Antibiotics, Bacteria, Infection, and RA

Patient Expert

In honor of Get Smart About Antibiotics Week, November 14-20, 2011, we are delving into the subjects of bacteria, viruses, appropriate use of antibiotics, and avoiding infection.

Bacteria and Antibiotics

Before the discovery of penicillin in 1928, bacterial infections were a major cause of death.   Bacteria are single-celled organisms which can live both inside and outside of the human body, including on the surface of non-living objects.   The bacteria, streptococcus pyogenes which is responsible for strep throat and some skin infections, was previously the cause of half of all post-birth deaths before penicillin (an early antimicrobial medication) came into common use.   The bacteria, staphylococcus aureus, was fatal in 80 percent of infected wounds.   Tuberculosis and pneumonia bacteria were also horribly dangerous.

Antimicrobial medications, or antibiotics, have saved countless lives during the past 80+ years.   However, when they are not used appropriately, bacteria can become resistant to medication.   An example is the frightening methicillin-resistant S. aureus bacteria, also known as MRSA.   As a bacteria becomes resistant to one medication, a stronger antibiotic must be developed to attack the evolved bacteria.   Improper use of antibiotics is how "super bugs" are created.

Viruses vs. Bacteria

Viruses are organisms (smaller than bacteria) which cannot survive independently.   They survive by invading a host body's cells and reproducing within healthy cells to cause illness.   Viruses can also contaminate food and water which is one reason foods should be cooked thoroughly before consumption.

The "common cold" is caused by a virus (more than 200 viruses actually) which can be easily transferred from person to person in close contact, through infected fluids transfered by sneezes or coughs, or through sharing items contaminated by the virus.   The "stomach flu" is also caused by viruses which can be transferred from person to person through close contact or through the consumption of contaminated food or water.

Some viruses can live dormant within a person's body without causing illness for many years.   One example is the varicella zoster virus which causes chickenpox.   Most people develop chickenpox at some point in their lives if they are not vaccinated against the varicella virus.   In children, chickenpox is not usually serious.   In some adults, the virus may become active again after years of lying dormant in the body to cause the viral infection known as shingles, a condition which can be extraordinarily painful.

Influenza is also an infection caused by a virus.   When a person has been diagnosed with viral infections such as the shingles or influenza, antiviral medications may be helpful to reduce complications of the infection.   These medications are most effective when used within 48 hours of symptom development.

Viruses and Antibiotics

Unlike bacteria, viruses cannot be killed through the use of antibiotics.   If you have the common cold, an antibiotic will not help you kick the infection.   In fact, taking antibiotics when they are not needed may increase your risk of developing an infection (bacterial) at a later date which is resistant to antibiotics.

The CDC (Centers for Disease Control and Prevention) stresses that "antibiotics cure bacterial infections, not viral infections such as: colds or flu; most coughs and bronchitis; sore throats not caused by strep; or runny noses.   Taking antibiotics for viral infections, such as a cold, cough, the flu, or most bronchitis, will not: cure the infections; keep other individuals from catching the illness; or help you feel better."

Immunosuppressants and Infections

Many of us living with rheumatoid arthritis take medications which suppress the immune system.   Examples of drugs which I've taken that do this include methotrexate, rituximab, and prednisone.   Taking these medications make us more vulnerable to infection.   The TNF-blocker medications commonly used to treat RA can also increase risk of serious infection.   Although a recent study suggests that anti-TNF drugs did not increase serious infection rate compared to nonbiologic drugs, including leflunomide, sulfasalazine, or hydroxychloroquine after any use of methotrexate.

In the case of these studies, serious infection is defined as one which requires hospitalization.   This may include pneumonia, infections of the respiratory tract, skin and soft tissue infection, urinary or gastrointestinal tract infection, central nervous system infections, and sepsis (bacterial infection in the blood).   Everyday infections such as colds, flu, strep throat, or minor wound infections are not considered.

It's important to remember that when you need to take antibiotics for a short period of time, you may need to avoid taking your medication (such as methotrexate).   Be sure to consult with your doctor for recommendations specific to your situation.

Protect Yourself Against Infection

Whether you are taking an immunosuppressant or not, you should try to avoid infection.   There are several easy things you and those around you can do to help keep everybody safe and healthy.

  • Avoid sick people.   Sounds simple but may be more challenging if you spend much time out in public.
  • Stay home if you are sick to avoid spreading contagious illness to others, especially if you are running a fever.   Cover your cough or sneeze with a tissue or your shirt sleeve".NOT your hands.
  • Do not share foods or drinks with others, regardless if they don't appear to be sick.   Cook foods thoroughly to kill any harmful bacteria.
  • Clean a wound with soap and water as soon as it occurs.   Minor cuts and scrapes can become infected quickly when your "watch dogs", your immune system, are leased.
  • Wash your hands regularly and avoid touching your eyes, nose, and face with unclean hands.   Carry hand sanitizer with you and use it as needed.
  • Consider that anything you touch may have been touched by someone else (or many, many other people) who may have left behind bacteria or viruses which would flourish in your immunosuppressed body.   Be proactive in protecting yourself.

A recent study found that of common surfaces one may encounter on the way to work gas pump handles are the filthiest.   Other surfaces which ranked high on the list include handles on public mailboxes, escalator rails, and ATM buttons.   Additional offenders were parking meters and kiosks, crosswalk buttons, and buttons on vending machines in shopping malls.   The study authors advice?   Wash your hands as soon as you get to work.

Key Take-aways?

Protect yourself against infection.   Consult your doctor if you feel you have developed an infection.   Antibiotics only work on bacterial infections.   Antibiotics won't help you if you have a viral infection.   Wash your hands regularly, especially after touching everyday public surfaces.

What are your words of advice when it comes to infection and antibiotics?** Lisa Emrich is author of the blog Brass and Ivory: Life with MS and RA and founder of the Carnival of MS Bloggers.**