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1: The Antibiotic Crisis

Crisis, What Crisis?

Health care in the industrialized world has never been more available, or so we are told.

More and better hospitals are built (are there more sick people?).

Ever more complex and high-tech treatments are devised.

Life-expectancy rates are rising (quantity, perhaps, but what of quality?).

Research continues at breakneck pace into all aspects of disease causation and treatment.

New, highly trained doctors and nurses are turned out every year.

… And yet there really is a crisis, as we will see.

Old diseases such as TB which were thought to be history are back, and are often untreatable because the bacterial agents which cause the infections have become resistant to antibiotics which previously controlled them easily.

This acquired resistance presents an enormous threat to the health of us all, not just those who are malnourished and impoverished.

Whether or not more and more hospitals and high-tech diagnostic and treatment methods equate with better health for the general public is itself open to question. However, what is not debatable is the fact that one of the most potent tools in the medical tool-box, antibiotics, are no longer working on many extremely dangerous bacteria, or only work when used in amounts so high that they are likely to cause serious side-effects.

The evolution of antibiotic-resistant bacteria – superbugs – therefore forms a significant part of the story we need to examine in order to understand the crisis.

The UK Office of Health Economics reported in September 1997¹ that –

5,000 people are being killed every year in British hospitals by infections they catch – when they are in the hospital.

A further 15,000 people’s deaths are being contributed to infections they catch – when they are in the hospital.

One in every 16 patients who goes into the hospital for anything at all will develop a ‘hospital acquired infection’ (HAI) – a serious illness which they catch from someone in the hospital, usually a member of staff.

In intensive care units the rate is as high as one patient in every five developing an HAI.

The most common of the infections acquired in this way relate to the bladder, chest and surgical wounds – and many of them involve difficult to treat ‘superbugs’ (see below).

In the US, figures published in 1994 show that one patient out of every 10 develops infections caught in the hospital, and that this involves around 2.5 million people every year.

Every year 20,000 of these people die from – and the deaths of a further 60,000 are contributed to by – the hospital acquired infections, a huge number of them involving antibiotic resistant superbugs.²

Internal Ecological Damage

There is, however, another major outcome from the use of antibiotics which forms a less obvious but nevertheless very important part of the crisis story; the devastation that occurs in the internal environment of the body, its own ecology, especially that of the intestinal tract where hundreds of trillions of ‘friendly’ bacteria live and provide life-supporting services for us.

When antibiotics are used against ‘bad’ bacteria which infect us, these friendly bacteria are also damaged or killed. This is why major sections of this book will describe ways in which this internal ecological damage can be minimized or avoided (by using alternatives to antibiotics and improving our own natural defense systems – see Chapters 5, 6 and 9).

The range of conditions which can develop as a result of antibiotics causing damage to the normal intestinal flora is very wide indeed and can include:

elevated cholesterol levels – because the friendly bacteria may not be able to adequately perform their usual ‘recycling’ role (see Chapter 8)

menopausal symptoms, including osteoporosis – more likely and more severe because the friendly bacteria may not be able to perform their normal estrogen- and progesterone-recycling tasks (see Chapter 8)

premenstrual and gynecological symptoms – likely to be more severe for the same reasons

liver disease – more likely because the friendly bacteria may not be able to perform their normal detoxification tasks, so causing excessive loading of the liver

chronic digestive and bowel problems – because of the ecological damage caused to the normal flora, which are vital to normal digestion and intestinal function

increased risk of bladder infections – because of this ecological disorder, which allows the overgrowth of undesirable bacteria and yeasts that are often the ‘reservoir’ for infections in the bladder

serious arthritic conditions – can develop after antibiotic damage to the bowel flora (for complicated reasons which are explained further in Chapter 8)

depressed immune function – a not uncommon antibiotic sequel (as explained in Chapter 5)

and many, many more health problems, ranging from acne to kidney disease, can be linked to antibiotics …

The really important messages which should emerge from the discussions and evidence which will be presented in this and later chapters include the facts that –

Antibiotics can save lives – when used appropriately: right place, right situation, right time, right antibiotic for the correct bacteria, right amount, right means of administration (by mouth or by injection, for example), etc.

Antibiotics are more often prescribed ‘wrongly’ (see below) than correctly – up to 70 percent of the time, say some experts.

One of the results of this wrong use is the emergence of strains of bacteria which can no longer be killed by antibiotics (there are a variety of other reasons for resistance developing, as will be explained).

Even when used appropriately, antibiotics almost always damage the internal environment – especially of the intestinal tract – and this can itself lead to an assortment of health problems later on.

There are tactics, which will be explained, by means of which many of the dangers and side-effects of antibiotic use can be reduced or avoided, particularly by replenishing and revitalizing the important bacterial flora which live inside us, as explained in Chapters 7 and 9.

There are alternatives to the use of antibiotics; the most important of these is an efficient immune system. Methods for encouraging this will be detailed in Chapters 5 and 6.

The antibiotic crisis we face will be evaluated from different perspectives in those sections of the book which deal with protective tactics.

First it is necessary to look briefly at the individual characteristics of a selection of bacteria, as well as at the different types of antibiotics and how they are thought to work.

The ‘alternatives’ to the present ways of handling infection will include the use of strategies that can enhance immune function, make our natural defenses work more efficiently, and reduce toxicity, as well as ways in which damaged internal ecological systems can be repaired or improved.

After that we will survey the short- and long-term dangers of using antibiotics, descriptions will be presented, along with the evidence which supports them, by means of which we can safely reduce the hazards which antibiotics present.

The major suggestions as to what alternatives exist to antibiotics, as well as what to do if you have to take antibiotics (see Chapter 9), as well as strategies for children who have to take antibiotics (Chapter 10) will therefore complete our journey through the story of antibiotic use: a story of high hopes, spectacular successes, emerging doubts and finally looming disaster, as bacteria seem to be winning the battle against medical science.

There Is Real Hope

This is far from being just a doom and gloom story. We can learn a great deal from what has happened in the medical adventure which represents the story of antibiotics up till now, and this will allow us to look at alternative methods of health care and prevention, so that out of this very real crisis can come a positive change for the better.

It is necessary to repeat the statement that antibiotics can and do save lives, and probably do so tens of thousands of times every day. There are times when not taking antibiotics, or not having them administered, could prove to be an unwise, and almost certainly fatal, decision. Some indication will be offered, when we look at different forms of infection, as to when antibiotics are really necessary, and when they might be dangerous.

The crisis in antibiotic use which has gradually emerged over the past 15 to 20 years or so is only partly the result of the overuse and misuse of these potentially life-saving drugs. It is also in large part the natural (and, as we will see, not unexpected) outcome of an attack on a life-form which has found ways of protecting itself – by mutation, by natural selection, as well as by means of in-built resistance.

Resistance

Over the past 15 years a significant change has taken place in the way bacteria that cause infection respond to antibiotics. Many of the bacteria are becoming increasingly drug-resistant, so that more (and stronger) antibiotics are required to control an ever wider, and increasing, range of potentially serious infectious diseases.

As a result there are more side-effects, which are often more severe than previously, and treatment has therefore become both more dangerous and more expensive.

For example, Professor Robert Baltimore of Yale University recently reported that Haemophilus influenzae, which can cause meningitis and which was in the past easily controlled with ampicillin, is now (1997) resistant to antibiotics in around 20 percent of cases. They just don’t work any more.³

The most feared superbug of all is Staphylococcus aureus, which has been the cause of the closure of an ever increasing number of operating rooms and hospital wards, usually temporarily but sometimes permanently, as well as being responsible for the deaths of numerous infected patients.

It has been estimated that around 90 percent of strains of Staphylococcus aureus are now resistant to penicillin and ampicillin, and some strains are resistant to almost all antibiotics except highly potent, highly toxic forms of antibiotic which can themselves cause serious side-effects unless used very cautiously.⁴

THE ECZEMA CONNECTION5,6

A new term is creeping into the medical vocabulary. Not only are we being told about the dangers of superbugs, but now there is talk of the dangers of superantigens (substances which provoke a severe allergic reaction). The superantigens which some bacteria can generate are being blamed for the dramatic increase in the incidence of childhood eczema.

Many bacteria do the damage they do because of toxic and allergy-provoking substances they produce. In the case of eczema, what seems to happen in an increasing number of cases is that the normal, harmless bacteria which live on the skin, such as Staphylococcus epidermidis, decrease in number, probably as a result of antibiotics, allowing Staphylococcus aureus to invade the territory usually occupied by S. epidermidis. This change in the local flora can cause eczema patches to become severely infected, especially if they are scratched, leading to yellow, encrusted, usually weeping lesions.

Research at the Hospital for Sick Children in London in the early 1990s showed that almost 100 percent of children with this form of severe eczema had colonies of S. aureus on their skin, and the more of these alien bacteria that were present the worse the eczema was. These particular strains of S. aureus are a new phenomenon, almost certainly resulting from changes caused by their response to antibiotics which has allowed them to produce the so-called ‘superantigens’.

As Professor Bill Noble of St. Thomas’s Hospital, London explains, ‘These superantigens produce a horrendous response, a vicious allergic reaction at the site of the skin problem.’

Current treatment usually involves more antibiotics, steroid creams and/or antiseptic creams. Now it is reasonable to ask why, if antibiotics have helped to produce the strains of S. aureus which are causing this rampant increase in severe eczema, is it logical to add even more antibiotics into the picture?

This question is even more urgent when there seem to be simpler and safer answers. It has become clear that some skin specialists have found that they can deal with severe eczema without more and more antibiotics. For example, dermatologist consultants in Sheffield, England have found that they can prevent S. aureus from doing its damage by the simple means of abundant use of creams and oils. They explain,

In eczema the skin barrier is not normal, it’s broken, so superantigenic exotoxins get through. But if you use plenty of emollients – bath oils, emollient creams and ointments and emollient soap substitutes (to stop the skin from drying) – you can restore the skin barrier.

By using these and other simple techniques (including wrapping the area in wet bandages after smothering it in emollient creams), antibiotics become largely unnecessary.

The key message which this offers us is that superbugs have emerged from the inappropriate use of antibiotics, that one of the byproducts of their existence is superantigens, and that the answer (except in the short term) surely does not lie in even more antibiotics being used.

Staphylococcus aureus infection occurring in hospital settings presents us with the ultimate horror – untreatable infection. This particular superbug is the bacteria most often referred to in newspaper and magazine articles on the subject.

It is, however, by no means the only dangerous multi-resistant bacteria, and in the list in Chapter 2 a brief profile will be given of major members of this select team of bacterial antibiotic survivors, each of which has developed resistance to antibiotics and therefore has the ability to produce infections of dramatic intensity, often totally impervious to treatment.

THE ‘GARBAGE CAN’ EXAMPLE

Before briefly examining the superbugs, we need also to try to get a picture of an important phenomenon: the fact that many potentially dangerous bacteria (and other microorganisms) live in or on us – all the time – and do us no harm, most of the time.

The fact is that a swab of your throat or mine will reveal the presence of hundreds of different organisms, some of which are known to be involved in potentially serious infection. Among those which are almost certainly living in your nasal areas, and mine, are that most dreaded of superbugs, Staphylococcus aureus – so why are we not ill?

When it is functioning normally, your immune system is capable of maintaining control of these microorganisms, and prevents them from spreading and producing disease or illness. When, for any of a large number of possible reasons, your immune system operates at lower levels of efficiency, controls are weakened and this gives the microorganism the opportunity to proliferate and cause illness. For ways to boost your immune system, see Chapters 5 and 6.

The fact that for most of the time, potentially dangerous bacteria live in and on us without causing harm, highlights what has been called the ‘garbage can’ effect.

If a garbage can contains a great deal of waste which is decaying, rotting or putrefying, it will act as a magnet to flies and other scavengers who are attracted to just such material. An environment will have been created which is just right for them to use, to eat the garbage, or to lay their eggs in it perhaps.

If we create a similar environment in our own bodies, one which is ‘just right’ for a particular bacteria, virus or fungus, which offers it the chance to breed and eat well and where the normal controls have been relaxed, we have to expect these scavengers to take advantage of the situation.

If you were to see a garbage can overflowing with putrid material and surrounded by swarms of flies, would you be tempted to think that the problem would be solved by spraying and killing the flies? Such an approach might offer a very short-term answer to the problem, but would do nothing at all about the underlying cause as to why they were there.

Instead of trying to poison the flies, would you not consider it likely that the flies would not be there at all if the garbage can was emptied and cleaned?

The analogy in which I have compared a garbage can with an unhealthy human body is not completely accurate. However, it is true that one of the factors which can allow an explosion of activity on the part of usually inactive but potentially dangerous microorganisms in the body is a toxic state of the tissues.

A toxic condition would also involve a reduction in the efficient working of at least local aspects of the protective (immune) system, which would have been controlling the activity of bacteria, yeasts and viruses.

OPPORTUNISM

All organisms on the planet – bacteria or people – thrive if they are given the right surroundings, a condition which includes accommodation, safety from attack, adequate nourishment and a chance to breed. Therefore, if we offer bacteria, yeasts and viruses an environment in which our natural defense mechanisms offer only weak and inadequate controls, so that they will not be vigorously attacked, and if at the same time the environment (in this case part of your body) offers them surroundings which are suitable (for them) and which meet their needs – offering food and a chance to multiply – we should not be surprised if they take advantage of this. As a result, infection occurs.

And if infection occurs and involves a particular microorganism which is resistant to antibiotics, as well as being confronted by enfeebled defense systems (our immune system can become weakened for any of a number of reasons which we will explore in later chapters), we will have placed ourselves in great peril.

When bacteria (or other microorganisms) take advantage of a weak immune system, they are said to be acting opportunistically – taking their chances because they have been offered an easy ride.

The degree to which our immune system is operating efficiently or inefficiently, and the excellence, or lack of it, with which our tissues are presenting ideal, or less than ideal, conditions for potential invaders, decides how vulnerable or susceptible we are.

The comparison of this scenario with the defense of a country by its army is obvious, and as we will see in later chapters there is a great deal we can do to enhance our own personal defenses and so deny opportunities to potential enemies.

If our natural defense systems have been weakened (again, for whatever reasons) and infection threatens life itself, we need to have available options.

One choice which a suitably qualified health care provider may make in such a crisis would be to use antibiotics. But what if the organism involved is not vulnerable, has become resistant to antibiotics?

This is the scenario faced by many doctors today, often in hospital settings, where superbugs have emerged as being almost impervious to antibiotic use.

It is also happening in the community, for example as TB reappears, involving strains of bacteria which have become resistant to the medications which previously controlled them.

The ways in which this has happened will be summarized later in Chapter 2, after which we will meet some of the leading characters in the story, the superbugs.

WILL GENETIC MODIFICATION HELP?

New research has suggested that genetic engineering may allow scientists to develop ways of modifying the genetic material of bacteria such as Staphylococcus aureus to remove their acquired or inherited resistance to antibiotics, so once again making them vulnerable and easier to control.

In a speech to the National Academy of Sciences, Nobel Laureate Professor Sidney Altman announced that, ‘This method may one day allow us to restore the full usefulness of today’s front-line antibiotics.’⁷

The research which led to this statement was performed at Yale, where scientists used synthetic genetic material to ‘switch off’ the genes in the bacteria which produce resistance. They were in this way able to restore the sensitivity of E. coli bacteria to ampicillin, to which the E. coli bacteria had become resistant. An enormous amount of research remains to be done, most notably as to how to get the synthetic genetic material into the infecting bacteria, nevertheless this research at least offers some hope for the future.

But even if this approach proves possible and ultimately ‘successful’, it will only represent the continuation of a method which has led us to the present crisis situation. This is, after all, still an approach which focuses attention on ‘killing the enemy’ rather than improving natural defenses, which many would say was doomed to failure from the start. It is likely, therefore, that initial success in using genetic engineering on resistant bacteria to once again make them vulnerable to antibiotics is almost certain to result, in time, in these bacteria finding other ways of becoming resistant, as they have so successfully done up till now.

WHY DO BACTERIA DEVELOP RESISTANCE TO ANTIBIOTICS?

In his book Alternatives to Antibiotics, Dr John McKenna reports that in the early days of the use of penicillin, its discoverer, Alexander Fleming, warned that if antibiotics were used inappropriately bacterial strains would mutate to produce resistance to the drugs.⁸ This would be more likely, and possibly more serious, if:

antibiotics (penicillin was the main one being used in 1945, when this statement was made) were used orally. By using the drug intravenously it would be more likely to reach the target area, whereas taken orally this is less certain.

the wrong doses were given. Too little would allow some bacteria to survive, and so increase the risks of mutation.

courses were not completed. This too would lead to survival of some, hardier bacteria, which would then proliferate.

courses went on too long. This would increase the likelihood of resistant organisms emerging from the attack on them, as well as the probability of damage occurring to the internal ecology of the body, something we will discuss in more detail in Chapters 8 and 9.

Clearly Fleming was correct.

And to this list should be added one of the worst of all ‘wrong uses’: when an agent (antibiotic) is used to treat something it cannot control, for example a virus.

A report in the British Medical Journal on research done at Southampton University indicated that when antibiotics are given to treat a sore throat (which could be of viral or bacterial origin) it made no difference whatever to the time it took for the individual to recover.

Over 700 patients were treated for 10 days with either antibiotics or with nothing at all.

All the patients got better at the same rate.

It is common practice for doctors to issue prescriptions, often in submission to demands by patients, for problems such as this. Undoubtedly, the degree of such inappropriate antibiotic use has added to the superbug phenomenon.⁹

Another study conducted in Holland involved over 200 patients with inflamed sinuses, confirmed by x-ray, in which half the patients were given antibiotics and the other half a dummy pill. There was no difference whatever in the speed of recovery, or in the number of subsequent relapses as confirmed when these patients were contacted a year later on.

Otitis media and Antibiotics

The way Otitis media (infection of the middle ear) has been and is being treated and mistreated using antibiotics gives us a perfect example of the problems we face.

Here we see a condition which is widespread, almost always bacterial in origin, almost always self-limiting (that is, gets better on its own), and almost always attracts antibiotic treatment – as a result of which resistant strains of bacteria have developed. Yet this obviously ‘wrong’ treatment continues to be suggested in most cases by most doctors and many specialists.

Consider what is now known (or what should now be known) about antibiotic treatment for Otitis media, which affects tens of thousands of children each year.