With more bacteria resisting antibiotics due to overuse, epidemiologists are at the forefront of the effort to
make effective change for the purposes of improved population health.
Dr. Patricia Cummings shares the importance of reducing the use of antibiotics and why they might not always be the answer.
Antibiotics Aren’t Always The Answer
Featuring:
Patricia Cummings, PhD, MPH
Patricia Cummings, PhD, MPH is a Clinical Epidemiologist at Eisenhower Health. She received her doctorate in Epidemiology from the Fielding School of Public Health at UCLA and a Master’s Degree in Public Health, with a specialization in Epidemiology and Biostatistics from the Keck School of Medicine at the University of Southern California. Dr. Cummings joined Eisenhower in 2016 to conduct epidemiologic research and perform a wide range of investigative and analytical activities related to hospital-based disease surveillance, antibiotic stewardship, infection prevention and control, quality improvement, and population health. She has been the principal or co-principal investigator of multiple federally-funded research and evaluation studies focusing on the epidemiology of foodborne diseases, obesity, diabetes and cardiovascular health, including school-based nutrition and food policy implementation. She has also conducted research on age-related diseases and received an award from Mayor Antonio Villaraigosa in 2009 for her work on the Los Angeles Partnership for Evidenced Based Solutions in Elder Health. In 2015, Dr. Cummings developed and led the Built Environment & Health Impact Assessment Unit at Harris County Public Health in Houston, Texas. She was selected by the Centers for Disease Control and Prevention (CDC) and the National Association of County and City Health Officials to be a mentor for their Health Impact Assessment Demonstration Sites. From 2008 to 2014, Dr. Cummings worked for the Los Angeles County Department of Public Health and was involved in a number of high-profile, public health policy evaluation efforts, such as menu-labeling, the County of Los Angeles’ Healthy Food Procurement Board Motion and 100% Healthy Vending Machine Policy. Transcription:
Bill Klaproth (Host): With more bacteria resisting antibiotics due to overuse, epidemiologists are at the forefront of the effort to make effective change for the purposes of improved population health. So here to talk with us about why antibiotics aren't always the answer is Dr. Patricia Cummings, a clinical epidemiologist at Eisenhower Health. Dr. Cummings, thank you for your time. So with the overuse of antibiotics, we have bacteria that resist antibiotics. So why does overuse make someone more likely to get an antibiotic resistant infection in the future?
Dr. Patricia Cummings, PhD, MPH (Guest): Hi Bill, thanks for having me. Yeah, so antibiotic resistance is really when organisms that would ordinarily be sensitive to an antibiotic becomes resistant to it. So in other words, it is the ability of bacteria to change in a way that reduces the effectiveness of drugs. So something simple like an ear infection can actually turn out to be something very difficult to cure because that antibiotic is no longer able to attack it in a way that would make it sensitive.
Bill: And you know, this is becoming a serious thing according to the CDC. Each year in the United States, at least two million people become infected with bacteria that are resistant to antibiotics, and at least 23,000 people die each year as a result of these infections. These are big numbers, Dr. Cummings.
Dr. Cummings: Yes, so that is correct. Antibiotic resistance has been called one of the world's most pressing public health problems, and it's right now deemed a national security threat to our country. If we don't act now, by 2050 there will be about ten million deaths each year from drug resistant bacteria. So that's about one person every three seconds. So it's really important that we are judiciously using antibiotics in a way that we're taking the right drug for the right bug, and taking it for the correct amount of time or duration, and really getting that proper dose so that we can help prevent further resistance among our bacteria pathogens.
Bill: So you were giving us the example about ear infections. So at what point does normal use become overuse?
Dr. Cummings: Sure, so or another question is what can individuals do to help prevent resistance? And they can do that by avoiding antibiotics when possible, and that means if you have a cold or a flu, avoid pressuring your healthcare provider in prescribing you an antibiotic. Instead ask them what you can do for symptomatic relief. Also consider getting vaccinated against the flu.
Bill: Okay symptomatic relief, I like how you said that. But Dr. Cummings, we always want that pill to make us feel better. How do we do the symptomatic relief? How do we ask for that? Do we say, "I don't want that pill, doctor. What can I do instead of taking that pill?" Is that what we should be asking?
Dr. Cummings: Yes, so your physician can give you tips and over-the-counter solutions to some of the symptoms that you're experiencing. As an epidemiologist, we're most concerned with controlling factors that influence the current distribution of disease in populations. And so for us, we're more concerned about preventing these resistant bacteria from even occurring. But talk to your healthcare provider and get tips from them on what you can do to feel better.
Bill: Alright help us out with this then; when should they be used or requested, and when shouldn't they be?
Dr. Cummings: That is something that your healthcare provider can determine based on what symptoms your experiencing. They can also run a number of lab tests to see if you have truly a bacterial infection versus a viral infection, and then they can go from there in terms of your treatment.
Bill: So if someone has been overusing antibiotics, are there side effects of antibiotic overuse?
Dr. Cummings: Yes, absolutely. So one of the urgent public health threats- so the Centers for Disease Control and Prevention actually has recently ranked a number of pathogens into urgent serious categories, and one of those urgent categories, or the top priority right now for the CDC is clostridium difficile, what we call C. diff, and C. diff is an infection in which results from one of the risk factors is antibiotic use. So actually using antibiotics can lead to further infection. And so one of the things that we're working on is coordinating with guild nursing facilities and other healthcare providers in our area to work together to communicate more effectively so that we can understand what patients are coming into and out of our facilities to be able to prevent those patients from interacting with other patients as we go from facility to facility. So that's one of the main risk factors for C. diff infection, which is a diarrheal illness, is actually being on an antibiotic for an extended period of time.
Bill: That's very interesting. Very interesting. So when is it okay to use an antibiotic? I mean if once a year I have a cold or an infection, and I get prescribed an antibiotic, is that okay?
Dr. Cummings: Yeah, so if your healthcare provider deems it important for you to be on antibiotics, then you should be on your antibiotic and follow your instructions of your healthcare provider. You know, we're mainly concerned about patients coming in and pressuring their healthcare provider into giving them an antibiotic. So overuse and misuse of antibiotics is what really can promote the development of antibiotic resistant bacteria. So for example, every time a person takes antibiotics, sensitive bacteria which is bacteria that antibiotics can still attack are killed, but the resistant bacteria are actually left over to grow and multiply over time. So this is how repeated use of antibiotics can actually increase the number of drug resistant bacteria. So you know antibiotics, like I said, are not effective against viral infections like the common cold or flu, and so it's this widespread use of antibiotics for these illnesses in particular of how overuse of antibiotics can promote the spread of resistance.
Bill: Now you mentioned vaccines as a way to help stem off even getting the infection in the first place. Are there other ways we can reduce the use of antibiotics to avoid infection?
Dr. Cummings: Yes, absolutely. So one of the most important things individuals can do to prevent getting an infection is hand hygiene. So making sure you're washing your hands often, especially during flu season, carry around your antibacterial hand gel in your purse, or as part of your belongings. Take it with you when you're out in public, and especially before eating a meal, make sure you're washing your hands.
Bill: So hand hygiene. Okay, wash those hands. And let me ask you this, for a parent, you were talking about ear infections before. For the parent that always goes in and is looking for that antibiotic, the same thing holds true for them too? Do you say, "Mom and Dad, you've got to hold off. I know the inclination is to want to give them a pill, but better to hold off than to have them potentially overuse an antibiotic." What's your counsel with parents for this?
Dr. Cummings: Right, so obviously for parents it's a huge concern with children, especially because you want to get them in early to see their physician or their healthcare provider. When you take them in, definitely listen to your healthcare provider, listen to their advice, and try to avoid pressuring them into giving you an antibiotic.
Bill: I just remember with my kids it was like, "Give me that Erythromycin! We need that!"
Dr. Cummings: Yeah, or the Z-Pak.
Bill: "I need the Z-Pak, darn-it!"
Dr. Cummings: We're all guilty of that.
Bill: We are all guilty. Is there an antibiotic that we should be more concerned with, or one that get prescribed more than any that we should know about?
Dr. Cummings: You know, the most important thing here, or another important issue to all of this that we haven't brought up yet is the use of antibiotics in our food supply. So not only do antibiotic resistant bacterial infections pose a risk in humans, animals are also affected, and this is a public health issue when bacteria are actually transmitted to humans as foodborne contaminants. So for example, 67% of Salmonella Typhi cases are actually resistant to at least one antibiotic. So we really need to be looking at all different factors that affect this issue.
Bill: So we could be building up an antibiotic resistance because of the food we eat.
Dr. Cummings: Exactly, yes.
Bill: Wow.
Dr. Cummings: So one thing that individuals can do is really to make sure that they're cooking their meat and poultry to the correct temperature, and that they're not eating raw, and making sure that they're rinsing their fruits and vegetables very thoroughly before they eat them because that's also one way that we could be getting a drug resistant bacteria, is through actually foodborne illnesses.
Bill: Wow you know, I didn't even think about that, but that makes so much sense. Wow. Well thank you for the great tips, Dr. Cummings. Really a lot of good information, and thank you so much for your time. And if you'd like to learn more, please visit www.EisenhowerHealth.org. That's www.EisenhowerHealth.org. This is Living Well with Eisenhower Health, I'm Bill Klaproth, thanks for listening.
Bill Klaproth (Host): With more bacteria resisting antibiotics due to overuse, epidemiologists are at the forefront of the effort to make effective change for the purposes of improved population health. So here to talk with us about why antibiotics aren't always the answer is Dr. Patricia Cummings, a clinical epidemiologist at Eisenhower Health. Dr. Cummings, thank you for your time. So with the overuse of antibiotics, we have bacteria that resist antibiotics. So why does overuse make someone more likely to get an antibiotic resistant infection in the future?
Dr. Patricia Cummings, PhD, MPH (Guest): Hi Bill, thanks for having me. Yeah, so antibiotic resistance is really when organisms that would ordinarily be sensitive to an antibiotic becomes resistant to it. So in other words, it is the ability of bacteria to change in a way that reduces the effectiveness of drugs. So something simple like an ear infection can actually turn out to be something very difficult to cure because that antibiotic is no longer able to attack it in a way that would make it sensitive.
Bill: And you know, this is becoming a serious thing according to the CDC. Each year in the United States, at least two million people become infected with bacteria that are resistant to antibiotics, and at least 23,000 people die each year as a result of these infections. These are big numbers, Dr. Cummings.
Dr. Cummings: Yes, so that is correct. Antibiotic resistance has been called one of the world's most pressing public health problems, and it's right now deemed a national security threat to our country. If we don't act now, by 2050 there will be about ten million deaths each year from drug resistant bacteria. So that's about one person every three seconds. So it's really important that we are judiciously using antibiotics in a way that we're taking the right drug for the right bug, and taking it for the correct amount of time or duration, and really getting that proper dose so that we can help prevent further resistance among our bacteria pathogens.
Bill: So you were giving us the example about ear infections. So at what point does normal use become overuse?
Dr. Cummings: Sure, so or another question is what can individuals do to help prevent resistance? And they can do that by avoiding antibiotics when possible, and that means if you have a cold or a flu, avoid pressuring your healthcare provider in prescribing you an antibiotic. Instead ask them what you can do for symptomatic relief. Also consider getting vaccinated against the flu.
Bill: Okay symptomatic relief, I like how you said that. But Dr. Cummings, we always want that pill to make us feel better. How do we do the symptomatic relief? How do we ask for that? Do we say, "I don't want that pill, doctor. What can I do instead of taking that pill?" Is that what we should be asking?
Dr. Cummings: Yes, so your physician can give you tips and over-the-counter solutions to some of the symptoms that you're experiencing. As an epidemiologist, we're most concerned with controlling factors that influence the current distribution of disease in populations. And so for us, we're more concerned about preventing these resistant bacteria from even occurring. But talk to your healthcare provider and get tips from them on what you can do to feel better.
Bill: Alright help us out with this then; when should they be used or requested, and when shouldn't they be?
Dr. Cummings: That is something that your healthcare provider can determine based on what symptoms your experiencing. They can also run a number of lab tests to see if you have truly a bacterial infection versus a viral infection, and then they can go from there in terms of your treatment.
Bill: So if someone has been overusing antibiotics, are there side effects of antibiotic overuse?
Dr. Cummings: Yes, absolutely. So one of the urgent public health threats- so the Centers for Disease Control and Prevention actually has recently ranked a number of pathogens into urgent serious categories, and one of those urgent categories, or the top priority right now for the CDC is clostridium difficile, what we call C. diff, and C. diff is an infection in which results from one of the risk factors is antibiotic use. So actually using antibiotics can lead to further infection. And so one of the things that we're working on is coordinating with guild nursing facilities and other healthcare providers in our area to work together to communicate more effectively so that we can understand what patients are coming into and out of our facilities to be able to prevent those patients from interacting with other patients as we go from facility to facility. So that's one of the main risk factors for C. diff infection, which is a diarrheal illness, is actually being on an antibiotic for an extended period of time.
Bill: That's very interesting. Very interesting. So when is it okay to use an antibiotic? I mean if once a year I have a cold or an infection, and I get prescribed an antibiotic, is that okay?
Dr. Cummings: Yeah, so if your healthcare provider deems it important for you to be on antibiotics, then you should be on your antibiotic and follow your instructions of your healthcare provider. You know, we're mainly concerned about patients coming in and pressuring their healthcare provider into giving them an antibiotic. So overuse and misuse of antibiotics is what really can promote the development of antibiotic resistant bacteria. So for example, every time a person takes antibiotics, sensitive bacteria which is bacteria that antibiotics can still attack are killed, but the resistant bacteria are actually left over to grow and multiply over time. So this is how repeated use of antibiotics can actually increase the number of drug resistant bacteria. So you know antibiotics, like I said, are not effective against viral infections like the common cold or flu, and so it's this widespread use of antibiotics for these illnesses in particular of how overuse of antibiotics can promote the spread of resistance.
Bill: Now you mentioned vaccines as a way to help stem off even getting the infection in the first place. Are there other ways we can reduce the use of antibiotics to avoid infection?
Dr. Cummings: Yes, absolutely. So one of the most important things individuals can do to prevent getting an infection is hand hygiene. So making sure you're washing your hands often, especially during flu season, carry around your antibacterial hand gel in your purse, or as part of your belongings. Take it with you when you're out in public, and especially before eating a meal, make sure you're washing your hands.
Bill: So hand hygiene. Okay, wash those hands. And let me ask you this, for a parent, you were talking about ear infections before. For the parent that always goes in and is looking for that antibiotic, the same thing holds true for them too? Do you say, "Mom and Dad, you've got to hold off. I know the inclination is to want to give them a pill, but better to hold off than to have them potentially overuse an antibiotic." What's your counsel with parents for this?
Dr. Cummings: Right, so obviously for parents it's a huge concern with children, especially because you want to get them in early to see their physician or their healthcare provider. When you take them in, definitely listen to your healthcare provider, listen to their advice, and try to avoid pressuring them into giving you an antibiotic.
Bill: I just remember with my kids it was like, "Give me that Erythromycin! We need that!"
Dr. Cummings: Yeah, or the Z-Pak.
Bill: "I need the Z-Pak, darn-it!"
Dr. Cummings: We're all guilty of that.
Bill: We are all guilty. Is there an antibiotic that we should be more concerned with, or one that get prescribed more than any that we should know about?
Dr. Cummings: You know, the most important thing here, or another important issue to all of this that we haven't brought up yet is the use of antibiotics in our food supply. So not only do antibiotic resistant bacterial infections pose a risk in humans, animals are also affected, and this is a public health issue when bacteria are actually transmitted to humans as foodborne contaminants. So for example, 67% of Salmonella Typhi cases are actually resistant to at least one antibiotic. So we really need to be looking at all different factors that affect this issue.
Bill: So we could be building up an antibiotic resistance because of the food we eat.
Dr. Cummings: Exactly, yes.
Bill: Wow.
Dr. Cummings: So one thing that individuals can do is really to make sure that they're cooking their meat and poultry to the correct temperature, and that they're not eating raw, and making sure that they're rinsing their fruits and vegetables very thoroughly before they eat them because that's also one way that we could be getting a drug resistant bacteria, is through actually foodborne illnesses.
Bill: Wow you know, I didn't even think about that, but that makes so much sense. Wow. Well thank you for the great tips, Dr. Cummings. Really a lot of good information, and thank you so much for your time. And if you'd like to learn more, please visit www.EisenhowerHealth.org. That's www.EisenhowerHealth.org. This is Living Well with Eisenhower Health, I'm Bill Klaproth, thanks for listening.