“I remember the astonishment when the first cases of pneumococcal and streptococcal septicemia were treated in Boston in 1937. The phenomenon was almost beyond belief. Here were moribund patients, who would surely have died without treatment, improving in their appearance within a matter of hours of being given the medicine and feeling entirely well within the next day or so.” Lewis Thomas, The Youngest Science, The Viking Press, 1983
It was a short 76 years ago in the history of humankind that using purified small molecules with antibacterial activity as treatment of patients with common bacterial infections were introduced into the practice of modern medicine. At the start of the 21st century, it is rare for even the healthiest of us in developed countries not to have been treated with these drugs, if not to save our lives, then certainly to change the course of what would have been a painful, debilitating illness.
Since their discovery, an enormous amount has been learned about the benefits of antibiotics in both laboratories and by physicians caring for patients. However, perhaps the most profound lesson is now being learned about the benefits of being smarter about when not to use these drugs.
Five years ago, the US Centers for Disease Control began an annual a week-long observation focusing the public to “Get Smart about Antibiotics”. For the past 4 years similar observations in Europe, Australia and Canada have been organized to coincide with CDC’s efforts.
So, this week the 2013 campaigns will begin, once again, by underscoring the value of appropriate and judicious use of these life-saving drugs. We will be reminded that using antibiotics to treat patients with self-limiting infections, some of which can be caused by bacteria, not only do not benefit the patient, but can be contributing to the next great and yet-to-be-solved challenge posed by the emergence of antibiotic resistance.
As a parent of three and a Pediatrician who specialized in infectious diseases, my personal and professional experience has given me the opportunity to witness a variety of coping behaviors, from paralyzing panic to deep denial, evoked when facing an irritable child with a high fever.
It is difficult to remove emotion from our decision making when faced with acute illness in an infant, even for the most experienced health care provider. However, the information that has become available over the last two decades has enabled us to be substantially smarter in deciding about using antibiotics in children.
Widespread use of highly effective vaccines against the major causes of bacterial meningitis, pneumonia and blood-borne infections in infants and children and rigorously conducted clinical trials demonstrating the limited role antibiotics play in treating children with middle ear infections and other upper respiratory tract infections have dramatically changed the view that antibiotics should play a routine part in therapy for the child with fever.
And, we will get smarter. Rapidly and accurately defining the cause of an infection and enabling selective use of antibiotics, holds the single, greatest promise for meeting the challenge we face in nearing the end of the first 100 years of an era; an era whose beginning was recalled with such awe by Dr. Lewis Thomas. It certainly took a whole lot of smarts to bring this era through its birth and infancy. It will undoubtedly require at least the same amount of smarts to ensureits continued development.
Gary J. Noel, M.D., FIDSA, FAAP is an experienced physician-scientist, who is board certified in Pediatrics and Infectious Disease. He recently joined Janssen’s Child Health Innovation and Leadership Department (CHILD), which helps champion the unique needs of children when developing drugs. Gary began his 33-year career as an academic pediatrician while his role in industry has been focused on development of antibacterials. Throughout his career, Gary has worked to improve the health and well-being of children everywhere.