What is resistance, anyway?
Resistance has been in the news a lot lately, both talking about resistance to malaria drugs and when talking about multi-drug resistance tuberculosis. I thought I'd step back for a moment and offer a brief explanation of antibacterial resistance and how it happens.
An infection - Tuberculosis, malaria, whatever - is caused when hundreds of millions of bacteria take up residence in a living body. Not all of these bacteria are the same. They are each individual lives and they have slight variations.
When you take an antibiotic, such amoxicillin, it kills all the bacteria that can be killed by amoxicillin. The bacteria which cannot be killed by amoxicillin survive, and now they have more food and space to breed. If there are only a few of these bacteria left, your body can kill them. If there are too many of these bacteria still alive, they can reproduce and take over. You're still infected, and now you're infected with bacteria that can't be killed by amoxicillin. If you infect someone else, they cannot be treated with amoxicillin either.
In the case of resistance to amoxicillin, you can take another antibiotic and knock off the remaining bacteria. In the case of tuberculosis, malaria, or staph infection, it's not as easy. They don't have that many effective treatments to start with; the bacteria which cause them are susceptible to few drugs. Backup options are hard to come up with. Extensively drug resistant tuberculosis can only be cured in about 30% of patients, and it requires a combination of five drugs individually tailored to the patient's infection. Methicillin-resistant staph infection has two antibiotic which currently work - vancomycin and teicoplanin, both of which can have powerful and unpleasant side-effects. Malaria has more options, but few of them are highly effective.
Resistance can be minimized by using antibiotics only when needed, using multiple-drug regimens to eliminate all bacteria, and through research to discover new anti-bacterial drugs. This means policy interventions such as requiring a physician prescription for antibiotics and limiting their sale and distribution and population education on the importance of not taking antibiotics without a prescription. It also means standardizing drug treatments for common infections in order to retain second-line drug options, and encouraging health care providers not to prescribe antibiotics except when they are necessary. Finally, it means supporting research on new antibiotics and anti-bacterial agents.
On an individual level, you can prevent resistance in your own life by always finishing your full course of prescribed antibiotics, never sharing drugs, and avoiding the use of antibacterial soaps. And don't bug your doctor to prescribe antibiotics because you think you need them, because they might prescribe just to humor you.
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