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
