Antibiotics—Double-edged Swords

PENICILLIN, the first and most widely used antibiotic, was discovered back in 1928 by the British bacteriologist Alexander Fleming. But he and his colaborers had many obstacles to overcome, and so it was not until World War II that it finally came to be recognized for its value in combating infections.

The results with penicillin were so remarkable that it was termed a “miracle” or “wonder” drug, and since then many, many other antibiotics have been developed, both organic and synthetic. There is no question about these antibiotics, such as penicillin, having accomplished much good, saving many a life, shortening the recovery time of many a victim of accident or illness.

But the use of antibiotics has not been an unmixed blessing. Why not? Because of the very nature of antibiotics. The name itself should prove a warning, for it comes from two roots: anti, meaning “opposed,” and bio, meaning “life.” So an antibiotic is an agent opposed to life, that is, it is a killer. A killer of what? Of germs, bacteria, microbes, for which reason “antimicrobials” seems to be preferred in medical literature. “Antimicrobiais” are said to have “toxicity,” that is, poisonous characteristics as well as other harmful potentials in addition to therapeutic qualities.

Thus Dr. Robert C. Zurek, writing in Diseases of Medical Progress, states: “Whenever we employ an antimicrobial agent, we are wielding a truly double-edge sword. We take a calculated risk.” That is, the physician hopes to kill certain microbes without harming the cells of the body.

But is this fact fully appreciated by the medical profession, not to mention the public at large? Apparently it is not, for as Dr. F. D. Adams states in the foreword to the above-mentioned textbook “drugs are frequently administered . . . apparently without due regard for their disquieting and sometimes dangerous potentialities. One need but mention, for example, the widespread use of antibiotics for trivial upper respiratory infections and comparable minor ailments—a practice that seems to continue in spite of the exhortations of many qualified authorities that these agents are, as a rule, ineffective in such cases.”

A committee for the United States Health, Education and Welfare Department brought out that in one study of 1,045 patients, 340 were receiving antibiotics but only 13 percent of these (or some 45) actually should have received such medication. In another report a physician tells that from “90 to 99 percent of those who were receiving chloramphenicol were getting it for a non-indicated purpose.” And Drs. Silverman and Lee, in their book Pills, Profits, and Politics, state that at times antibiotics “have caused illnesses more severe than the diseases they were intended to combat.”

Indicative of the overuse of antibiotics is the fact that in the United States, in the 1971-1972 fiscal year, roughly 26,400 tons of antibiotics were produced and certified for distribution. This is enough for fifty doses for every man, woman and child in the country. According to Dr. H. F. Dowling, a highly respected authority on this subject, “it is doubtful that the average person has an illness that requires treatment with an antibiotic more often than once every five or ten years.”

Helping to account for this great consumption of antibiotics is their use in hospitals. On an average day some 40 percent of the patients are given at least one antibiotic. According to a leading authority on this subject, “it is inconceivable to me . . . to believe that 40 percent of the patients in the hospital require an antimicrobial drug. . . . I think that there is no question but that these drugs are . . . used excessively.”

Obviously, all such overuse of drugs results in much needless expense for the patients or their families or whoever else pays the bills. One hospital, recognizing this problem, organized an antimicrobial committee to monitor the use of such drugs. As a result, it was able to cut down the use of them by 20 percent. If all hospitals in the United States followed suit, it would mean an annual saving of $117,000,000. Another study showed that 93 percent of the patients receiving an antibiotic costing $12 a prescription were receiving it needlessly.

Cutting the Wrong Way

Just how serious is the double-edged aspect of antibiotics? According to Dr. Zurek, “the list of untoward effects is enormously long,” and “it would seem there is a true ever-increasing incidence of adverse drug reactions.”

While some may hold them to be exceptions, take note of these examples: There was a man of twenty-five years with a sore throat. His doctor gave him an antibiotic, chloramphenicol, for nine days. In less than two months he had very severe symptoms caused by this drug and in six months he was dead.

Then there was a woman forty-seven years old who was treated for a sore throat with penicillin. In three days she had all manner of complications, such as red lumps on her body, itching and difficulty in urinating. In spite of the use of an artificial kidney machine, she died.

In another instance a twelve-year-old girl was treated with chloramphenicol. It resulted in her being afflicted with a dangerous blood disease, from which she died. According to another report, hundreds of persons have died from chloramphenicol (trade name “Chloromycetin”), and in spite of the fact that for more than twenty-five years doctors have been warned about this drug, it is still being prescribed unnecessarily.

Why this overuse of antibiotics? With the advent of antibiotic therapy, the treatment of most infectious diseases took on a new specificity. At least something was available that could attack the germs causing the disease. Where a cause could not be isolated, the antibiotic was given empirically, that is, without sound basis, by enthusiastic doctors. And what is more, the patient many times demanded it. As a consequence, there has been much unjustified use of antibiotics.

No doubt another reason for the overuse of antibiotics is the desire of doctors just to do something, tending to consider only the potential benefits of these drugs. Still another reason, suggested by S. M. Wolfe, director of Ralph Nader’s Health Resource Group, is the possibility that for information about drugs doctors depend too much on the biased sales pitches of drug company representatives.

Why Two-edged?

Why do antibiotics help many people but not help all? Why are they so often two-edged swords? One factor is the physical condition of the patient. Powerful antibiotics are likely to have powerful toxic side effects. It is the function of the liver and the kidneys to get rid of toxic agents. But if the liver is diseased or the kidneys function inadequately, they may not get rid of the toxic residues of the antibiotic and, as a result, the cells of the body succumb to the poisons and the patient sickens and may even die.

An even more frequent cause of complications resulting from the use of antibiotics is allergy or some type of intolerance. Any patient may be allergic to one or more antibiotics, as a result of which harm and even death may come to the patient. For example, of more than a thousand reported life-threatening reactions caused by antibiotics, the vast majority involved penicillin, and, of these, 10 percent were fatal.

There is also the problem of microbes developing drug immunity, resisting the bacteriocidal effect of the antibiotic. This has been seen recently in the treatment of gonorrhea. For years the gonococcus germ causing this disease was extremely sensitive to penicillin so that recovery from this disease was almost certain if the antibiotic was administered. Lately, however, penicillin-resistant strains of gonococcus have developed, so that now other, less effective drugs have to be used.

Still another reason why an antibiotic may turn out to be a double-edged sword is that it may wipe out all except certain strains, which then increase and cause completely new or complicating diseases. Such “superinfections” are caused by the microbes not susceptible to the antibiotic but which have been kept in check by the other microbes in a sort of “natural” balance.

Regarding this aspect of matters, The Sunday News, Detroit, Michigan, July 28, 1974, told of doctors warning that overuse of the most widely administered antibiotic has fostered development of a new resistant kind of infant brain inflammation. The antibiotic is ampicillin, a synthetic form of penicillin. According to Dr. S. Ross of the Children’s Hospital in Washington, D.C., “ampicillin has been beaten to death by being used indiscriminately by physicians both inside and outside the hospital.” It “used to be the drug of choice for . . . a serious intestinal disease. In 1967, 5 percent of [such] cases were resistant to it. Now 95 percent are resistant. . . . The growing resistance scares . . . us.”

An example of this is the potential effect of some antibiotics on the intestinal flora, the useful bacterial population of the intestines so essential to the proper and maximum assimilation of food. According to many practitioners, continued use of antibiotics may kill not only harmful bacteria but also much of the intestinal flora. For this reason certain practitioners urge the use of yogurt or like milk products whenever a person is taking antibiotics.

What Can You Do About It?

Some might conclude from the foregoing that all this information is the concern of physicians, not of their patients. But is that so?If so many doctors are not sufficiently cautious, even as their own spokesmen confess, perhaps the “layman” should show concern. That is the position taken by Science Digest, January 1975. It states: “All antimicrobials—as a group—are overused and abused by physicians in general to the point where the public must learn to protect itself by learning the dangers, for clearly doctors as a group are blowing it.”

From the foregoing it is apparent that you should be very careful about using antibiotics. Never urge your doctor to prescribe antibiotics. Never use those prescribed to others; never experiment yourself. Let your doctor know of your past use of antibiotics, whether unfavorable or not; also let him know what other drugs you may be taking. If he prescribes antibiotics, inquire as to an alternate treatment. If they seem imperative, then follow his instructions closely.

To sum up, we cannot do better than to quote from the “Concluding Remarks” in Dr. Zurek’s chapter, “Antibiotic-induced Diseases”: “It is hoped this review of untoward reactions to antimicrobial agents will foster appropriate respect for these drugs. Their use has produced tragedies as well as miracles. None are completely without hazard. . . . Successful antibiotic therapy can be achieved only by knowledge of the capabilities of these agents and a constant awareness of their hazards.”