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Bacteria are constantly changing — some even evolve to outsmart antibiotics. This phenomenon, called antibiotic resistance, means bacteria will survive despite treating an infection with antibiotics.
Public health experts consider antibiotic resistance to be a global public health threat, associated with nearly 5 million deaths in 2019. And even if you don’t get sick very often, you should care about the rise of antibiotic-resistant bacteria — here’s why.
What is antibiotic resistance?
Say you contract a urinary tract infection or come down with strep throat. Your doctor will likely prescribe antibiotics to kill the infection-causing bacteria in your body, which helps you heal. However, this treatment won’t work if the infection-causing bacteria have evolved to resist those antibiotics.
“Normally, antibiotics are meant to kill bacteria, but resistant bacteria adapt so that the antibiotic no longer works,” says Zahra Kassamali Escobar, PharmD, the co-medical director of the UW Center for Stewardship in Medicine and a clinical pharmacist of infectious diseases for the Antimicrobial Stewardship at Fred Hutch, a program designed to make sure antibiotics are used wisely — in other words, only when needed and with the right drug, dose and duration.
“This ability isn’t new, as bacteria have found ways to survive in harsh environments long before antibiotics were discovered,” says Escobar.
But it’s become a problem in medicine as antibiotics are misused or overused.
“Bacteria that have evolved to survive antibiotics can spread between people, across communities and even around the world,” says Rupali Jain, PharmD, a co-director of the Antimicrobial Stewardship at UW Medical Center – Montlake.
Your doctors can help you figure out if you’re dealing with antibiotic resistance through antimicrobial susceptibility testing (AST). This is done by growing the bacteria on a plate containing different antibiotics. If the bug is stopped by one of the drugs, it’s sensitive; if not, it’s resistant.
What happens if your infection is antibiotic-resistant?
If your infection isn’t going away after treatment with antibiotics, it might be caused by antibiotic-resistant bacteria. And then things get more complicated.
Linda Lei, PharmD, a co-director of the Antimicrobial Stewardship at UW Medical Center – Northwest, explains that at this point you might need to try different antibiotic treatments, some of which require taking pills four times a day (instead of once or twice a day), or might even need to be given intravenously.
“It could also have a lot of uncomfortable side effects,” says Lei.
There could also be more serious consequences.
“These resistant bacteria can lead to infections that make routine surgeries and cancer treatments much more complicated,” says Jain. “When resistant bacteria cause infections, they can be harder to treat, often requiring toxic, expensive and extended treatment courses.”
Plus, antibiotics can kill the bacteria that make up your microbiome — the community of bacteria in your gut that keeps you healthy — leading to the overgrowth of harmful organisms and preventing different types of healthy bacteria from thriving.
“These changes to the microbiome have correlated with several health outcomes from antibiotic-associated diarrhea to obesity, and we are learning more about it every day,” says Lei.
4 ways to prevent antibiotic resistance
While it may not be possible to prevent contracting an infection from an antibiotic-resistant bacteria entirely, there are ways to help prevent their spread.
Not overusing antibiotics
It’s no fun to be sick, but one way you may be contributing to the antibiotic resistance problem is using antibiotics when they are truly not needed.
For example, when you have a common cold or respiratory illness that is caused by a virus, you don’t need an antibiotic.
“Antibiotics don’t work against viruses and pressure the bacteria normally found in our bodies to evolve and mutate, increasing the chance that they’ll develop into antibiotic-resistant bacteria,” says Chloe Bryson-Cahn, MD, an infectious diseases physician and Medical Director of Antimicrobial Stewardship at Harborview Medical Center. “For this reason, antibiotics should only be prescribed and used when necessary.
Taking antibiotics for shorter periods
Another contributor to antibiotic resistance is taking antibiotics for longer than necessary.
“While patients are often told to complete every dose of their antibiotics even if they start feeling better, research shows that shorter courses of antibiotics — such as five days or fewer — are just as effective as longer ones,” says Bryson-Cahn.
This applies to many common infections for which you may need antibiotics, such as urinary tract infections, skin infections and pneumonia.
If you need antibiotics, Bryson-Cahn recommends asking your doctor: “Is this the shortest course of antibiotics I can take?”
Getting vaccinated
Maggie Green, MD, an infectious disease physician and Medical Director of Antimicrobial Stewardship at University of Washington Medical Center, says that respiratory viral infections such as the flu, COVID-19 and RSV can increase the risk of getting bacterial infections, especially for people with underlying health conditions.
“Viruses can weaken your body’s immune defenses, making you more vulnerable to bacterial infections,” says Green. “By preventing respiratory viral infections through vaccination, it may also reduce the chance that an antibiotic would be inappropriately prescribed.”
Practice good hygiene
It’s more than just washing your hands for at least 20 seconds — make sure to cover your coughs and sneezes (into your elbow, not your hands), throw away used tissues and regularly clean frequently touched surfaces, such as countertops, handrails and doorknobs.
Keep hand sanitizer in your bag if you’re out and about (think: on public transit or in the grocery store). For extra protection, wear a mask (especially if you’re sneezing or coughing) and keep your distance.
Be proactive, but not worried
While antibiotic resistance is a serious problem, doing what you can to stop the spread of viruses and bacterial infections, and making sure the antibiotic prescription your doctor gives you is appropriate, can do a lot to help yourself — and your community — stay safe.
