Antibiotics: What’s in a Name?
The term antibiotics literally means “against life”; in this case, against microbes. There are many types of antibiotics—antibacterials, antivirals, antifungals, and antiparasitics. Some drugs are effective against many organisms; these are called broad-spectrum antibiotics. Others are effective against just a few organisms and are called narrowspectrum antibiotics. The most commonly used antibiotics are antibacterials. Your child may have received ampicillin for an ear infection or penicillin for a strep throat.
When a child is sick, parents worry. Even if he has only a mild cold that makes him cranky and restless or an achy ear that only hurts a little, these times can be very stressful. Of course, you want him to get the best possible treatment. For many parents, this means taking him to the pediatrician and leaving the office with a prescription for antibiotics.
But that isn’t necessarily what will happen during the doctor’s visit. After examining your youngster, your pediatrician may tell you that based on your child’s symptoms and perhaps some test results, antibiotics just are not necessary.
Many parents are surprised by this decision. After all, antibiotics are powerful medicines that have eased human pain and suffering for decades. They have even saved lives. But most doctors aren’t as quick to reach for their prescription pads as they once were. In recent years, they’re realizing there is a downside to choosing antibiotics—if these medicines are used when they’re not needed or they’re taken incorrectly, they can actually place your child at a greater health risk. That’s right—antibiotics have to be prescribed and used with care, or their potential benefits will decrease for everyone.
A Look Back
Serious diseases that once killed thousands of youngsters each year have been almost eliminated in many parts of the world because of the widespread use of childhood vaccinations.
In much the same way, the discovery of antimicrobial drugs (antibiotics) was one of the most significant medical achievements of the 20th century. There are several types of antimicrobials—antibacterials, antivirals, antifungals, and antiparasitic drugs. (Although antibacterials are often referred to by the general term antibiotics, we will use the more precise term.) Of course, antimicrobials aren’t magic bullets that can heal every disease. When used at the right time, they can cure many serious and life-threatening illnesses.
Antibacterials are specifically designed to treat bacterial infections. Billions of microscopic bacteria normally live on the skin, in the gut, and in our mouths and throats. Most are harmless to humans, but some are pathogenic (disease producing) and can cause infections in the ears, throat, skin, and other parts of the body. In the pre-antibiotic era of the early 1900s, people had no medicines against these common germs and as a result, human suffering was enormous. Even though the body’s disease-fighting immune system can often successfully fight off bacterial infections, sometimes the germs (microbes) are too strong and your child can get sick. For example,
Before antibiotics, 90% of children with bacterial meningitis died. Among those children who lived, most had severe and lasting disabilities, from deafness to mental retardation.
Strep throat was at times a fatal disease, and ear infections sometimes spread from the ear to the brain, causing severe problems.
Other serious infections, from tuberculosis to pneumonia to whooping cough, were caused by aggressive bacteria that reproduced with extraordinary speed and led to serious illness and sometimes death.
The Emergence of Penicillin
With the discovery of penicillin and the dawning of the antibiotic era, the body’s own defenses gained a powerful ally. In the 1920s, British scientist Alexander Fleming was working in his laboratory at St. Mary’s Hospital in London when almost by accident, he discovered a naturally growing substance that could attack certain bacteria. In one of his experiments in 1928, Fleming observed colonies of the common Staphylococcus aureus bacteria that had been worn down or killed by mold growing on the same plate or petri dish. He determined that the mold made a substance that could dissolve the bacteria. He called this substance penicillin, named after the Penicillium mold that made it. Fleming and others conducted a series of experiments over the next 2 decades using penicillin removed from mold cultures that showed its ability to destroy infectious bacteria.
Before long, other researchers in Europe and the United States started recreating Fleming’s experiments. They were able to make enough penicillin to begin testing it in animals and then humans. Starting in 1941, they found that even low levels of penicillin cured very serious infections and saved many lives. For his discoveries, Alexander Fleming won the Nobel Prize in Physiology and Medicine.
Drug companies were very interested in this discovery and started making penicillin for commercial purposes. It was used widely for treating soldiers during World War II, curing battlefield wound infections and pneumonia. By the mid- to late 1940s, it became widely accessible for the general public. Newspaper headlines hailed it as a miracle drug (even though no medicine has ever really fit that description).
With the success of penicillin, the race to produce other antibiotics began. Today, pediatricians and other doctors can choose from dozens of antibiotics now on the market, and they’re being prescribed in very high numbers. At least 150 million antibiotic prescriptions are written in the United States each year, many of them for children.
Problems With Antibiotics
The success of antibiotics has been impressive. At the same time, however, excitement about them has been tempered by a phenomenon called antibiotic resistance. This is a problem that surfaced not long after the introduction of penicillin and now threatens the usefulness of these important medicines.
Almost from the beginning, doctors noted that in some cases, penicillin was not useful against certain strains of Staphylococcus aureus (bacteria that causes skin infections). Since then, this problem of resistance has grown worse, involving other bacteria and antibiotics. This is a public health concern. Increasingly, some serious infections have become more difficult to treat, forcing doctors to prescribe a second or even third antibiotic when the first treatment does not work.
In light of this growing antibiotic resistance, many doctors have become much more careful in the way they prescribe these medicines. They see the importance of giving antibiotics only when they’re absolutely necessary. In fact, one recent survey of office-based physicians, published in JAMA: The Journal of the American Medical Association in 2002, showed that doctors lowered the number of antibiotic prescriptions they prescribed for children with common respiratory infections by about 40% during the 1990s.
Antibiotics should be used wisely and only as directed by your pediatrician. Following these guidelines, their life-saving properties will be preserved for your child and generations to come.