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Columbia woman raising awareness on the usage of antibiotics

By KARINA ZAIETSDecember 21, 2018

COLUMBIA, Mo. (AP) — Christina Fuhrman, now 37, almost didn’t make it to her wedding. She was extremely ill as she chose her dress, veil and shoes. The honeymoon in Sweden was spent in a hospital.

“I was just disappearing and just dying,” Fuhrman said to the Columbia Missourian .

Two years later, she watched her toddler nearly die from the same illness.

Fuhrman and her daughter were both infected with the C. difficile bacteria, also known as “C. diff,” that are naturally resistant to many common antibiotics. When the normal healthy microbiome in the intestines is disrupted, the bacteria can take over the colon and cause inflammation and chronic diarrhea.

Each year, nearly half a million Americans suffer from C. diff infections. According to a study published in 2015, C. diff infections contributed to around 29,000 deaths in 2011.

Studies also show that people taking antibiotics are seven to 10 times more likely to get C. diff while on antibiotics or in the month after taking them than people not taking these drugs.

Now, Fuhrman is an advocate for careful use of antibiotics and is trying to raise awareness about C. diff infection. She took three trips to Washington this year to talk to people in Congress about the problem and plans to return to the capital next year for more advocacy. She also shared her story online.

The Fuhrmans’ story begins in 2012. Two years after that, hospitals around the country began establishing Antibiotic Stewardship programs. A year later, the Centers for Disease Control established a National Action Plan for Combating Antibiotic-Resistant Bacteria that set a goal to reduce inappropriate antibiotic prescriptions by 20 percent by 2020.

For now, studies show that 30-50 percent of antibiotics prescribed in hospitals are either unnecessary or inappropriate.

Fuhrman got into the habit of overusing antibiotics after she was bitten by a spider when she was 21. The wound got infected, so she went to the hospital. The doctor prescribed antibiotics.

“I felt so amazing after that, and I felt that wonderful joy of what antibiotics are. I mean, they truly are lifesaving,” Fuhrman said. “I think it kind of started like, ‘Well, I’m not feeling well again. I’ll go get more antibiotics. Oh, my goodness, I have a cough for two weeks. So go get more antibiotics.’ They were always prescribed.”

Fuhrman frequently had sinus and urinary tract infections. So she took antibiotics roughly every four months.

Antibiotics fight bacterial infections, not viruses like those that cause colds and flu. They are usually helpful in treating urinary tract infections, which occur when bacteria take up residence in the urinary tract.

However, sinus infections are most often caused by a virus. Antibiotics will not help. Common cold, runny nose, sore throat and flu are other diseases that antibiotics won’t necessarily cure.

“Oftentimes in outpatient settings, patients going for respiratory tract infection will be like, ‘Can I get antibiotics?’” said Hariharan Regunath, an infectious diseases physician at MU Health Care. “If patients (didn’t) put pressure on physicians to prescribe antibiotics, that would be the best.”

Physicians also sometimes fear missing something, and that can compel them to prescribe antibiotics inappropriately, said Amruta Padhye, pediatric infectious diseases physician at MU Health Care.

Fuhrman had that experience after having a root canal. Her dentist prescribed a very strong antibiotic “just in case,” she said. That was June 2012, two months before her wedding.

After root canal therapy, patients usually have mild pain and rarely experience flare-ups with or without antibiotics, according to a study done as far back as 1993.

Use of antibiotics can lead to allergic reactions, among other risks. This is especially dangerous for children. A study published in February in the Journal of Allergy and Clinical Immunology has shown that the longer antibiotics are used in young children, the higher the risk that they will develop allergies including asthma.

Also, according to the CDC, the majority of children’s emergency room visits for reactions to antibiotics are for allergic reactions. At the same time, a study published in 2015 in Nature Reviews Endocrinology showed that the disruption of gut microbiome that antibiotics are usually responsible for can have long-lasting effects on children’s body weight in adulthood, promoting weight gain or stunting growth.

Among the elderly, who are already at high risk for infectious diseases, side effects from antibiotics can include dizziness, kidney damage, a higher potassium level in the blood and seizures, among others.

“The most commonly prescribed antibiotic like Azithromycin can actually affect the electrical activity of the heart,” Regunath said.

Antibiotics can also increase the risk of some types of infections. According to the CDC, among the most common infections are Candida, the fungus infecting skin or mucous membranes, and C. diff, the one that almost killed Fuhrman.

Within one week after her root canal, Fuhrman became very sick. “I was in my best friend’s wedding, and I could hardly make it through. I hardly could work,” she said. “It was horrible, horrible diarrhea.”

Her doctors in Columbia didn’t understand what was happening. They didn’t expect the C. diff test to be positive, as the infection usually occurs in older people in hospitals and long-term care facilities.

Then they arrived in her hospital room in full isolation suits. C. diff can spread quickly and is very difficult to contain.

“When the doctors walked into my room in isolation suits, I felt fearful and confused,” she said.

Her doctors told her they would give her antibiotics and that she should be fine.

She wasn’t. Two days after Fuhrman stopped using antibiotics, the infection returned and she was back in the hospital.

According to CDC, C. diff infection returns in about 20 percent of patients after treatment with antibiotics. In a small number of these patients, the infection returns over and over and can be debilitating. The CDC estimates the fatality rate from the infection at 6-30 percent, and it seems to be increasing.

“So, I was hospitalized six times over the course of seven months, which I didn’t work at all those seven months, and it just kept coming back,” she said. “As soon as I stopped taking antibiotics, it immediately returned within days.”

While in the hospital, Fuhrman didn’t eat or drink and was fed intravenously. She basically lived in the geriatric ward.

“It just was unending,” Fuhrman said.

Her doctors just couldn’t understand why she had the disease.

“And they kept testing me for HIV or immune diseases, but I had nothing,” she said. “I had absolutely nothing.”

Fuhrman said the only reason she’s still alive is fecal transplant, the introduction of stool from a healthy person into the colon of a C. diff patient. Studies suggest it’s the most effective method for treating recurrent C. diff infection.

The CDC warns the long-term safety of the procedure has not been established. This year, the Infectious Diseases Society of America and Society for Healthcare Epidemiology of America updated the clinical practice guidelines on C. diff infection recommending fecal transplants for patients with multiple recurrences of C. diff who have not responded to appropriate antibiotic treatments. The procedure also hasn’t yet received FDA approval but is allowed.

“They take the stool, they mix it with saline solution, you do a colonoscopy,” Fuhrman said. “They look at it, they administer it into your colon, and then you stop all antibiotics.”

In January of the next year, Fuhrman was healthy enough to go back to work. In April, she got pregnant. After her daughter, Pearl, was born, she was on guard against letting pediatricians give her child antibiotics.

“I’ve always had my ears perked since C. diff. I’ve always been on the alert for it, because it’s scary,” Fuhrman said.

Pearl got sick anyway at 21 months. She had never had antibiotics.

“She started having, like, a lot of stools, and then I noticed that they got worse,” Fuhrman said. “So I brought her in (to the hospital), and they ran a regular stool test.”

Doctors didn’t run C. diff test at first, as the infection is uncommon among young children.

“Then another doctor there said, ‘I’m running a C. diff test on her,’ and it was positive, and it about knocked me off my feet,” Fuhrman said.

Pearl was extremely ill and in the hospital for five days, fed intravenously.

Doctors prescribed antibiotics. In a month, C. diff was back.

Pearl had a fecal transplant right about the time Fuhrman was due to deliver her second child.

“When I was about to deliver and Pearl was sick, I felt as if I was never going to wake up from this terrible nightmare,” Fuhrman said. “I was terrified my daughter would die from it since it took so long to get her diagnosed. I was afraid my newborn son would get it.”

Now Pearl is almost 5. She has taken antibiotics only once — for strep throat. Although there are some situations where antibiotics are necessary, Fuhrman fends off their unnecessary use with the help of her children’s doctors.

“I think that we’re such a busy culture,” Fuhrman said. “You just don’t want to be inconvenienced by not feeling well, so you want this magic pill to heal everything but you have to take it right.”

Because of the implementation of Antibiotics Stewardship Programs throughout the country, hospitals have stricter regulations in prescribing antibiotics.

“We try to keep the antibiotic spectrum narrow enough to treat the infection adequately,” Padhye said. “We also are trying to make sure that patients do not remain on antibiotics for longer durations than indicated. We want to limit unnecessary use of antibiotics to prevent emergence of antibiotic-resistant infections.”

At the same time, patients should feel empowered to ask their doctors why they’re prescribing antibiotics.

“I wish I knew that my body was strong on its own and about conservative use; just wait and see what happens,” Fuhrman said. “I wish I knew about antibiotic resistance — that the bugs are growing stronger. I wish I knew I was putting myself at risk for chronic diseases by my antibiotic habit that would affect the rest of my life.”

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Information from: Columbia Missourian, http://www.columbiamissourian.com

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