On the ABC Nightly News this week there was an interesting segment by their new medical correspondent, Dr. Richard Besser – “The Question You Should NOT Ask Your Doctor.”

What would you think it was?

I was ready for something illegal, like don’t ask for narcotic pain meds if you aren’t hurting, but no. It was “Don’t ask for antibiotics!”

This was the perfect follow-up to something I had read recently on-line on Medscape, written by Laura A. Stokowski, RN MS in “Emerging Antibiotics: Will We Have What We Need?” about the same thing about the global problem of emerging antibiotic resistance. After reading the list of “who should be blamed,” I admit that I should probably be saying “Mea culpa” myself.

We’ve all done it if we are truthful:

That patient that we know will tell all of their friends that we did a bad job because we did not give them a prescription for antibiotics so we cave in.

That patient who just won’t budge until we do pony up a script even though we try to tell them, you don’t need it.

Those are just the reasons that fall on our shoulders. Then there are the pharmaceutical companies that don’t invest in the development of new antibiotics, the governmental agencies that don’t make it easy to do so in the first place and the agricultural industry that uses too many antibiotics in animals, thus creating resistance there as well.

How important do you think the crisis is?

Which infections kill more people in the United States every year? HIV/AIDS, TB or MRSA.

More patients die in the United States from MRSA infections than HIV/AIDS and TB combined! Startling, isn’t it.

The most  life-threatening infections, coined as the “six bad bugs” are caused by a group of drug-resistant bacteria that the Infectious Diseases Society of America (IDSA) has labeled the "ESKAPE" pathogens. The pneumonic is perfect and easy to remember because they escape effects of antibiotics. (Table)

Table. The ESKAPE Pathogens

HCA = healthcare associated; BSI = bloodstream infection; MRSA = methicillin resistant S aureus; ESBL = extended-spectrum beta-lactamase; LTCF = long-term care facility; MDR = multiple drug-resistant

If we as physicians, healthcare consumers, pharmaceutical companies, the agricultural industry and the world don't wake up and recognize that we have a tsunami of a problem upon us, we are going to have to wrestle with a problem that may indeed overcome us.

It sounds like the script for a science fiction film, doesn't it? The smallest organism overtaking supposedly the smartest ones? Who was the smartest organism after all.

Very true article in the portrayal of what practitioners go through everyday. I think stories like this help "educate" the potential patient that may come into one's practice. There are some patient's that may "resent" or "question" why they did not get an antibiotic from me initially after an avulsion procedure. I have gotten around this by taking a culture. First, it is good medicine! Secondly, unless the patient is immunocompromised, reflects a more seriously advancing skin infection, or has frank signs of infection (purulence included), I explain to the patient I need to wait for the bacterial cultures and sensitivity. I explain to them "my draining the infection and application of an antibiotic dressing" to be removed by me in 24-48 hours usually results in complete resolution that is even for the patient obvious that they do NOT require antibiosis at this time. There is a greater acceptance of this explanation in my practice today than 20 years ago when I first entered practice. No doubt, I feel it is due to media stories and most doctors educating their patients.

H.G. Wells wrote "War of the Worlds" in 1898......Amazing, isn't it, how true to life certain elements in that story have become.  Through our unnatural selection and careless use of antibiotics we have selected these strains of 'superbugs' which we now must face  -- it is as though WE are the martians now!