Nathan Chomilo, MD:
Stories of Antibiotic Use and Resistance

Antibiotics are one of the most important and effective treatments I have as a doctor. When I see patients in the hospital, I am often using antibiotics to treat life or limb-threatening infections. When I see patients in the clinic, I use antibiotics to treat relatively minor illnesses that without antibiotics could quickly become dangerous or have serious complications.

Because antibiotics are so effective when used appropriately, they are often seen as a "quick fix" by doctors and patients alike. However, like any treatment, there are risks and benefits to weigh. In a setting where a doctor's time can be limited and patients' well intended expectations can be misplaced, you end up with a quick fix being the path of least resistance. It's easier to write a prescription and have a satisfied patient and feel like you are doing something palpable for them vs taking the extra time to explain why an antibiotic isn't indicated, and in fact could be harmful.

Initially it was contained to the hospital where I would see patients with serious infections that would not improve with standard therapy. Some patients lost limbs because of these infections and others lost their lives. More recently, however, I have started to see antibiotic resistant infections in my patients in the pediatric clinic, which is really alarming. These are toddlers who are picking up MRSA (methicillin-resistant Staphylococcus aureus) infections in their communities and requiring multiple courses of antibiotics or even surgery to treat them.

I try to be very conscious of what I'm treating, what antibiotics I have selected, and the duration I choose whenever using antibiotics. I do talk about possible risks of antibiotic resistance developing if treatment is not followed as intended. I have even begun to discuss the concerns of antibiotic resistance with my vaccine-hesitant parents, as many do not take in to account the risks of early antibiotics (impact on the gut microbiome and potential metabolic diseases like obesity and diabetes) or antibiotic resistance when they are considering not vaccinating their children against infections that would require antibiotic treatment.

My biggest concern as both a clinician and a Father/Husband/Brother/Son is that we return to a time where simple infections once again become life-limiting illnesses. My grandma was a nurse and a missionary in West Africa in the 1940s-70s. She wrote about the infections she would see people arrive at her door with, a cut on the leg from an accident, an ear infection, a mother with an infection after giving birth, and how little she had to offer them. The worst thing that could happen to modern medicine would be taking a seismic step backwards in our fight against infectious diseases.

A semi-annual update on the rates of resistant infections across the state would be helpful and if one is already produced, finding ways to distribute it more publicly (via health systems or social media). Also, what, if any, new antibiotics are being developed and where they are in the process of clinical trials or being approved.