The wise medic will store antibiotics to deal with infections in survival scenarios, but what happens when a bacteria becomes resistant to them? In other words, a “Superbug”?

In the U.S., 2 million people are infected annually with bacteria resistant to standard antibiotic treatment. At least 23,000 of these will die as a result. In an increasingly overburdened health system, resistant microbes are responsible for a huge increase in the cost of caring for the sick.

This article will discuss antibiotics and the epidemic of resistance that has spawned a growing number of superbugs.

Antibiotics

Antibiotics are medicines that kill micro-organisms in the body. Amazingly, the first antibiotic, Penicillin, was discovered entirely by accident in 1928 when Alexander Fleming returned to his lab from a vacation. He noticed that a lab dish with a bacterial culture had developed a mold known then as Penicillin Notatum. Around the mold, an area had developed that was clear of bacteria. Further study proved the potent germicidal effect of the compound processed from the mold.

By the 1940s, penicillin was in general use and credited with saving many lives during WWII. Since then, more than 100 different antibiotics have been identified and developed into medicines.

Antibiotic Overuse

The huge success that antibiotics had in eliminating bacterial infections caused them to be used excessively. Liberal employment of antibiotics is a bad idea for several reasons:

• Overuse fosters the spread of resistant bacteria.
• Allergic reactions can occur, sometimes severe.
• Antibiotics given before a diagnosis is confirmed may mask some symptoms and make identifying the illness more difficult.

Antibiotics will kill many bacteria, but they will not be effective against viruses, such as those that cause influenza or the common cold. They are also not meant as anti-fungal agents.

Most will be surprised to hear that almost 80% of the antibiotics used in the U.S. don’t go to people, but to livestock. This is not to treat sick livestock but to make healthy livestock grow faster and get to market sooner. No one knows for sure why antibiotics have this effect, but the gross overuse on food animals is a big reason for the epidemic of resistance seen today.

The Superbug List Grows Longer

The Center for Disease Control and Prevention has compiled a list of close to 20 bacteria that have shown a tendency towards antibiotic resistance. They include various organisms that cause severe diarrheal disease, respiratory issues, wound infections, and even sexually transmitted disease.

The CDC’s list:

• Clostridium difficile
• Carbapenem-resistant Enterobacteriaceae (CRE)
• Drug-resistant Neisseria gonorrhoeae
• Multidrug-resistant Acinetobacter
• Drug-resistant Campylobacter
• Fluconazole-resistant Candida
• Extended spectrum β-lactamase producing Enterobacteriaceae (ESBLs)
• Vancomycin-resistant Enterococcus (VRE)
• Multidrug-resistant Pseudomonas aeruginosa
• Drug-resistant Non-typhoidal Salmonella
• Drug-resistant Salmonella Typhi
• Drug-resistant Shigella
• Methicillin-resistant Staphylococcus aureus (MRSA)
• Drug-resistant Streptococcus pneumoniae
• Multidrug-resistant tuberculosis
• Vancomycin-resistant Staphylococcus aureus (VRSA)
• Erythromycin-resistant Group A Streptococcus
• Clindamycin-resistant Group B Streptococcus

There have been no effective treatments identified for some of the above microbes, as in the case of multidrug-resistant Tuberculosis. MRSA, Methicillin-Resistant Staph. Aureus, was responsible for more deaths than AIDS in recent years.

Although this is the CDC’s list of superbugs that affect the United States, they aren’t the only ones. A new type of Malaria, a very common parasitic disease of warmer climates, is turning up that is resistant to the standard drugs.

Viruses are “resistant” to antibiotics by nature (in other words, they are unaffected by them) and include Influenza A, Swine Flu, Ebola, Bird Flu, SARS, and Middle East Respiratory Syndrome (MERS). These will be discussed in detail in a future article.

An Effective Strategy

Many believe that antibiotic-resistant Superbugs listed are exotic diseases that could never affect their community. With the ease of commercial air travel, however, cases of antibiotic-resistant diseases from afar can easily arrive on our shores.

Recently, a case of multi-drug resistant Tuberculosis was identified and then isolated at the high level isolation unit at the National Institute of Health in Maryland. Although we have increased our capacity for handling this type of patient significantly since the arrival of Ebola in the U.S. last year, it wouldn’t take much to overwhelm our facilities.

Therefore, the medic must have a plan to decrease the chances for antibiotic-resistant infections. The main strategy is to hold off on dispensing that precious supply of antibiotics until absolutely necessary, but other strategies include:

• Establishing good hygiene practices: Everyone should be diligent about washing hands with soap and hot water or hand sanitizers. Good respiratory hygiene includes coughing or sneezing into tissues or the upper arm, but never the bare hands.
• Supervising sterilization of water, preparation of food, and disposal of human waste and trash. Contaminated water and food will lead to many avoidable deaths in survival scenarios. Make sure that food preparation surfaces (counter tops, etc.) are disinfected frequently.
• Dedicating personal items: Personal items like towels, linens, utensils, and clothing may be best kept to one person in an epidemic setting.
• Cleaning all wounds thoroughly and covering with a dressing. Skin is the body’s armor, and any chink in it will expose a person to infection.
• Social distancing: When a community outbreak has occurred, limiting contact with those outside the family or survival group may be necessary to stay healthy.
• Keeping a strong immune system: Getting enough rest, eating healthily, and avoiding stress will improve a person’s defenses against disease. Unfortunately, it may be difficult to achieve these goals in times of trouble.
• Going natural: Allicin, a compound present in garlic, is a natural antibiotic that is thought to have an effect against some resistant bacteria like MRSA. Crush a clove and eat it.

Preventing the spread of infections, especially antibiotic-resistant ones, is important to maintain the viability of a survival community. If you’re the medic, have antibiotics in your storage but use them wisely. If you do, you’ll help prevent not only resistance, but a lot of heartache if things go South.

Joe Alton, MD