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December 14, 2007

Antibiotics face the Tragedy of the Commons

The evolution of antibiotic resistance is just scary. Through careless prescribing and poor compliance, we've gotten ourselves into a trap referred to as the tragedy of the commons. While each individual faces to gain a large benefit, the cost of that individual benefit is shared across the entire population. Since the individual doesn't see or bear the cost, he/she will continue to do whatever is necessary to reacquire that benefit without public conscience. Hence the tragedy.

Every time an antibiotic is prescribed, the risk of resistance increases. Does this mean we shouldn't be prescribing them? Of course not. But their usage should be governed by special circumstance or how effective they'll be for that individual. Offhandedly prescribing antibiotics for the cold or flu (for which they have no effect because they're viral, not bacterial) has frankly become dangerous. Same with not completing the full regimen prescribed. The FDA provides a brief, informative fact page here.

MRSA or Methicillin-resistant Staphylococcus aureus is a great example of this phenomenon. Methicillin's the antibiotic and S. aureus is the infectious bacteria. This type of staph has become resistant to the antibiotic that killed it and is causing the most havoc in hospitals where bacteria and its killers are in a constant battle. In this case, the bacteria won and now we're recouping for another fight where we've lost the higher ground. This is serious and current!

There's a great sidebar in this USA Today article, "Hospitals marshal resources to wipe out MRSA", that describes how to avoid MRSA. Below are a few excerpts.
"...hospitalizations related to MRSA nearly doubled between 1999 and 2005, from 127,000 to almost 280,000."

"At the University of Texas Medical Branch in Galveston, the main battle strategy against MRSA is what it calls the "search and destroy" method. The hospital screens all adult intensive-care-unit patients each week for MRSA and places those testing positive in isolation."

"Watch before and after an examination. Do doctors wash their hands? If not, ask them to do so. Look around. Is the hospital clean?"

"After any procedure, be persistent about cleanliness. If a catheter is in place, inquire whether it's still needed. Bacteria can enter the device and quickly spread through the body."