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 OUR SPECIES HAS A MAJOR PROBLEM. BACTERIA.
Infections
have probably killed more human beings than any other force. Be it by infant
mortality or the dying man's friend (pneumonia) infections have always been
with us.
Paleontologist
Steven Jay Gould argues that bacteria are the dominant life form on the planet!
Man has had to accept bacteria as part of not only death but life. Research
has indicated that some of the components of our cells were once separate
organisms that became so close to us that they actually became us!
Nature
is filled with instances of different life forms intimately co-existing, in
fact it's the rule rather than the exception. Many animals can only digest
their food with the help of enzymes produced by bacteria in the digestive
system. Bacteria live in and on our bodies and protect us by preventing other
more dangerous organisms from infecting us. These organisms are called our
normal flora - like our own private garden.
When
the delicate balance between symbiots is disrupted is when disease occurs.
There was little we could do but depend on our highly evolved immune system
to save us until we discovered Penicillin and the age of the miracle drugs
was born.
Although
our immune system and the modern pharmaceutical industry are quite competent-
the bacteria are better. Bacteria can develop resistance to any antibiotic in
short order. It takes modern pharmaceutical companies years and millions of
dollars to develop the next generation antibiotic. It may take the bacteria
one infection to develop immunity.
Successful
treatment is also dose related. Whereas treatments used to be successful with
100,000 units of penicillin, it is now common to give doses as high as 3
million units of penicillin - four times a day! Unfortunately most
antibiotics are not this safe and the toxic dose may be reached before the
infection is cured.
You
may have heard the phrase "What doesn't kill me - makes me
stronger." This is the bacteria's theme song. You may also recall your
doctor saying, "Take the antibiotic pills as directed until all the
pills are gone". Unfortunately, after half the prescription is gone - we
get lazy and forgetful, "But it doesn't hurt anymore", we say.
The
best chance to eliminate the greatest number of bacteria is to complete the
course of treatment. What happens when we take half a course is - the
bacteria develop resistance.
Another
way to induce bacterial resistance is to take antibiotics frivolously -such
as when we have a common cold - always caused by a virus and not affected by
antibiotics.
By
repeatedly exposing bacteria to our weapons - it gives them more
opportunities to develop resistance. And this is precisely what has happened.
We now have tuberculosis that is resistant to all known antibiotics and other
bacteria are also escaping our ability to deal with them.
All
of the above is a description of the environment in which the following takes
place:
I
am often asked when planning surgery whether an antibiotic will be given
before surgery. There are a few cases when this is indicated but generally
the answer is no. The current practice in this office is to not give
antibiotics "prophylactically".
The
literature supports preventive antibiotic treatment only when the patients
defenses are compromised in some way such as immune deficiency states,
Diabetes Mellitus or the presence of a heart murmur, prosthetic heart valve,
or prosthetic joint. But not every patient requires antibiotics.
In
these cases the probability of infection is so high and the consequences of
that infection potentially so deadly that antibiotics are recommended.
The
protocols for modern surgical prophylaxis dictate that the antibiotic be
given in a large dose at the time of surgery and one or no postoperative
doses. This is based on the theory that the antibiotic should be in the blood
when the bacteria are in the blood. The antibiotics are not given
preoperatively nor postoperatively so as to not induce resistant strains.
These
issues have been addressed for years by the American Heart Association, The American
Dental Association, Orthopedic societies, and just about every other
organization that has an opinion has published it.
The
American Heart Association has taken the lead in establishing guidelines for
the administration of antibiotics for heart patients under going surgery of the
mouth, respiratory tract, and genitourinary tracts because this is when the
serious infections have been observed. Specifically: sub-acute bacterial endocarditis
- or infection of the inside of the heart.
The most recent guidelines were published in the Journal of the American Medical Association (JAMA) June 11, 1997 and reported in the Journal of the American Dental Association.
An expert panel of dentists and orthopedic surgeons from the American Dental Association and the American Academy of Orthopedic Surgeons recently reviewed all available data regarding prophylaxis for prosthetic joint patients undergoing dental treatments. This statement was published in the Journal of the American Dental Association in July, 1997.
With
the growing concern over antibiotic resistance, the potential risks as well
as benefits of antibiotic use must be considered. Risks include toxic
reaction to the drug, allergic reaction, and the selection and transmission
of bacterial resistance as described.
The
above bodies distribute these advisory statements to delineate the limited
circumstances in which prophylaxis should be used. Your dentist and physician
should advise you of all reasonable treatment options.
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