Anti-biotics: Stewardship, Resistance and Risk
Updated: Jul 23, 2019
The first antibiotic discovered, Penicillin, was discovered serendipitously when a researcher discovered that his bacterial cultures had been contaminated by a fungus that produced penicillin naturally and wiped them out.
The War Against Infectious Disease
The discovery led to the synthesis and mass production and use of the drug penicillin. It was humanity’s first offensive attack in the prolonged and retracted war with infectious disease. Since then, scientists have been engaged in efforts outsmart the microbes that readily spread across the globe and develop resistance to every possible remedy we can concoct. Many believe we are perpetually on the verge of losing this battle and experiencing, once again, the massive scale loss of life we’ve gone through with past epidemics.
Infectious disease specialists are at the front of this battle with our deadly microscopic foes. Around the world they routinely risk their lives to contain outbreaks that otherwise might fan out like wild fire. Their success hinges on finding effective antibiotic strategies.
The trend of emerging “Super Bacteria” species which are resistant to all antibiotics is a threatening specter on humanity’s horizon. The widespread medical use of antibiotics, and industrial agriculture’s veterinary use, is thought to have spurred on the rise of aggressive, resistant infectious bacteria. Antibiotic and prescription drugs are now commonly found in tested ground and tap water.
Antibiotics used to be reflexive prescriptions for anyone with a cough, sore throat, ear infection or even the slightest scratch. These days, there is a very strong push to educate practitioners in the cautious and sparing use of antibiotics; it is called “Antibiotic Stewardship”. The idea is promoted in the hopes that we can slow down the coming shortage of effective antibiotics in the face of emerging and inevitable infectious disease threats. Now that many physicians are resisting knee jerk antibiotics, it’s often the patients that insist on antibiotics for situations that do not call for them.
It’s even become relatively common alternative medicine practice to use very potent and even intravenous antibiotics for vague and essentially universal symptoms like fatigue, body aches and “fuzzy thinking”. The practitioner theorizes the symptoms to be infection related. They may employ lab diagnostic methods that are far from accepted infection diagnostic standards. I’ve been seeing an increase in patients who’ve been treated with long term IV antibiotics for Chronic Lyme Disease and co-infections, some based on nothing more than energetic muscle testing.
The Repeated Use of Antibiotics
The use of antibiotics as an elective treatment for ambiguous symptoms without clear need is equal to bowling with a hand grenade. The possibility of developing a life threatening allergic response is a serious risk, especially in the case of repeated IV antibiotics. All IV treatments also carry the risk of transferring bacteria into the blood stream itself! Once commonly prescribed fluoroquinolone antibiotics like Cipro now have black box warnings due to severe and irreversible toxicity to nerves, heart and muscles. Other adverse reactions to antibiotics include kidney, liver and blood toxicities.
The CDC and use of IV Antibiotics
The federal agency tasked with fighting infectious disease, the Center for Disease Control, made a statement on 6/16/17 about the use of IV antibiotics for treatment of Chronic Lyme Disease due to several reported deaths (https://www.cdc.gov/mmwr/volumes/66/wr/mm6623a3.htm).
The statement from the CDC highlights the dangers of antibiotics causing an aggressive opportunistic infection from bacteria in the gut called Clostrium difficile. This infection is notoriously aggressive and can cause infection in the colon severe enough to require surgical removal of the colon. C-Diff is resistant to most antibiotics and newer drugs can cost $4000 per dose. It infects 500,000 and kills 30,000 patients yearly in the U.S per year. That’s a serious infectious risk when compared to functionally diagnosed Chronic Lyme Disease, the existence of which is highly debated. As a functional diagnosis, it has never been once been shown to be fatal or to be treated successfully with IV antibiotics*. Even cherry picking the data leads to underwhelming evidence thus far.
Recent Office Visit
I recently had a patient return after months of repeated IV antibiotic treatment with very potent, broad spectrum antibiotics for presumed Chronic Lyme Disease. Her Labs did not fit even the “fuzziest thinking” of Chronic Lyme lab criteria. She told me that she was “in love” with the effect of the antibiotics though it did not last long before requiring more treatment. She was asked to take a probiotic but was not compliant and never asked again. She had no idea that it was to provide friendly bacteria to protect her from serious opportunist gut infection. She was shockingly unaware that two of her antibiotics had black box warnings for Clostridium difficile. She dodged a bullet if you ask me.
The funny thing is that I had only seen her once prior and my diagnosis was chronic sinusitis of unknown cause. I was pretty certain that her fatigue, aches and fuzzy thinking would respond if we cleared up her sinus inflammation. I’m a firm believer in a light touch with medicine and advised her to start with saline nasal rinses twice daily and return later. She didn’t enjoy the salt water up her nose and consequently did not return to our office for follow up. She drifted from practitioner to practitioner till finding a Lyme specialist. She joined a waiting list of patients filling the chairs that pump out IV antibiotics 6 at a time.
I gasped a little when she told me her story. It didn’t sound anything like the natural medicine I believed in. My first precept remains, 1st Do No Harm. Now, it’s 6 weeks after her last IV, and she notices that the symptoms of her sinusitis are creeping back and along with it the fuzzy thinking, fatigue and aches… She is now ready to try the saline nasal rinses. I’m pretty sure that the cure to her “Chronic Lyme Disease” has always been right under her nose.
Come See Me First
If you are considering or undergoing treatment for infectious disease and are being advised to do long term antibiotics, please consider coming and seeing me for a consult.
*This is not a comment about antibiotics use in acute Lyme infection. It also makes no comment about Post Treatment Lyme Disorder.