Dukes County Health Council: Working for your health

Antimicrobial resistance: When the magic bullet is a dud.

The Dukes County Health Council wants to inform the community on ways to be more conscious about health. — MV Times

Imagine a world where infections don’t heal, where illnesses do not rapidly turn around with a prescription, where all you can do is hope and pray that effective treatment can be found and that IV fluids and oxygen for a critically ill loved one can buy enough time for healing. 

Guess what? We are already part-way there. Several diseases and conditions, such as Tuberculosis, HIV, C.diff, Salmonella, some Influenza strains, and many more are at various stages of developing resistance to some of our most potent treatments. Even more disturbing, resistant organisms can be found in wild and domestic animals, and in natural systems including water bodies such as rivers and streams, as well as soils. Much of this is attributed to inappropriate use of antibiotics. Like climate change, growth in antimicrobial resistance is already well underway and our current ways of addressing this threat can’t make big enough changes fast enough to do more than put a dent in the problem. 

What is antimicrobial resistance? Microbes are very small living organisms including bacteria, fungi, parasites, and viruses. Most microbes are harmless and even helpful to people, but some can cause infections. Harmful microbes are called pathogens. Antimicrobial is a term used to describe drugs that treat many types of infections by killing or slowing the growth of pathogens causing the infection. People sometimes use “antibiotic” and “antimicrobial” interchangeably, but the term antimicrobial refers to all of the following:

  • Bacteria cause infections such as strep throat, foodborne illnesses, and other serious infections. Antibiotics treat bacterial infections.
  • Fungi cause infections like athlete’s foot, yeast infections, and other serious infections. Antifungals treat fungal infections.
  • Viruses cause infections such as influenza, COVID, Ebola and the common cold.  Antivirals treat viral infections.
  • Parasites such as tapeworm, heartworm or the scabies mite can invade animals or humans and are treated with Antiparasitics such as Ivermectin.

Effective antimicrobials are a complete game-changer for a wide range of dangerous diseases.  When microbes develop resistance to antimicrobials, some of our best tools for healing are rendered useless.

Control of infectious diseases through antimicrobial substances has been practiced in cultures around the world for tens of thousands of years. In western medicine, antibiotics began with the accidental discovery of Penicillin in 1928. In the 1940s, it became widely available, and new antibiotics were being rapidly developed. And this was less than a century ago, within living memory. 

Between the advent of widespread vaccination for the most common infectious diseases in the same timeframe, and the development of antimicrobial treatments when people were sick, the results for population health were dramatic. We went from an average life expectancy of 58 years in 1925, to 79 years in 2020. Most of the gains in health and longevity during the 20th century were due to control of killer diseases via prevention through vaccination and treatment with antimicrobials. 

Sadly, humanity has managed to squander this 20th century healthcare miracle with abandon, within decades rather than centuries. Antibiotics provide perhaps the clearest example.

They were freely prescribed for every ailment, including for viral illnesses like the common cold or the flu, (even though antibiotics target bacteria, not viruses).

Often, people would opt to stop their medication as soon as they began feeling better. What this did was to allow the strongest bacteria to survive, and that strength was passed on to the next generation of microbes. 

To this day, roughly 65 percent of medically important antibiotics consumed in the U.S. are currently fed to farm animals. While U.S. meat producers are no longer allowed to use antibiotics to promote animal growth, they can still use them to prevent bacterial diseases in flocks and herds.

In the U.S., more than 35,000 people die as a result of antimicrobial-resistant infections each year, according to CDC’s 2019 Antibiotic Resistance Threats Report. Many, but by no means all, resistant infections are acquired in healthcare settings. Strict infection control measures can bring down the rate of hospital-acquired infection. 

The Martha’s Vineyard Hospital has included Antimicrobial Stewardship (AS) among its top initiatives for the past several years. The goals of the MVH AS program are to enhance appropriate use of antimicrobial agents, improve the overall quality of patient care, minimize the emergence of antimicrobial resistance, and select the most cost-effective medication regimens.

“Our efforts have demonstrated improvement to patient care and outcomes as it relates to the utilization of common antibiotics,” said Brittany Baron, infection preventionist at MVH. “We use approved protocols and guidelines for the initiation and maintenance of antibiotics based on the medication and the condition being treated, and monitor the safety and effectiveness of the antibiotics.” Hospital pharmacist, Dave Caron, adds that antibiotic safety practices are evaluated and assessed throughout the facility on a regular basis through a standing multidisciplinary committee, the Antibiotic Stewardship Infectious Disease Quality Collaborative.  Recent areas of focus have included guidelines on the treatment of C Diff, broad spectrum agents, and publishing a hospital-wide antibiotic reference. Through continued education and diligence among prescribers, staff, patients, and families, public safety will ultimately be enhanced by reducing further bacterial resistance.

What can you do? Take antibiotics only when prescribed. Take prescribed antibiotics for the full duration of the prescription. Know that many common infections that were treated with antibiotics in the past are not resolved with antibiotics, e.g. the common cold, bronchitis, and middle ear infections. Know that taking antibiotics inappropriately causes harm; sometimes immediately and often over time by reducing their effectiveness in the community. Ask your doctor when you have questions about your treatment. Most common infections are viral and get better by themselves. 

Marina Lent is the Health Agent for Aquinnah. She has been involved with the DCHC starting in 2012. She was with the Chilmark Health Department from 2008 to 2022. Before that, she worked on all four Island ambulances from 1999 to 2008.