My nephew was recently hospitalized with what the doctors called a resistant infection. He became very ill and his treatment required several different antibiotics. Why do these resistant infections occur? Is there anything that we can do to reduce the occurrence of these types of infections?

The doctor responsible for the discovery of penicillin, Alexander Fleming, predicted in his Nobel Prize acceptance speech in 1945 that the overuse of antibiotics could result in the rise of "resistant" bacteria.

This has happened. Here's why: In every instance where a bacterium is exposed to an antibiotic, there is a chance that strain of bacteria will respond by developing resistance.

In 1945 a typical case of pneumonia could be treated with 40,000 units of penicillin. Today, in cases where penicillin can still be used, which is much less frequently than in 1945, the patient may need 20,000,000 units for many days.

While we currently have many relatively new antibiotics, if we look ahead, the development of new antibiotics has almost ground to a halt. In contrast to medications treating chronic conditions, antibiotics are medications taken by relatively few people for a short period of time, and so the profit line is too small to be compelling to the pharmaceutical industry.

The antibiotics we do have are now overused to a level that is almost criminal. For example, it's estimated that antibiotics are prescribed in approximately 70 percent of cases of simple acute bronchitis when in fact no antibiotics should be prescribed. To make matters much worse, antibiotics are routinely added to the feed of farm animals and are even sometimes used by fruit growers.

What can you do? First, don't demand antibiotics when your doctor says that you don't need them. Second, perhaps it's helpful to support food sources that don't use antibiotics in their production to reduce your (and your microbiome's) exposure to unwanted antibiotics.

All that being said, the overwhelming majority of bacterial infections can still be treated with available antibiotics and so-called "superbugs" are relatively rare.

John R. White is the chair of the Department of Pharmacotherapy at WSU-Spokane.

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