Distrust of the state promotes antibiotic abuse

Iwona Schymalla: Antibiotics - professor, do they still work?

Prof. Ernest Kuchar: They definitely work. On the other hand, we want them to work for as long as possible. What is the point? Antibiotics are a special drug. If one is treating hypertension or lowering one's cholesterol too high, that is one's business. This is not the case with antibiotics. Antibiotics are an asset for all of us. I've already explained what this is all about. An antibiotic does not work on the person who takes it, but on the microorganism. The essence of antibiotic use is selective selective toxicity. That is, they are actually poisons for the bacteria, while for us, ideally, these antibiotics should be completely harmless. And this can be achieved, for the reason that bacteria, fortunately, are very different from us, so we can disrupt their metabolism or structures that are not present in our body (such as the cell wall). The cell wall we don't have, otherwise we wouldn't be able to move. So we can destroy it with impunity, damage it (this is how beta-lactams or vancomycin work), and it will effectively deprive the bacterium of life. When we give an antibiotic, we create selection pressure, that is, those bacteria that are susceptible to the antibiotic die, but those that are resistant multiply and begin to dominate. After some time, after a number of antibiotic treatments, we see that there are more and more of these antibiotic-resistant bacteria in the environment, and fewer and fewer of the susceptible ones. And since bacteria reside in our digestive tract, on our mucous membranes, basically everywhere, they also get into the environment.

Iwona Schymalla: So there will always be resistance?

Prof. Ernest Kuchar: Yes. This is a process that is basically inevitable. Whether we use an antibiotic rationally or completely unnecessarily, the effect is the same - we exert selection pressure and after some time we observe resistance. When the first antibiotic - penicillin - came into use in the 1930s, it was staphylococci that were sensitive to it. But time has passed, and today no one would think to treat staphylococci with penicillin, because 98 percent of their strains are already resistant.

Iwona Schymalla: So it's not that overuse of antibiotics gives resistance, it's just their use.

Prof. Ernest Kuchar: And that's why we should treat antibiotics a bit like nuclear weapons. Well, maybe I'm exaggerating, but it's a strategic weapon, not a tactical weapon, that is - treat when it's really needed. Let me give an example. When someone has pneumonia, which can kill, of course it's a condition to use antibiotics. Likewise sepsis or purulent meningitis. But if someone has a green runny nose, here an antibiotic is not necessary.

Iwona Schymalla: So it's just that doctors assign antibiotics too often? Sometimes patients themselves demand them, for example, parents ask for an antibiotic for their children.

Prof. Ernest Kuchar: Yes. This is all true. There have been papers published on this topic, too, comparing, for example, antibiotic use in Western Europe and Central and Eastern Europe. And it turns out that the use of antibiotics is greatly influenced by social transitions, public trust. Where there is a lot of trust in the authorities, but also in the doctor, in the system, antibiotics are abused much less. This can be seen in Scandinavian countries like Norway, Denmark. In contrast, in countries that are post-transition, such as Poland (a legacy of communism) - trust is zero. There we endure badly, let's say, a sense of uncertainty. That is, if you don't know what kind of illness, let there be an antibiotic, even if it's a runny nose. And what seems on the surface rational, because we think to ourselves: if it's a virus, the antibiotic won't hurt, and if it's a bacterium, it will help. That is, de facto you can take an antibiotic in any indication. This does not work! On the contrary. The price we pay for this is precisely the huge increase in antibiotic resistance.

Iwona Schymalla: What could this threaten us with?

Prof. Ernest Kuchar: The post-antibiotic era. Twenty, 30 years will pass and it will turn out that you, the editor, or I, will end up in the hospital with pneumonia and there will be nothing to treat us with.

Iwona Schymalla: There used to be a song called "Merry is the life of an old man."

Prof. Ernest Kuchar: Yes, I know this song. I am already preparing...

Iwona Schymalla: Can an old man's life be cheerful at all? Because, however, the years of healthy life are getting shorter.

Prof. Ernest Kuchar: We are living longer and longer, and everyone is delighted with this, forgetting one small detail, that we are adding years in our 70s, 80s, 90s. These are not the same years as we are in our 20s or 30s (these are not years in the prime of life). We are being added to the brittle years, I call it, when health is no longer so, memory is not so, our functioning is generally worse. But as long as we are independent, it's not bad. I once, while reading an article on quality of life, pointed out that this quality of life generally declines somewhat with age. But it breaks down, that's probably the best word, somewhere around the age of 70. That's when the biggest differences in quality of life occur between people of the same age. What I mean by this is that some are doing quite well, functioning independently, living the life of a happy old man to the fullest, completely coping and having pleasures. In contrast, others of the same age may be people who already walk on a walker, or, perhaps worst of all, are already bedridden people who lie down and require the help of a third person on a permanent basis. The causes are many. Among the most important diseases, it is worth mentioning stroke, myocardial infarction, femur fracture, and the fourth place is infectious diseases like pneumonia, or viral diseases (like influenza, COVID-19, RSV, which can run hard in the elderly) or bacterial diseases, which is usually pneumococcal. And there is a lot of work to be done here, for the reason that we can prevent these diseases. Please note what a huge impact this has, not only from the point of view of the individual, but also society. Seeing how my wife regularly goes to visit her in-laws because someone has just fallen over, or some illness has appeared, made me realize that although they function well on a daily basis, when illness comes, as eighty-year-olds they can't cope, they need support. And now imagine that such a person becomes completely dependent on assistance. For the family, this is a huge burden. In practice, one has to adjust life plans, forget about trips (unless one can afford to hire a person to care for 8-12 hours a day, which of course involves a huge cost). So, given our capabilities, let's try to prepare a little for what is inevitable in old age, such as an increased risk of pneumonia, but also hemiplegia. Simply put, our immune system is aging and the risk of these diseases increases every year.

Iwona Schymalla: So vaccination?

Prof. Ernest Kuchar: Yes. Vaccinations! Definitely. But be careful, not when one is already sick, but one should think about it earlier. Just remember that our immunity in middle and old age is no longer the same as it was when we were in our 20s. I already vaccinated against herpes zoster, against influenza and COVID too. Against RSV I haven't, but the indications are after age 60, so I can still wait.