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Originally Posted by robbdn
... And I'm not saying that I still don't believe the average person takes too many medications for conditions that don't require them, but I also think there are a lot of people like me who are too wary to take medications even when they are needed, probably due to misconceptions like mine.
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There is an antibiotic crisis, but it cuts across medicine. If you need one, use it. Use it correctly.
I wish there were an infectious disease guy here to respond intelligently. My knowledge is limited.
There are a limited number of antibiotics. New ones are few and far between. As bugs develop resistance to old classes, doctors move to new. The problem is that nature is better at evolving around our discoveries than we are at discovering, and pharmaceuticals aren't ideally motivated...profit vs. risk. Hopefully alternatives will pan out. Researchers are playing with "active" treatments. There's work with animals (reptiles) that have built-in systems we may be able to borrow from. But last I heard any solutions are far in the distance. In the meantime we have a limited arsenal.
Careless patients aren't the only cause of resistance. Doctors can contribute, whether by prescribing when it isn't needed. If needed, prescribing too short, too weak, or just a bad match for the target. Their job is a dance between using something effective enough to kill the target but without nasty side-effects. The antibiotics are not perfect precision munitions. They kill more than just the intended target, and so while they're being administered it can lead to a cascade of problems depending on how far out of whack the normal bug community becomes. So doctors try to start with a minimum dose plus safety margin and hope.
The uniqueness of each patient contributes. What if, as in Rodney's Mother's case above, the pnumonia patient has scar tissue in her lungs? (Pnumonia causes scar tissue, so it's a progressive problem.) That scarred area will not receive normal circulation therefore perfusion of the antibiotic will be reduced. The duration or method of application may need to change, but they don't know that until they fail, which creates more scar tissue, etc. Each failure brings reduced lung function, and the congestion strains the heart and other systems. It just keeps getting worse. Liquid ventilation may reach impaired areas but it's exotic and hazardous in its own right. Instead the patient lives with an oral antibiotic for life and any side-effects it may bring. Better than the alternative.
Other hazards are foreign objects. Implants like pacemakers, hardware for the repair of broken bones (screws, plates, rods...), in the future it could be identity chips your parents installed, artificial eyes, whatever. If the bug has set up a colony in or on one of these "dead" areas, it can hang out until the antibiotics have passed and then spawn new infections. After each cycle the surviving bugs will be more resistant to the treatment. Doctors will ID for another treatment, but eventually they run out of choices. The complications (collateral damage) increase as the battle escalates to harsher drugs. These battles result in what you've heard described as "superbugs" for which the treatment is brutal or nonexistent. Eventually doctors begin treating the hospital. It may be better to lose a patient than force a new strain of some critter that could take out an ICU of lowered-resistance patients.
So yes, there's a crisis, and it's why doctors no longer prescribe antibiotics for runny noses, but those who need it need it. For something that's bothered you this long doctors will be better at deciding.
Edit: Need a spelling antibiotic.