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 The following is a guest post from Jo of Head Nurse, who calls it "a simple guide to antibiotic resistance for the liberal arts major."

 If you've been paying attention for the last couple of years, you might've noticed that there's a whole lot being said lately about antibiotic-resistant "superbugs" in the media. You might be able to name one of 'em: MRSA, or Methicillin-Resistant Staphylococcus Aureus. You might even know somebody who's been in a hospital or nursing home and who's ended up with an antibiotic resistant bug. 

But what, you might be asking yourself, makes some bugs harder to kill than others? How does this "antibiotic resistance" stuff happen, anyhow? What's an antibiotic in the first place? And are we all gonna die from flesh-eating nasties that can't be cured?

The answers, my friends, couched in terms even an English major can understand, are below. Read on:

  1. What's antibiotic resistance, anyway? For that matter, what's an antibiotic?
  2. Antibiotics are drugs that kill bacteria. That's it. There's nothing magical about 'em, and they don't work on viruses (like the flu virus or cold viruses). 

    Antibiotic resistance, simply put, is the ability of various bacteria to become immune to certain poisons. The poisons they're immune to are, sadly, the ones we've been using for years to kill them. Antibiotic resistance develops over time as bacteria mutate.

  3. How the heck do they work?
  4. Different antibiotics work in different ways. Mostly, they interfere either with the metabolism of bacteria or with the ability of the bacteria to repair itself. Bacteria, see, are entirely complete living organisms unto themselves, eating and excreting and making more little bacteria. (No word yet on whether they have hopes and dreams.) They're like us in those ways, but unlike us--and this is important--in some of their specific chemical processes and markers. Antibiotics target those chemical processes and markers to, say, starve a bacterium or keep it from repairing its cell wall (the equivalent of our skin).

  5. How is resistance developed, and what does it mean for little old me?
  6. Antibiotic resistance happens when bacteria (hereafter referred to by the complex medical term of "bugs") get exposed repeatedly to drugs that that are unable to kill off them. It can happen pretty darned fast, because bugs breed like crazy. The faster something breeds, the more likely it becomes that there will be mutations in later generations that allow for resistance.

    What that means for us, as laypeople, is this: As time goes on, we're that much more likely to get exposed to bugs that nothing but the strongest, nastiest, most side-effect-laden antibiotics can touch. Some of those infections can be really serious, and the treatments for them are officially No Bueno.

  7. How can I avoid resistant bacteria or lessen their effect on me?
  8. You can avoid antibiotic resistant bugs by locking your door, shutting your windows, and never going outside.

    If you're not really up for the Salinger method, try this: wash your hands. Wash 'em frequently and well, with plain soap and water, especially when you or somebody you're around is sick.

    If you're visiting someone in the hospital, and you see people going into and out of their room in ugly plastic gowns, ask one of the nurses what you should do before going into the room. That person is in isolation, probably for an antibiotic-resistant bug, and the plastic gowns, gloves, etcetera, are there to keep it from being spread to other people. 

    If you yourself are in the hospital and are able, pay attention to your caregivers. If they're not washing their hands and wearing gloves, ask them to. Nobody's going to get their noses out of joint if you do that.

    If you get sick, and your doc tells you that you have a bacterial infection and NEED antibiotics, take 'em. Don't save them for the next time you get sick, don't borrow antibiotics from anybody else, and don't take the stuff that was prescribed for your dog or cat. 

  9. What does resistance mean going forward?
  10. Good question. The answer, sadly, is "probably nothing real good." Remember MRSA from the start of this essay? Well, MRSA now has a bigger, badder brother with the catchy name of VRSA, or vancomycin-resistant staph. Vancomycin is the only drug that'll reliably kill MRSA...and now there's a strain of bug out there that can survive even that. Awkward!

We can expect to see more drug-resistant strains of bugs in the future. A *lot* more. We can therefore expect our arsenal of antibiotics to get both smaller and stronger, with the result that side effects will get nastier, and things'll get considerably harder to cure. 

The good news is that there are plenty of bright people working on ways to cure infections using drugs that, say, keep a bug from reproducing rather than killing it outright (those are called "bacteriostatic" drugs, by the way).There are also folks researching other antibiotic alternatives like ways to prevent quorum sensing and developing bacteriophages, viruses used to attack bacteria that don’t hurt humans. Research is, though, slow and painstaking, and can't keep up with the pace of mutation in a bacterial population.

There's no miracle drug out there that'll kill everything. Even if there were, the chances of some sort of bug developing miracle-drug resistance are good. We've gone back in time, in a sense, to the days before reliable antibiotics, and we're gonna have to get a lot more careful and creative as a result.

So wash your hands. Don’t use antibiotics when you don’t need them. Don't share your pills, and refuse any that a well-meaning friend offers you. That's about all anybody who isn't a researcher can do, and it's just as important to stopping the spread of resistant bugs as puttering around with test tubes.

 Jo is an RN on the dusty plains of central Texas. Mostly, she deals with brains and spines. She can be found complaining and being cranky at