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Killian Coen
ENG 413
Dr. Michelle Kells
12/8/2016
No Fate But What We Make:
Stopping the Advance of Superbugs for Future Generations
It is very easy to look at large-scale problems that threaten entire societies and shrink
back in fear due to the sheer scale of the issue. After all, how can one person ever hope to affect
change in the face of something so huge and powerful. That is exactly how I felt when I began
this project. The overuse of antibiotics has become so prevalent across the globe that it seemed
foolish to even try and stop it, in spite of the fact that this overuse has directly lead to the
development of superbugs that have the potential to threaten global health. However, this
defeatist attitude simply will not due in the face of such an insidious and powerful predator.
Superbugs have already developed to the point that they are completely resistant to all but the
newest and most powerful class of antibiotics, and if we continue on the same path and maintain
our blas attitude toward the overuse of antibiotics, these bugs will only continue to grow more
resistant, to the point that they are simply fatal to those that catch them. As members of the
generations that have allowed this to happen, it falls to us to fix it. As with many public health
issues, the biggest weapon in the fight against antibiotic overuse is education, and we must use it
if we are to have any hope of stemming the tide of superbugs. Our youngest generation is not
only the most susceptible to these bugs, but the responsibility of assuring that antibiotic overuse
does not continue into the future will be theirs. For these reasons, a critical step in the fight to
stop antibiotic overuseand the resulting superbugsis an educational program geared towards

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showing students in kindergarten through eighth grade health science classrooms the dangers of
continuing to abuse a life-saving class of drugs.
The process that lead to this discovery took many steps. As the father of a daughter who
struggles with fairly extreme immune deficiency, the issue of antibiotic overuse hits close to
home and is one that I have spent much time personally considering. At first, even questioning
the advice and prescriptions of medical professionals seems almost heretical; after all, how dare I
not believe the expertise of people who have spent many years studying these exact issues? After
doing further research however, the questions only increased. Article after article mentioned the
words antibiotic overuse and superbugs in the same sentence, stating specifically that
antibiotic overuse has lead directly to the development of superbugs. Apparently, this connection
is so well-known in the medical world that in June 2011 in Annecy, France, a meeting was held
for 70 internationally-recognized experts to discuss a possible international program designed to
stem antibiotic overuse. These experts concluded that, Resistance to antibiotics has increased
dramatically over the past few years and has now reached a level that places future patients in
danger. Microorganisms such as Escherichia coli and Klebsiella pneumoniae...have become
increasingly resistant to carbapanems and therefore increasingly resistant to third-generation
cephalosporins. Moreover, in certain countries, they are also resistant to cabapanems and
therefore susceptible only to tigecycline and colistin (Carlet et al). What is clear from these
experts is that resistant bacteria are on the rise, and if nothing is done to stop them, they will only
continue growing moreso.
Now, what to do? The dream of a world without superbugs is one that future generations
deserve, so how do we bring it about? It seems clear that there has been plenty of research in the
medical and academic spheres concerning antibiotic overuse, yet almost none of it has made its

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way to the general public in the form of policy shifts or even public statements. In a recent study
that sought to decrease antibiotic use for respiratory tract infections, the authors state that, An
analysis of U.S. ambulatory antibiotic prescribing practices estimates that overall antibiotic
prescribing for ARIs decreased from 65% of visits in 1995 to 52% of visits in 1999. However,
there is still significant room for improvement, since it has been estimated that only 25% of
patients with ARIs who seek medical attention have a bacterial etiology of their illness (Harris
et al).Though improvement has been made, in spite of blatant scientifically-based evidence, such
studies and their results are constrained within the halls of academia and the hospital, unable to
effect change in society as a whole. Even large-scale social awareness programs like those
conducted by the Centers for Disease Control on behalf of congress in 2015 have failed to result
in any meaningful reform. That said, the issue of antibiotic overuse is simply too dangerous to be
left alone, and an alternative social awareness plan must be enacted if we are to have any hope of
a generation with the ability to fight back against the development of resistant bacteria.
Childhood psychology has shown us that many of the behavioral patterns and mindsets
that we develop as children end up staying with us throughout our lives and impacting us in
adults in surprising ways. In light of this, perhaps the most effective way to educate the populace
as a whole about antibiotic overuse is to start with its youngest members; an educational program
targeting young children that warns them of this threat as well as giving them the tools they need
to fight back could be exactly what is needed to begin solving this problem for future
generations. This program would be based on the work of David Orr and his Students and
Teachers Restoring a Watershed (S.T.R.A.W) project. Detailed in Michael Stone and Zenobia
Barlows work Ecological Literacy: Educating Our Children for a Sustainable World, this
project was designed to, cultivate in children the competencies of heart and mind that they will

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need to create sustainable communities (Stone et al). The idea of educating children in order to
create sustainable communities is the crux of an antibiotic overuse education program. The
S.T.R.A.W program was also enacted with the idea that pedagogical solutions that are designed
to solve large-scale problems must have its roots in multiple avenues of learning; in the mind,
the hands, and the heart; not just the mind as is typical of modern pedagogy (Stone et al). The
same can be said for antibiotic overuse awareness; students must understand with their minds
how these bacteria function and the reasons for their development, and also must understand
with their hearts that the issue affects everyone, not just themselves.
Even if this pedagogical solution is a viable one, how should it be designed in order to
achieve the best results? Such a program would be best implemented once students have already
had some introductory classes in health and biology so that they are familiar with some of the
relevant terminology and jargon as it relates to biology and other natural sciences. Depending on
the schools curriculum, introducing this antibiotic awareness program should occur during
middle school and follow the students throughout their high school careers. If students are
routinely reminded each school year of the threat posed by antibiotic overuse, it is not
unreasonable to assume that this knowledge will remain with them throughout their adulthood
and impact the way they view and use antibiotics in their lives.
It is critically important to establish whether or not such an educational program would
have any positive effect. To find out, I consulted the advice of a subject matter expert, Dr.
Matthew Sierra. Matthew is a graduate from the Doctor of Pharmacy program at the University
of New Mexico, and since graduation has been working as a pharmacist at CVS Pharmacies.
Both his education and his profession focus heavily on antibiotics; the mechanisms of how they
function, the myriad different brands, and the reasons for their prescription are all things he has

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studied in-depth in school and uses daily in his job. All of this makes him uniquely qualified as a
subject matter expert for this project. In my interview with Dr. Sierra, I began by asking him how
much of his course load in college focused on the study of antibiotics, and he said that,
Antibiotics were mentioned in nearly every course we took, covering aspects of medicinal
chemistry, pharmacokinetics, mechanism of action of the drugs, antibiotics role in therapy,
pathophysiology, and treatment regimens for many disease states (Sierra). Not only this, but the
issue of antibiotic overuse was mentioned in course work constantly...when discussing
antibiotics. The professors always focused on treating each infection with the correct antibiotic
for the appropriate amount of time (Sierra). In short, Dr. Sierra has studied all issues concerning
antibiotics in extreme detail. Yet, in spite of this, he has not heard of any programs that have been
sufficient in educating the public about the dangers of antibiotic overuse, up to and including the
public awareness efforts on the part of the CDCthe most significant effort to date. When asked
whether or not he thought that a pedagogical program warning kindergarten through eighth grade
students about antibiotic overuse would be a viable public awareness solution, he said that, Yes
- children are often influenced by their parents at this age, even to the point of fabricating
medical symptoms to coerce the prescriber into writing them a prescription for antibiotics.
Reinforcing honesty in these children regarding their interactions with healthcare providers and
understanding when and how antibiotics should be used can reinforce the importance of using
antibiotics appropriately (i.e. as prescribed) and only when necessary. This emphasizes not only
respect for the health care system but importantly for medications and will hopefully allow this
conscientiousness to persist into their adolescent and adult lives (Sierra).
It can be disheartening to see that issues as important as antibiotic overuse have a
problem gaining the public attention that is required to have a positive effect. Despite this, there

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is no excuse for not taking action when global health is what is at stake. By enacting this
educational program, we are taking the first step towards ensuring that future generations will
not have the threat of superbugs looming on their not-so-distant horizon.

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Works Cited

Harris, Robert H., Thomas Mackenzie, and Bonnie Leeman-Castillo. US National Library of
Medicine. Society of General Internal Medicine, 2003. Web. 04 Nov. 2016.

Jean Carlet, Vincent Jarlier, and Stephan Harbarth. "The Pensieres Antibiotic Resistance Call
To Action." Biomed Central. N.p., 14 Feb. 2012. Web. 13 Oct. 2016

Michael Stone, and David Orr et al. Ecological Literacy: Educating Our Children For
A Sustainable Future. San Francisco: Sierra Club, 2005. Print

Sierra, Matthew. Personal Interview. 18 Nov. 2016.