Bubblegum and Band-aids
By David A. Watson, Ph.D.
Each year
at the beginning of the holiday season, I take a few minutes to reflect on what
I am most thankful for. As you know by
now if you peruse this space regularly, my wife and I have four healthy and
happy young children. Although in many
ways raising children has never been easy, much of the anxiety and uncertainty
related to their health has disappeared in just this century thanks to the
miracle of modern medicine. The
widespread availability of antibiotics and vaccines have all but defeated
serious infectious diseases of childhood—in the developed world, at least. No longer do we lose large numbers of
children to measles, diphtheria, rubella, or a host of other
vaccine-preventable diseases. Of course,
better nutrition and clean water matter a great deal as well, but within just
the past 50 years (certainly within the lifespan of many individuals still
alive today) antimicrobial usage has become common and vaccination of children
is nearly universal.
A world
free from serious infections of childhood is a wonderful utopian vision; the
reality, however, is that any declaration of victory over them is almost
certainly premature. I say this since
somewhere along the way to being eradicated from the planet, the microbes
rebelled. They started becoming
resistant to the miracle antibiotics discovered not so very long ago. How did this happen, and what can be done? First, some information, then some bad and
good news.
Microbes,
or germs if you prefer, are actually a very heterogeneous group of living
organisms, really sharing little more than small size. Viruses are generally the most common causes
of infection, and while such infections may lead to considerable misery, they
are often self-limited (although not always, as in the case of e.g. the Human
Immunodeficiency Virus-HIV). They are
usually extremely small, so tiny in fact that most cannot be seen using a light
microscope, and are parasites that carry miniscule amounts of genetic
information. Viruses are very different
from bacteria, the other major culprit in infectious disease processes. Bacteria are much larger, and can be
visualized using most microscopes. The great
majority of antibiotic compounds have been developed for use against bacteria
(although a small number of antiviral drugs are now available).
Resistance
to antibiotics by microbes, mostly bacteria (but also by HIV against antiviral
drugs), has resulted simply because bacteria follow the dictates of
nature. That is, the appearance of large
concentrations of antibiotics in the environment has presented what biologists
call “selection pressure.” The microbes
either adapt or die. Overwhelmingly,
they die. A few survive, not because
they choose to, but simply due to the randomness of mutations (changes) in
their genetic information. These mutant
forms proliferate and are no longer vulnerable to the drug. This is not the only mechanism of development
of resistance, but it serves to illustrate the resilience of bacteria. Where have the antibiotics come from and why
has there been such an increase in resistance over the past decade? The blame is ours. Antibiotic usage has climbed steadily for two
decades. Very often antibiotics are
prescribed for what are in reality viral infections, against which antibiotics
are not effective. The bad news is that
superbugs are beginning to show up that defy treatment with almost every
available antibiotic. We may see a time
when we are again no better off than the pre-antibiotic era with regard to
certain types of bacteria. The good news
is that when antibiotics are used with greater restraint, there is apparently a
return to lower levels of resistance.
So…I’m
thankful: for liquid antibiotics that taste like bubblegum because it made convincing
our 12 year old to take her medicine when she was small almost as easy as
giving candy to a baby; that our nine year old set up a howl that filled the
doctor’s office one day over an inoculation, because it means vaccination is a
part of his young life that my wife and I take for granted; that our five year
old underwent surgery, because it meant his inflamed ear canals could properly
drain a chronic infection; and, that our two year old had to wear band-aids on
both of his chubby little thighs for a day following a round of vaccination,
because it means he won’t be one of the thousands of kids who used to fall
victim to acquired mental retardation resulting from complications of bacterial
meningitis. Have a happy and safe
holiday season!