease to become the leading cause of death. This is not surprising, since in their weakened state, many patients including those with cancer, are likely to acquire these untreatable organisms in a health-care setting and die from them.

So it is up to you. Here is what you can do and need to know to survive in the post-antibiotic world:

▪  When seeking health care, ask about their MRSA (methicillin-resistant staphylococcus aureus) and c. diff (clostridium difficile) rates and any recent outbreaks of other dangerous bacteria. Check Hospital Compare to at least determine the facility’s track record. An institution’s reputation or ability to handle complex cases do not mean they are good at preventing these infections.

What is needed to protect against these dangerous organisms is a seek-and-destroy methodology, similar to that employed by the Veterans Administration and England’s National Health Service. If you are going for surgery and are not offered a test to see if you are a MRSA carrier, ask for one. If you are told it is not cost effective, remember it is a $10 preoperative test. What is not cost effective are the seven-figure salaries paid to many nonprofit hospital CEOs. There is solid evidence that MRSA preoperative screening is needed for most major surgeries to optimize preoperative antibiotic selection and, if MRSA is detected, to decolonize patients.

▪  Avoid the use of antibiotics whenever possible. Antibiotics are not over-the-counter drugs; doctors have a statutory and ethical responsibility to be the gatekeeper of antibiotic usage, but all too often they succumb to patient pressure. Not using antibiotics is a hard sell in Kentucky. The accompanying map shows antibiotic usage in Medicare patients for fiscal year 2016. Kentucky is in the red bull’s eye of antibiotic overusage. Similar to opioids, but in this case we are the top user, more than double the usage in other states.

For most common illnesses, antibiotics are not effective, they will not work on viruses that cause the common cold nor on the flu. They will also not work on most “sinus” infections.

You might still want an antibiotic and ask, why take the risk? But remember antibiotics are toxins which kill bacteria and can cause side effects in those who take them. Diarrhea, nausea, dizziness and skin rashes are common but are more of a nuisance compared to contracting the dangerous gastrointestinal infection caused by c. diff. This organism is almost impossible to get rid of since it is not only resistant to many antibiotics but will transform into a spore which is an impervious fortress, allowing it to remain inactive for years, only to reemerge when the body is in a weakened state. You know this is a bad actor when severe cases are being cured (and to a very high degree) by using a tube to place someone else’s feces into the patient’s GI tract. Even the mention of this a decade ago would have been meet with ridicule and disbelief but “desperate times call for desperate measures.” Lucky this one works.

In Kentucky, the fluoroquinolone (Cipro, Floxin) class of antibiotics is prescribed at one of the highest rates in the nation. They are often prescribed inappropriately and given for acute sinusitis, bronchitis and uncomplicated urinary tract infections. The Food and Drug Administration warns of “disabling side effects.” These include tendon rupture and central nervous system toxicity resulting in confusion and hallucinations.

▪  Finally, stay healthy and get your vaccinations. Rather than subjecting your body to dangerous toxins, vaccinations are a natural way of augmenting your defenses to fight bacteria by putting your immune system on alert to ward off invaders.

Drug-resistant bacteria are here to stay, and the very place you trust and turn to when you are in need may well be the place that makes you deathly sick. Taking simple steps of avoiding antibiotic use, maintaining good hygiene, and making smart, informed decisions when you become ill can help keep you out of harm’s way.

Kevin Kavanagh of Somerset is a retired physician and board chairman of Health Watch USA.

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