You've probably heard of “superbugs,” the name for infections that have built up a dangerous resistance to antibiotics. Could you or your doctor be contributing to their rise?

Antibiotics, or antimicrobial drugs, have saved many lives from bacterial infections. But the bad bugs are catching on, and morphing into illnesses that are much tougher to fight.

Public health experts blame overprescription and unnecessary use for the rise of antibiotic resistance. Dr. Lauri Hicks, Medical Director of the Center for Disease Control and Prevention's Get Smart: Know When Antibiotics Work program says the responsibility lies with both doctors and patients.

Antibiotics are often prescribed for non-bacterial infections, like coughs and colds or viral infections, Dr. Hicks said. In fact, antibiotics are unnecessary 50 percent of the time that they are prescribed.

Patients have become accustomed to getting antibiotics when they go into their doctor's office, and ask doctors specifically for a prescription. On their part, doctors may give patients a prescription if they're not clear on the diagnosis.

Dr. Hicks encourages patients to talk to their doctors about what the best treatment is for their sickness, without putting pressure on them to prescribe antibiotics. But if you are taking an antibiotic, use it properly – finish the entire prescription, even if you're feeling better.

Want to know more about how antibiotic resistance impacts medical treatment, and how you should approach antibiotics as a patient? Read on to learn Dr. Hicks' answers to common questions.

DailyRx: Can you give me a brief history of antibiotic resistance and what it means?
 
Dr. Hicks: Antibiotics, also known as antimicrobial drugs, are drugs that fight infections caused by bacteria.

Alexander Fleming discovered the first antibiotic, penicillin, in 1928. After the first use of antibiotics in the 1940s, they transformed medical care and dramatically reduced illness and death from infectious diseases.

Shortly after the first use of antibiotics, there was evidence of resistance.
 
Antibiotic resistance occurs when bacteria change in a way that reduces or eliminates the effectiveness of antibiotics.  Infections with resistant bacteria have become more common in healthcare and community settings, and many bacteria have become resistant to more than one type or class of antibiotic. 

How does antibiotic resistance develop?

Antibiotic resistance occurs when bacteria change in some way that reduces or eliminates the effectiveness of drugs, chemicals, or other agents designed to cure or prevent infections. The bacteria survive and continue to multiply causing more harm.

Bacteria can do this through several mechanisms. Some bacteria develop the ability to neutralize the antibiotic before it can do harm, others can rapidly pump the antibiotic out, and still others can change the antibiotic attack site so it cannot affect the function of the bacteria.

Antibiotics kill or inhibit the growth of susceptible bacteria. Sometimes one of the bacteria survives because it has the ability to neutralize or escape the effect of the antibiotic; that one bacterium can then multiply and replace all the bacteria that were killed off.

Exposure to antibiotics therefore provides selective pressure, which makes the surviving bacteria more likely to be resistant. In addition, bacteria that were at one time susceptible to an antibiotic can obtain resistance through mutation of their genetic material or by acquiring pieces of DNA that code for the resistance properties from other bacteria.

The DNA that codes for resistance can be grouped in a single easily transferable package. This means that bacteria can become resistant to many antimicrobial agents because of the transfer of one piece of DNA.

Doctors are being blamed for prescribing too many antibiotics. Would you say that's true, and how does over-prescription impact patients? Are some doctors more likely than others to overprescribe antibiotics?

Both providers and patients contribute to the prescribing of unnecessary antibiotics.

Patients often put pressure on their doctors to prescribe antibiotics, thinking they will help them get back to work faster or get rid of symptoms. Providers may succumb to that pressure to keep their patients satisfied or may prescribe an unnecessary antibiotic due to diagnostic uncertainty.
 
Parent pressure makes a difference. For pediatric care, a study showed that doctors prescribe antibiotics 62% of the time if they perceive parents expect them and 7% of the time if they feel parents do not expect them.
 
Antibiotic use promotes development of antibiotic-resistant bacteria. Every time a person takes antibiotics, sensitive bacteria are killed, but resistant germs may be left to grow and multiply.

Repeated and improper uses of antibiotics are primary causes of the increase in drug-resistant bacteria. Smart use of antibiotics is the key to controlling the spread of resistance.
 
Unnecessary antibiotic use may also lead to adverse drug events, like serious allergic reactions or a C. difficile infection. In children, reactions to antibiotics are the most common cause of emergency department visits for adverse drug events.