Above: e. coli bacteria. Earlier this year the Centers for Disease Control reported a Pennsylvania woman carried a version of the bacteria that was resistant to 'last resort' antibiotics.

A personal mission in the battle against superbugs

In the war against infection, sometimes it's better to wait and see before administering antibiotics, says Dr. Zachary Willis.

For parents, it’s hard to imagine a scarier scenario than a child with an illness that won’t respond to medicine. So when a parent reads news reports about an increase in infections from “superbugs” - bacteria that have evolved to resist antibiotics - it’s easy to understand why a simple earache may have parents fearing for the worst. 

 Clinicians and researchers at UNC Children’s are working tirelessly to address this problem and calm those fears as much as possible. For Zachary Willis MD, it’s a personal mission.

 Dr. Willis leads antibiotic stewardship efforts at UNC Children’s.  An infectious diseases specialist, Dr. Willis’ interest in the issue grew from his experiences as a pediatric resident. He cared for children who suffered from infections most doctors thought were avoidable or easily treated. While his peers focused their research and clinical interests on specific diseases, Dr. Willis observed a growing number of infections and a shrinking number of effective treatments. The problem was too frustrating to ignore. 

 “We’ve gotten so accustomed to public health problems getting better over time, because of better water treatment or vaccinations or new treatments,” Dr. Willis said. “But antibiotic resistance continues to become more common and more severe.”

 To understand Dr. Willis’ work it’s helpful to know how antibiotic resistance happens.  Infections occur when bacteria find their way into the body, and then grow inside it. As the bacteria reproduce, some develop slightly different characteristics such as resistance to an antibiotic. So if a patient takes that antibiotic, the non-resistant bacteria die while the resistant bacteria survive.  As the remaining bacteria reproduces, the younger generation of bacteria inherits the resistance from the older generation, just as parents pass on certain traits to their children.  Over time, only the resistant bacteria remains, and the antibiotic no longer works.

 With this in mind, Dr. Willis shares a simple fact: “The more antibiotics we use, the faster these drug-resistant infections will develop.”

 Of course, antibiotics remain an important and powerful tool in treating infections and protecting public health.  So Dr. Willis works with pediatricians and other providers across North Carolina to help people understand when it’s smart to use them, and when it’s not.

 “The goal of antibiotic stewardship is to encourage doctors, nurse practitioners, and physician’s assistants to use antibiotics as wisely as possible. In the hospital, that means reviewing patients who are receiving antibiotics and making sure that each patient is receiving the best possible treatment,” said Dr. Willis. “Usually that means that we choose the drug that’s going to target the patient’s infection as specifically as possible while also having as few side effects as possible. Many times, the medical team diagnoses a viral infection, and no antibiotic is needed at all.”

 Dr. Willis also stresses that antibiotic stewardship has short term benefits for patients as well. “The physicians and pharmacists on our team have years and years of experience treating complicated infections, and we provide that expertise to the ‘front-line’ pediatricians and surgeons,” he said. “In a lot of cases, we can help the patient get out of the hospital faster and avoid complications, and in the meantime we’re helping to prevent antibiotic resistance in the future.”

 Parents don’t have to feel powerless when it comes to fighting “superbugs,” according to Dr. Willis. He points to two specific things parents can do to join this effort.

 “The first is to prevent your kids from getting infections as much as possible, and then they’re less likely to need antibiotics,” Dr. Willis said. “The first step is stay up-to-date on vaccinations, including the flu shot every year.”  Of course, Dr. Willis also cites the one activity that clinicians and staff probably do more than anything else at UNC Children’s when he exclaims with a grin, “It’s important to wash hands frequently, especially during flu season!”

 The second item is more about knowledge and resisting action.  “When your child does get sick, remember that most infections that children get – colds, sore throat, even many ear infections – are caused by viruses, so antibiotics won’t help,” Dr. Willis says. “Your child’s doctor only wants to use antibiotics when they’re really needed to avoid causing side effects. In a lot of cases it’s not clear if it’s a virus or bacteria, and sometimes the best thing to do is wait a day or two before deciding whether or not to start an antibiotic, even though it’s a lot easier to just pull out the prescription pad. When parents understand that a lot of times antibiotics do more harm than good, it’s easier for the doctor to use a watch-and-wait approach.”