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Dear Dr. Roach, In a recent column, you talked about the overconsumption of antibiotics that I had never heard before: "Antibiotics will be more effective when you choose to use them." I thought the argument against overconsumption was strictly altruistic. prevalence of drug-resistant disease strains in the general population. I would like to know more about how an antibiotic would be more effective if someone had not used it before. If two people infected with the same strain receive the same antibiotic, but one has already used it, why would it be less effective for that person?
JG
Bacterial cells are older, more adaptable, grow faster and cause many more spontaneous mutations than animal cells. As a result, they can quickly develop antibiotic resistance, or even spread the resistance mechanism between them by genetic transfer. The longer and longer the bacteria are exposed to antibiotics, the more likely it is that resistance will develop unless all the bacteria are literally killed, which is difficult.
A person who frequently takes antibiotics is more likely to have resistant bacteria colonizing his body and, in some circumstances, bacteria that colonize the body can become invasive. If these bacteria have developed antibiotic resistance, this will make the treatment of the individual more difficult.
Over time, bacteria with an anti-biotic resistance tend to be supplanted by non-resistant bacteria (called the "wild type" in genetics). Thus, for an individual, taking antibiotics does not often increase the likelihood of harboring resistant bacteria. As you say, the general population is critical. If there is a lot of use of antibiotics in the community, then everyone is at increased risk. Therefore, there is both an individual benefit and a greater societal benefit of minimizing the use of antibiotics where it is clearly indicated.
We have long badumed that resistance was a problem if patients were undergoing incomplete antibiotic treatment, but the main problem of too short a treatment is that it is ineffective: the infection may reappear, but it is not likely to resist. We are beginning to realize that overly long antibiotic treatments may play a more important role in the development of resistance. This is why the ideal duration of antibiotic treatments is being reviewed. It is likely that shorter antibiotic treatments than currently prescribed may reduce overall resistance. For the moment, patients should take their antibiotics as prescribed and only when necessary.
Dear Dr. Roach, I have to undergo hip replacement surgery because x-rays show joint failure. I am 81 years old and I am in excellent health. For now, I do not feel any pain in my hip and I walk very easily. I'm going to swim three times a week. My question is whether I should accept this operation as a preventive method to avoid painful situations and possibly riskier because of my age.
P. H.
Hip replacement is indicated for people with severe and debilitating symptoms (such as pain or loss of function) despite conservative management. It does not look like what you are describing. The X-ray results are less important than your symptoms and function, so I could not recommend a hip replacement at the moment. Age in itself is not a contraindication to hip replacement if you need it later.
I understand what you are saying: you are less likely to have a surgical problem sooner. For this reason, some surgeons operate on patients with less severe symptoms. However, you do not even describe the slightest symptoms, hence my recommendation against surgery at the moment.
Dr. Roach regretted that he could not reply to individual letters, but would incorporate them in the column whenever possible. Readers can e-mail their questions to [email protected]
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