Antibiotics can not only make you sick, they can kill you. And a new report says they’re doing so at a rate far greater than we realizedBy
An expansive study by the U.S. Centers for Disease Control and Prevention published in the New England Journal of Medicine this Wednesday tells us that the rate of death and infection caused by the bacterium Clostridium difficile, or C. diff, is actually about twice as much as we thought.
And what we thought was bad enough. As recent as the fall of 2013 the CDC released a report, “Antibiotic Resistant Threats in the United States,” that placed C. Diff in its top category of dangerous pathogens because of its widespread harm. It killed about 14,000 Americans a year and seriously infected about 250,000. Hence the CDC warning: “This bacteria is an immediate public health threat that requires urgent and aggressive action.”
We learned this week, however, that the 2013 C. diff numbers were a gross underestimate by half. The new report concludes that “C. diff was responsible for almost half a million infections and was associated with approximately 29,000 deaths in 2011.” (The last year for which we have data.)
Even these numbers underestimate the true extent of the harm because the researchers only counted deaths within 30 days of infection, and because they only counted the initial and 1 subsequent infection – there were 83,000 of those — in the same person. This matters because C. diff can return time and again. With each subsequent infection the disease is more severe thus harder to treat, and it becomes easier to transmit to others.
The study raises 2 special concerns.
One, people over 65 catch C. diff at a rate 8 times greater than the general population.
Two, there’s a new strain of C. diff out there that’s more severe and easier to catch. “In the past, patients infected with C. diff have had diarrhea related to antibiotic use that was often perceived as a nuisance, but not a major problem. Unfortunately, the type of C. diff circulating in the US today produces such a powerful toxin that can cause a truly deadly diarrhea. Patients receiving antibiotics are now at risk for not just mild diarrhea, but intense illness that can cause damage to the bowel so painful and severe that part of the colon needs to be surgically removed,” says the CDC’s Michael Bell, MD.
This brings us to the heart of the problem. “Antibiotics are clearly driving this whole epidemic,” says Dr. Bell. It works like this. Your intestines contain millions of bacteria, many of which help protect your body from infection. But when you take an antibiotic to treat an infection, the drug can destroy some of the normal, helpful bacteria as well as the bacteria causing the illness. Without enough healthy bacteria, C. diff can quickly grow out of control and become the dominant bacteria in your GI tract. They would be the majority bacteria in step 3, below.
Margaret Riley, Ph.D., professor of biology at the University of Massachusetts, Amherst, analogizes the taking of antibiotics to the ingestion of a hydrogen bomb on the basis that it kills everything, all of your body’s bacteria, the good and the bad. Antibiotics, she says, are not like a laser-guided missile that kill only the bad bacterial cells.
Sound familiar? Think cancer. Because in this sense the effect on your body of a course of antibiotics is similar to the effect of a course of radiation to treat cancer: in both cases you’re using a shotgun to kill a fly and so you end up with “collateral damage,” examples of which are well-known in the case of radiation therapy – hair loss, fatigue, decreased appetite, radiation sickness, and so on.
So the good news is you have a vital role to play in your own healthcare – you have more control than you may realize. In this context the rule is simple: Stop asking for antibiotics. That’s the message from the Harvard School of Public Health at a public forum held a year ago. It’s a patient-empowering discussion that we highly recommend.