In depressing medical news this week, the World Health Organization reported that 64% of adults believe that antibiotics can be used to treat flu and colds. That’s terrible because those 64% are likely to pressure their doctors for antibiotics when they don’t need them, which in turn will speed the evolution of bacteria resistant to the drugs … and then people die from bacterial infections that used to be treatable.
There are several beliefs that contribute to this statistic, and I think it’s important to tease them apart so we can better craft outreach strategies. The one that gets the most attention, of course, is when people (e.g., Robin in the popular Batman meme I based on original by Dr Nick Bennett and his wife) think that colds are caused by bacteria. A second reason is that some people think viruses are a kind of bacteria and thus treatable with antibiotics.
But there’s a third, even more important explanation that gets almost no attention: people thinking antibiotics are effective against a wide range of microorganisms (i.e., not just bacteria). Why on Earth would people think this? I think kids are almost certainly to blame. When young kids are sick, they don’t really care about the whole virus-versus-bacteria thing … they just know something is infecting them and that the parents keep chanting “antibiotic” over and over again. So I think it’s unavoidable that kids construct a definition for antibiotics before they even start kindergarten (pollsters: can you ask?). Kids are also genius at figuring out word meanings when they don’t get full information from teachers or parents, so it is probable that many assume that the anti (against) and biotic (living) parts of “antibiotic” mean that the drug kills all life. (This is, indeed, what the word “antibiotic” used to mean before microbiologists commandeered it to mean something else.) Although kids might be told later in life (in high school, college) that antibiotics target only bacteria, the correction might not stick in the average person’s brain. In addition to the above, ignorance about antibiotic efficacy is probably increasingly pulled from the Internet. If you doubt me, just type “antibiotic definition” into Google and read the top five or so definitions: they all say that antibiotics can kill microorganisms.
If “antibiotic” (the word) is the source of so much confusion, replacing it with a better word might cause people to stop asking for it, which could save lives via preserving antibiotics. Luckily, the word “antibacterial” is just waiting there, perfect for the job. The anti and bacterial parts of the word convey its meaning unambiguously, plus it’s an old word (older than antibiotic!), and is already used by the general public. You can even Google the definition if you don’t believe me: all the definitions indicate it is a drug that kills bacteria (and only bacteria). It would join other words such as “antifungal” and “antiviral”, all of which tend to be used and understood by both doctors and patients.
There would, of course, be a certain amount of work associated with the switch. For example, websites promoting antibiotic awareness would need to run a Search and Replace macro to insert “antibacterial” everywhere instead of “antibiotic”. That might take 10 minutes for a large site. And brochures and cartoonish wall art for waiting rooms would have to reprinted, but the result would be that waiting patients and parents would be measurably less confused on what antibacterials do. And once everything was converted to “antibacterial”, outreach organizations like WHO and CDC could focus on the more important issues such as making people understand what colds are (please see Batman comic #2) and making sure that the full course of antibacterials is taken.
Note that I’m not suggesting everyone stop using “antibiotic” altogether. But in terms of public outreach, discussion with patients, and the names on drug containers, we should give it a try.
What would also be great is if pollsters could replace “antibiotic” with “antibacterial” for half of the survey participants. Currently, most physicians and “antibiotic awareness week” coordinators LOVE the word “antibiotic” and can see no fault in it; they blame ignorance levels on the educated, ignorant masses. But if poll data could show them that ignorance goes down by (say) 50% after adoption of “antibacterial,” they might rethink their opposition to change.
BONUS FACT: Alexander Fleming used the word “antibacterial” 19 times in his paper describing the isolation of penicillin. He used “antibiotic” 0 times. He got a Nobel prize for the work.