Although antibiotics have been used for over 50 years, In the 1890’s science advanced when Louis Pasteur revealed the concept that microbes in dirt cause infections. Cholera and typhoid fever and typhus epidemics, which often killed millions, were contained by the institution of sanitation practices at around the turn of the century. The introduction of flush toilets, sewers and waste-processing systems and clean drinking water greatly improved the health of the community so that by the early 1900’s the life expectancy had increased to 55 years. Despite the progress that was made, people often died of infections. It was found that Staphylococcus caused skin and bone and joint infections, Streptococcus Pneumonia (also called “Pneumococcus”) caused severe pneumonias, ear infections, mastoiditis and meningitis, and Beta Strep caused throat infections which could be followed by Rheumatic Fever. H. Influenza was responsible for 90% of childhood meningitis. Unfortunately, there was no treatment for these diseases. In the early 20th century, a scientist named Fleming, noted that a It appeared that medical science would soon gain control of all bacterial infections, as modifications of the penicillin molecule were developed to treat a wider and wider spectrum of bacteria. Erythromycin, tetracycline, and cephalosporins, new and different types of antibiotics, were invented. The fatality rate for pneumonia and other infections decreased and the life expectancy increased to 65 years. Antibiotics are effective only in bacterial illnesses. They do not have any benefit in illnesses caused by viruses, such as colds, influenza, and intestinal viruses. Despite this fact, for over forty years, antibiotics were prescribed freely by many primary care physicians to everyone who was ill with fever, often even to people with viral illnesses. During this time everyone was blissfully unaware that the bacteria were growing stronger and more resistant to control. Each time an infection was treated, a few germs escaped because they had a mechanism to counter the effect of the drug. With all of the susceptible germs killed off there was room for these hearty survivors to grow and multiply. No one was particularly worried since new antibiotics were constantly being developed to control the newer and stronger germs. In the setting of hospitals, the bacteria that survived exposure to the most advanced intravenous antibiotics became true super bugs. In the 1990’s a very resistant strain of Pneumococcus appeared in South America which quickly spread to the United States. For the first time the medical community stopped and took notice. This dangerous, untreatable, germ was spreading in the healthy community. We trembled in fear of returning to the helplessness of the 1930’s. There are three major organisms that cause most ear infections; H Flu, M. Catarrhalis, and Pneumococcus. In the 1980’s one germ, H Flu, became resistant to ampicillin, so new anti resistance antibiotics had to be prescribed. M. Catarrhalis, which started as a benign throat germ became a pathogen that started causing ear infections, and also developed resistance. Pneumococcus, a particularly dangerous organism, was ignored since it had remained susceptible to penicillin throughout the 1980’s. It became routine practice to prescribe the more powerful antibiotics for all ear infections. As the years passed the escalating war against resistant ear infections caused millions of doses of broad spectrum antibiotics to be used by pediatricians everywhere. These antibiotics are so powerful and broad in their spectrum that they routinely eradicate many of the germs that normally inhabit the healthy throat and the healthy digestive system, known as “normal flora.” As these benign, protective organisms are cleared out, yeast has more room to grow, and diarrhea often develops from the lack of helpful bacteria in the gut. More importantly, newer germs, which have developed means of protecting themselves from the strongest antibiotics, take up residence. Even healthy people become colonized with these resistant germs. The germs live quietly in the healthy person until some weakening of the immune system allows them to invade. When this happens, treatment becomes very difficult. As a result of the growing threat of resistant pneumococcus, a call went out to the pediatricians in 2003 to reconsider the use of antibiotics in ear infections. Studies had shown that 80% of children over one year of age would be able to fight off their ear infections in a few days without the use of antibiotics. Doctors were urged to simply give pain control and if the child improves, just observe. If a day or two goes by and there is no improvement, antibiotics should be prescribed. The recommended treatment should be with very high doses of older antibiotics. This seems to be the best way of eradicating an infection completely, without leaving over any resistant organisms and without killing the “normal flora.” There is one exception - the child with a recurrent ear infection who has been treated recently with antibiotics should not be merely observed. These rebound infections tend to be more difficult to overcome naturally. To help overcome the threat of resistant pneumococcus, Fortunately, the result of the change in prescribing habits for
ear infections has been very encouraging. Millions of antibiotic doses were avoided in the last year. There is some evidence that fewer new resistant strains of bacteria appeared in the United States in the last year. With G-d’s kindness, and many recent advances in medical care, the average life expectancy in 2004 has increased to 75 years. |
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