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Abuse, Overuse of Antibiotics Creates Public Health Crisis

Before the discovery of antibiotics in the 1940s, millions of people died routinely of staphylococcus and streptococcus and more serious bacterial infections like meningitis, pneumonia and tuberculosis. But over the years, antibiotics have become less effective because some bacteria have developed ways to survive the medicines meant to kill or weaken them. VOA's Rosanne Skirble reports on how the overuse and abuse of antibiotics is creating a public health crisis and how some communities are responding to it.

Consider this: Bacteria comprise about one-20th of our body weight. Most of these organisms are harmless, like those in the intestinal tract that help us to digest our food. Others can make us really sick.

Streptococcus is a common bacteria found on the skin and in the nose, even in healthy people. But it can also cause acute respiratory illness, sinusitis, some ear infections and pneumonia.

Over the last 60 years, most serious bacterial infections have been treated with some type of penicillin-related antibiotic. Today penicillin is not as effective as it once was. Drug-resistant bacteria are to blame. We are all at risk of getting an untreatable infection because it is the bacteria and not the person that becomes resistant to antibiotics. And those bacteria can be spread by simple physical contact.

Antibiotic resistance is not new, but what is troubling is that the number of drug-resistant bacteria is growing at the same time that the drugs used to combat them are decreasing in potency and number.

A new study released by the Alliance Working for Antibiotic Resistance Education, better known as AWARE, tracks the effectiveness of penicillin against Streptococcus pneumoniae, a common bacterial cause of meningitis, ear infections, pneumonia and sinusitis.

It reports that in Northern California, drug-resistant cases fell from 27 percent of all infections in 2000 to 19 percent in 2002. In Southern California resistance remained at 27 percent, still lower than the 30 percent national average.

The decline is good news and in part due to the work of AWARE, a statewide partnership that includes physician organizations, health agencies, healthcare providers and consumer and education groups. Elissa Maas is the executive director.

"The overall goals of AWARE are really three: to increase the appropriate prescribing of antibiotics, to increase the public's awareness of the importance of the issue of both appropriate use and antibiotic resistance and then mobilizing communities to take action," she explains.

The U.S. Centers for Disease Control and Prevention estimates that 50 percent of antibiotic use may be inappropriate. Elissa Maas says AWARE targets doctors who over-prescribe antibiotics and consumers who routinely demand them for everything from a headache to the common cold.

"It is about not asking for an antibiotic when we have a cold or flu bug and we go in and we want that from the doctor. We do not need it. It will not work. And, so part of this [work] is just hammering those messages over and over because they are simple behaviors that can solve the problem," she says.

And that means bombarding citizens with information in public service announcements heard on radio stations across California.

Other simple behavior changes include using the entire prescription and not saving or sharing the drugs with anyone. Taking an antibiotic in too small a dose or for too short a time allows the bacteria it was meant to kill to develop mutations or to acquire drug resistance from other bacteria.

A World Health Organization report recommends aggressive action to combat drug resistant infections, which it says, "could rob the world of its opportunity to cure illnesses and stop epidemics."

The Centers for Disease Control and Prevention has initiated a campaign for the appropriate use of antibiotics, of which the California AWARE program is part. The solution, says AWARE executive director Elissa Maas requires a collaborative effort.

"I can't stress enough the word 'partner.' This issue is so gargantuan that no one organization is going to solve it," she says. " We have got to have the doctors involved. We have got to have the pharmacists, and nurses. We have to have the health plans. We have got to have the pharmaceutical companies. We have got to have consumer groups. We have to have the media. Everybody has to sit there and say, 'Oh my gosh, we have a problem.'"

And from that realization, Elissa Maas hopes, will come aggressive programs that the World Health Organization is urging, to ensure that the drugs we have today will be available to fight tomorrow's infections.

This is part one of VOA's five-part series on Curbing Abuse of Antibiotics.