I create superbugs. I don’t mean to, and it’s not intentional, but every time I write a prescription for antibiotics, I run the risk of encouraging bacterial resistance.

Especially if it’s not taken for the full course or if the same antibiotic is given to the same person month after month.

I know I shouldn’t and there are plenty of studies to prove that using fewer antibiotics is better for everyone. But try telling that to someone who is suffering with a severe case of sinusitis and blowing neon green mucous all day long. “Take one for the team. Just let it run its course,” are not words you want to hear from your doctor.

The U.S. Centers for Disease Control and Prevention put out a bulletin regarding antibiotic stewardship, their term for the appropriate use of antibiotics. It focused on hospitals and nursing homes, where routine use of medications is commonplace.

However, it all starts in the office. Patients I see every single day are expecting treatment for their illness, especially if it’s not gone in a few days or if it’s an inconvenient time for them to be sick.

When should people take antibiotics? Well, the current list of conditions is pretty small and pales in comparison to the millions of antibiotic prescriptions given out each year. What’s on the list? Pneumonia, urine infections and strep throat. What’s not on the list? The types of conditions I see every day: Sinusitis, bronchitis, cold symptoms and the flu.

The biggest danger is that one superbug can be found in one person, and if they get infected with another superbug from somewhere else, those two bugs can mutate and create an infection that modern day antibiotics just can’t treat.

So what’s the harm? It seems like every time a superbug is discovered, scientists find a super-drug to treat it. Over the past few decades, this has worked, or so we think.

However, look no further than the upcoming Olympics to see what happens when we are so complacent about bacterial resistance. Brazilian scientists have found carbapenem-resistant enterobacteriaceae in the waters off of Rio de Janeiro’s most scenic beaches, the location for games next month. Officials suspect untreated raw sewage coming from a local hospital as the source.

It’s not the first time we’ve seen this resistant bacteria. Last February, the University of California Los Angeles, reported two fatal cases of CRE and five serious infections, along with Cedars-Sinai Medical Center noting four additional cases of the infection, all tied to the same procedure.

A medical device known as a duodenoscope was to blame. In fact, the Food and Drug Administration warned that even with proper handling, the scope could still transmit infection.  New guidelines on cleaning of the scopes were developed to reduce the chances of infection.

When Bacteria Mate

How do bacteria become resistant to antibiotics? How is the prescription I write in my office part of the problem?

Some bacteria are naturally resistant to certain antibiotics. But others become resistant to antibiotics in one of two ways. First, through genetic mutation, which results in the bacteria no longer being killed by exposure to antibiotics. These instances are rare, and usually relate to the target of the antibiotic no longer being on the bacteria cell, or that the bacteria sneakily finds ways to pump the antibiotic out before it has any effect.

The second, most concerning way, is that resistant bacteria mate with other bacteria or even get infected with viruses and they transfer genes to one another. It’s a process called “conjugation” and it can make a staphylococcal bacteria develop the same abilities to resist penicillin as an E. coli bacteria and vice versa.

Each time I write a prescription for antibiotics, I am encouraging the very types of resistant bacteria that scientists fear.

The biggest danger is that one superbug can be found in one person and if they get infected with another superbug from somewhere else, those two bugs can mutate and create an infection that modern day antibiotics just can’t treat.

Think it can’t happen? Well, unfortunately, it already did. Just this past May, E. coli bacteria was found in a woman in Pennsylvania that was resistant to what is referred to in the medical community as a “last-resort” antibiotic: colistin.

The implications of such a finding are enormous. Colistin is the only antibiotic that can kill resistant CRE and if the E. coli bacteria finds a home in someone with CRE, the bacteria can transfer this resistant gene and then it’s game over. Despite popular misconceptions, there are no new antibiotics to treat CRE in the pipeline.

Each time I write a prescription for antibiotics, I am encouraging the very types of resistant bacteria that scientists fear. Already, there is a 40 percent resistance to Z-Pak, a commonly used antibiotic that no longer is recommended for streptococcus pneumoniae, one of the common causes of sinusitis. The more resistant bacteria we create, the greater likelihood that patients will get worse.

In serious cases, the sick person might be hospitalized, further increasing the chances that resistant bacteria will “meet one another” on the hands of hospital workers or on medical equipment, like scopes and ventilators. It’s not a coincidence that the bacteria found in the waters around Rio de Janeiro has been traced back to a nearby hospital. Even if no one gets sick from it, there is no guarantee that the bacteria won’t find its way to a new international destination and spread its resistance to other bacteria elsewhere in the world.

So the next time you get sick, the next time you come rushing to your doctor’s office for a magic bullet of a cure, the next time I write a prescription for any type of antibiotic, we all have to accept responsibility for what will happen in the near future if we are not careful enough.