What's Wrong With Using an Antibacterial Soap?

The global increase in resistance to antimicrobial drugs, including the emergence of bacterial strains that are resistant to all available antibacterial agents, has created a public health problem of potentially crisis proportions.

~American Medical Association, 1995 
Remember the "revolution," when injuries and infections that for centuries had eluded human control began falling to the new miracle drug, penicillin? Infection in many parts of the body responded quickly and consistently to treatment with penicillin and its semisynthetic cohorts. City-dwellers lost their fear of tuberculosisSince refreshed. and equatorial regions were at last free of malaria. Armed with antibiotics, we firmly believed that microbes must give way before us. 

We would stamp them out!

How do we conquer these invaders that we cannot see? Most bacteria will succumb to chemicals such as potassium hydroxide, commonly known as lye, or to sodium hypochlorite, but infected individuals given such substances to kill bacteria might be almost as much at risk as the target microbes ... and ever-so-much more likely to sue.

Antibiotics solved the impasse with selective toxicity, with which they harm the parasite while sparing its host. They killed or halted the spread of bacteria, commencing what seemed to be a shining new age in health and cleanliness, when the days of resistance were yet before us. 

Toxins neither.

It is easy for us to forget that bacteria have been around much longer than has humanity. They are successful organisms, and as such they are not without defenses. 

The resistance that bacteria exhibit toward antibiotics can be genetic or nongenetic. The nongenetic variety occurs when microorganisms are not in an active growth phase, because most successful antibacterial drug activity requires that bacteria be replicating. 

Genetic resistance is much more nefarious. It occurs when bacteria previously susceptible to a substance develop genetic defenses against it. 

In some cases, a spontaneous mutation occurring on a part of the bacterial chromosome that controls vulnerability to a particular antimicrobial happens in the presence of that antimicrobial drug. Bacteria possessing the protective mutation survive; because bacteria reproduce so quickly, it takes little time for the variant to prosper. 

Other genetic defenses devised by bacteria involve plasmids, circular DNA molecules that may either carry their own genes for replication and transfer or rely on genes carried by other plasmids. 

In either case, plasmids account for more than their share of bacterial diablerieBlack magic, sorcery, or mischievous conduct. . Plasmid-mediated methods of eluding antibiotics include counterattack (producing enzymes that destroy the destroyer), armoring (changing cellular permeability to a drug), and disguising (developing new metabolic pathways to bypass that which had been hampered by the drug). 

When any bacterial defense is successful—meaning that the organism lives—it passes its method of defense on to its daughter cells. 

However, resistance genes can also be passed on to colleagues, as it were, non-genetically, with the exchange of plasmids, thus conferring defense before the need arises. Bacteria will even exchange resistance genes across bacterial species. 

Antibacterial agents that are used improperly or excessively provide a breeding ground for resistant bacteria. 
In the heyday of antibiotic optimism, antibiotics were prescribed almost routinely in the Western world for treatment of fever before verifying what produced the fever, which may or may not have been bacteria.  Although twilit, this heyday is not yet dearly departed. Some Westerners demand and receive from their health-care providers antibiotics as remedies for such ludicrously ill-suited maladies as the common cold (which, of course, is viral). 

Unfortunately, because of low cost, easy availability, and lack of diagnostic acumen, to this day antibiotics are over-prescribed in many developing countries and other pockets of short-sighted expediencyHey, why should they be left behind in *any* way? . In fact, in more than half the world, antibiotics are available without prescription—Over the counter. 

In some parts of Europe, people receiving for the first time the potent antibiotic vancomycin actually failed to respond, because the bacteria that infected them were already resistant.  Food animals had been fed the antibiotic under the name avoparcin, resistance developed, and resistant strains were ingested by unsuspecting consumers.   Twig resistance.

Currently the United States is awash, as it were, in a flood of Antibacterial! cleaning products. You've seen them—hand and body soap, hand and body lotion, dishwashing and laundry detergent, window cleaner, wall cleaner, shoe cleaner, rug cleaner, dog shampoo, baby shampoo, baby diapers, geriatric diapers, even cotton swabs, all of them touted as "antibacterial!" (Swabs?) 

In most of these cases the source of the "antibacterial" activity is not antibiotic—It is the chemical triclosan, a common disinfectant.  You may wonder if there is a problem with using a disinfectant, rather than antibiotics, to kill germs. 

Flower antibiotics.

The problem is that bacterial resistance may be more robust than we think.  Resistance need not, and does not, stop with antibiotics.  Bacteria protect themselves against that which injures them.  The list is not limited to antibiotics; it includes insecticides, fungicides, herbicides, even antiviral agents. 

Resistance has been shown by at least one researcher to develop after exposure to chemicals—to common household bleach and hydrogen peroxide. Now another researcherDr. Herbert Schweizer who, at least as of this writing, was at the Colorado State University College of Veterinary Medicine. has reported that, in the lab, triclosan causes at least one bacterium to develop resistance not only to triclosan but to a variety of other antimicrobial agents, including antibiotics. 

What new forms of defense might we succor with indiscriminate exposure of our adaptable adversaries to that which selects for resistance among them? Certainly we continue to develop new antibiotics, with new methods of action, even as bacterial resistance spreads. And bacterial resistance is inevitable; it has always happened and always will, as long as the planet survives. 

But it need not spread so fast and (from humanity's perspective) so virulently. In Europe the antibiotic animal-feed additive avoparcin has been banned, yet we (that is, all countries but Sweden) continue to ply our food stock and our fruit trees with other antibiotics. In New York City, new strains of the bacterium that cause tuberculosis have been found to be resistant to as many as nine antibiotics, and that renders them essentially untreatable. 

Despite what some advertisers would have us believe, we need not attempt to stamp out germs; the attempt is not only futile but ill-conceived. Our guts are host to more bacteria than we have cells in our bodies, and some of them are integral to our very living status. 
We can be clean without being sterile; in fact, low-level exposure to toxins keeps the immune system tuned. Give some thought to slogans, as well as to more-subtle forms of persuasion ("Every day when I clean the bathroom bowl ..."), before surrendering to their ploys. 

For us to admit to a state of containment, rather than eradication, of our unseen microbial companions will simultaneously spare us futile labors and help maintain our defenses. 


 The Clock is Ticking           

 even in Boulder!