The federal government took another small step in the battle to combat antibiotic-resistant bacteria. In the same week the WHO released a statement on the growing global crisis of antibiotic resistance, and a week after our own adviser Dr. David Shlaes spoke out against a proposed NIH funding increase that didn t make specific mention of antibiotic research, the FDA is asking for more information about whether antiseptic soaps and hand sanitizers used in hospital settings do more harm than good. This is a fair question, and not an unreasonable request.
Antibacterial agents were first approved in the 1970s by the FDA well before the bacterial resistance crisis had even begun. Things certainly have changed. What seemed to be a harmless (at worst) policy then, is no longer so.
The antibacterial soap additive in question is called triclosan. Yes it is bactericidal (i.e., it kills bugs). But does that mean that it is beneficial in terms of preventing bacterial infection or transmission? It would seem that the answer is no, as suggested recently in a large literature review published in Pharmacotherapy. The study found that there is abundant evidence that proper hand washing with soap does just as good a job of getting rid of bacteria as washing with soap that includes triclosan.
Furthermore, might the chemical actually be harmful, because it could speed up the process of antibiotic resistance? This is not a straightforward question, but the data is beginning to appear that suggest that it may do just that. Triclosan, although not used therapeutically can promote reduced susceptibility to therapeutically used antibiotics.
As ACSH advisor Dr. David Shlaes explains, Bacteria can become resistant to triclosan by pumping the drug out of the bacterial cell before it can do any damage. These pumps probably exist to rid the bacteria of waste products and toxins that they either produce or encounter in the environment.
In other words, bacteria have evolved a mechanism that protects them from a wide variety substances that can harm them. There are a number of different ways that they can do this.
Dr. Shlaes focuses on one of these: Under certain circumstances, the germs can press the accelerator, and then these pumps work harder and faster. The problem is that these pumps are not very specific - and they can pump out a number of antibiotics as well as triclosan, which makes resistance to multiple antibiotics possible. Not such a good thing.
ACSH s Dr. Josh Bloom says, These are not easy concepts, but they are very important. This issue highlights that even if an antibacterial agent has no similarity to therapeutic antibiotics, it can nonetheless cause bacteria to become resistant to these antibiotics just about the last thing we need. On balance, the math here is simple. Possibly high risk. Little or no benefit. In the absence of further evidence, triclosan should get the boot.
Additionally, we recently discussed whether antibiotics in animal feed should be banned. The same logic applies here.