Overuse of Antibiotics is Causing a Worldwide Threat to Human Health

As many know, antibiotics are used to treat infection. But specifically what types of infection do they treat? And how do they work? 

Antibiotics are used to treat, and in certain situations prevent, certain types of bacterial infection. They usually either prevent the reproduction of bacteria or kill the bacteria. They are not effective against viral infections, which include the common cold, flu, most coughs, and sore throats, so taking antibiotics for these is an example of misuse. It won’t help your infection, and it contributes to antimicrobial resistance. 

Many mild bacterial infections do not require antibiotics, as our immune system can often clear these effectively. Antibiotics in most cases should be used to treat bacterial infections that have a higher risk of more serious complications or persistent infections. 

There are also certain conditions, which carry a greater risk of developing infective endocarditis, which is an infection caused by bacteria that enter the bloodstream and settle in heart lining, a heart valve, or blood vessel. These patients will typically need to take antibiotics prior to certain dental procedures. 

Overprescription

In 2019, a study showed that 81% of preventive antibiotics prescribed by dentists were unnecessary.

The current infective endocarditis guidelines state that use of preventive antibiotics before certain dental procedures is reasonable for patients with: prosthetic cardiac valves, prosthetic material used for cardiac valve repair, history of infective endocarditis, a cardiac transplant with valve regurgitation due to a structurally abnormal valve, unrepaired cyanotic congenital heart disease, including palliative shunts and conduits, and any repaired congenital heart defect with residual shunts or valvular regurgitation at the site of or adjacent to the site of a prosthetic patch or a prosthetic device.

Yet, you may have been told to pre-medicate for conditions outside of this list. One of the most common examples of this is the recommendation by doctors for pre-medication for prosthetic joints. In general, for patients with prosthetic joints, prophylactic antibiotics are not recommended prior to dental procedures. This is based on a review of scientific evidence, which showed that the risk of adverse reactions to antibiotics generally outweigh the benefits of prophylaxis for many patients who would have been considered eligible for prophylaxis in previous versions of the guidelines. It also takes into account the concern regarding the development of drug-resistant bacteria. There may be exceptions for patients with a history of complications associated with their joint replacement surgery. But for many cases, antibiotic prophylaxis is not recommended. Yet, many doctors still pre-medicate patients for these and other conditions outside of the guidelines.

The CDC estimates that at least 30% of antibiotics prescribed in the outpatient setting are unnecessary.

Leftover Antibiotics

Not all antibiotics are equally effective against different bacteria. For example, in dentistry, Amoxicillin is the typically the first-line recommended drug, but it may not be the first choice for every type of infection. There are broad spectrum antibiotics and there are narrow spectrum antibiotics, which have different indications. Expired antibiotics can lose potency, fail to treat infections and promote antibiotic resistance. The same can occur if you take improper doses. Persisting infections should be evaluated by a doctor to recommend the best course of action. Dental infections typically indicate a problem that requires treatment, not just a prescription.

For these reasons, you should never take leftover or expired antibiotics, whether they are yours or not. You should consult with a doctor with antibiotic stewardship to find out if an antibiotic is necessary at all, and if so, the most appropriate drug and course.

Typically there should not be leftover antibiotics when taking a course as prescribed. But in cases when you may have leftover antibiotics, you should dispose of them responsibly to minimize potential abuse. If you have a nearby pharmacy or med drop that takes back drugs, this is the best method. If you have no other option, mix liquids or uncrushed pills with an unappealing substance such as cat litter or used coffee grounds, and place in a sealed bag, with all personal information removed before tossing.

Threats to Human Health

The World Health Organization has declared antimicrobial resistance as one of the top ten global public health threats facing humanity.

Antimicrobial resistance (AMR) occurs when germs develop to resist the drugs designed to kill them. Anytime antibiotics are used, they can contribute to AMR.

This is because AMR is driven by a combination of germs exposed to antibiotics, the spread of both those germs and their mechanisms of resistance. Antibiotics are vital and in some cases can be life-saving. But the misuse and overuse of them compromises their continued effectiveness.

Have you ever heard of MRSA? MRSA stands for Methicillin-Resistant Staphylococcus Aureus, which is essentially a super bug that has evolved to be resistant to some antibiotics, and it isn’t the only one.

Over 35,000 people die each year in the US as a result of antimicrobial-resistant infections.

In addition to death and disability, extended illnesses lead to longer hospital stays, the need for more expensive medications, and it can be difficult to manage financially for those impacted. Without effective antimicrobials, our ability to successfully treat infections, including for life-saving procedures are at significant risk.

Another issue, which should not be taken lightly is that antibiotics disrupt microbial balance, sometimes eliminating unintended bacteria, and making hosts more susceptible to other infection, such as those caused by Clostridioides difficile. Illness from this bacterium most often occurs after use of antibiotics. It can cause severe diarrhea and even life-threatening damage to the colon.

Dental Infections

Many patients believe they need an antibiotic prior to being able to perform certain procedures, such as dental extractions. This is generally not the case. In most situations, the most ideal course of action is to complete the procedure immediately without the use of antibiotics. Blanket prescriptions after certain procedures are also not warranted. Pain is not an appropriate reason for the prescription of an antibiotic. Never pressure your doctor for a prescription.

ABOUT THE AUTHOR

Dr. Kelsey B.P. Garza is a General Dentist and the owner of Darling Dentistry in Bulverde, TX. She is delighted to be able to provide patients in and around Bulverde and Spring Branch with an elevated experience to the dentist through quality, compassionate, and ethical care with special attention to providing a more relaxing environment and helping patients overcome dental anxiety and fear. She is an active member of the Academy of General Dentistry, American Dental Association, American Association of Women Dentists, Texas Dental Association, San Antonio District Dental Society, and the Bulverde - Spring Branch Area Chamber of Commerce. She is a an advocate of antibiotic and prescription stewardship. She is accepting new patients. If you have any questions or concerns or would like to schedule an appointment, click the Schedule Now button to reserve your spot through our online scheduling, or reach out to 830.357.7177 or care@darlingdentistry.com.

References:

https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/antibiotic-prophylaxis
https://www.cdc.gov/antibiotic-use/antibiotic-resistance.html
https://www.cdc.gov/drugresistance/biggest-threats.html
https://www.fda.gov/drugs/special-features/dont-be-tempted-use-expired-medicines
https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/antibiotics/art-20045720
https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance