Using Antibacterial Products

The facts that bacteria are everywhere and most are harmless to us are at the heart of the potential problems with antibacterial products

• Adams Rogers
• Feb 01, 1999

"Antibacterial." The word is suddenly all over the place--on soaps, household cleaners, toothbrushes, lotions, toys and even socks. It´s enough to make you think germs are waging war on us. And you would be right. Disease-causing bacteria have become both more virulent and more mobile than ever before.

But before you use those new antibacterial products, consider: When they work, they may contribute to the problem, and the claims for their effectiveness are not always all they are cracked up to be. "I´m not sure they are doing anything except hyping the product," says microbiologist Stuart Levy, head of the Center for Adaptation Genetics and Drug Resistance at Tufts University School of Medicine. "It´s playing on the misinterpretation by the public that bacteria are all bad, that bacteria are out to get you."

Welcome to the paradoxes of the antibiotic age. For five decades--ever since penicillin became widely available in the 1940s--antibiotics have been miracle drugs, successfully fighting most diseases caused by the tiny, single-celled organisms. But all that time bacteria have been fighting back, with strategies that dazzle and terrify scientists. And public misunderstandings of the threats, the science and the best ways to stay healthy have been a big part of the problem.

Microbiologists recently estimated that the world holds five million trillion trillion (a five followed by 30 zeros) bacteria--the most ubiquitous wildlife on the planet. At around a millionth of a meter in diameter, they don´t need circulatory systems. Nutrients simply diffuse. With no blood vessels or bones to get tangled up, bacteria can have limbs that rotate, pulling or pushing them along like propellers. They also can fasten themselves to surfaces. And they easily hitch rides on international flights from one side of the world to the other in hours.

The habitats of various strains range from hot-water vents on the ocean floor to the polar ice caps. "Bacteria have the ability to withstand tremendous environmental extremes," says Hans Paerl, a University of North Carolina ecologist who studies Antarctic bacteria. "There are clearly advantages to being simple and small."

The microbes are on our skin, in our mouths and on everything we touch--and most pose no risk to humans. Some, on the other hand, can be dangerous and even deadly. Chances are a scientist could culture disease-causing bacteria such as Staphylococcus aureus from your skin. If you cut yourself, you could get infected. That´s why doctors advise washing wounds and keeping them as clean as possible--and that´s also why your immune response is a critical defense.

The facts that bacteria are everywhere and most are harmless to us are at the heart of the potential problems with antibacterial products. When the products are effective, they attack bacteria indiscriminately, which likely opens up niches for other, perhaps more dangerous bacteria to come calling. "We aren´t going to sterilize our world," says Levy. And trying to do so could make the very bacteria we want to eliminate stronger than ever. That´s what has happened with antibiotic drugs that are taken internally, most of which work by interfering with biological processes of bacteria. Penicillin, for example, interferes with cell-wall construction. But as the organisms multiply, some mutations invariably develop, and when one bacterium develops resistance to a drug, it can thrive under conditions that kill others.

The ways the organisms thwart drugs give new meaning to the term "germ warfare." Some essentially eject the drugs from their bodies, some make enzymes that render the drugs ineffective and some change the molecular targets that antibiotics latch onto. Survivors not only pass on their abilities to their offspring, they trade resistance genes with other bacteria.

So in the last few decades we´ve seen whole new pathogens and fiercer versions of old favorites. A disease-causing strain of E. coli that sickened almost 10,000 people in Japan in 1996, for example, was not known to cause illness until 1982 and may not have existed before the 1940s. Drug-resistant staph infections have become serious problems in hospitals. In 1997, a few rare strains of staph around the world began to resist even antibiotic heavyweight vancomycin.

Researchers used to think that the antibacterial agents in household products fell into the category of unsubtle weapons of mass destruction. (That category includes hydrogen peroxide and bleach, which kill primarily through drying and oxidation. Think napalm.) But last summer, a paper in the journal Nature by Levy and colleagues reported that the ingredient triclosan, often used in the new household products, is more subtle. Triclosan kills bacteria by preventing them from making fatty molecules that are part of their cell membranes.

That´s the sort of targeted attack that bacterial mutations often can overcome. So the more we use triclosan--and possibly other antibacterial agents as well--the greater the chance of encouraging the growth of strains that can resist the chemicals, concludes Levy. For their part, manufacturers suggest that such discoveries could lead to more powerful agents in the future, and they maintain that their products serve a vital public health role when used appropriately. Indeed, hospitals have long used antibacterial cleaners similar to the household versions.

Levy´s concern applies, of course, only when the products do their jobs. That can mean using them as directed: Some cleaners, for example, must be left on a surface for 10 minutes to disinfect it. Sometimes the fine print reduces the antibacterial claim to near irrelevance: One toothbrush is made of ingredients that squelch bacteria "that may affect the plastic in the handle," not in bristles that could harbor gum-disease bacteria or other germs.

And no one knows whether antibacterial products help control the spread of disease in the home. "Whether these products make any difference in terms of food safety is yet to be determined," says Fred Angulo, a medical epidemiologist with the federal Centers for Disease Control and Prevention in Atlanta. That is a critical question, as the kitchen harbors more disease-causing microbes than any other place in the home--even more than the bathroom.

So, short of retreating into a plastic bubble, what commonsense measures can we take to fight germs? First, suggests Angulo, try basic hygiene, which not only controls disease-causing bacteria but viruses as well. Our hands are carriers of many diseases, so plain old hand washing is particularly important. "Our message is not to wash your hands with antimicrobial soap, but just to wash your hands. Soap is antimicrobial," he says. The effect is mostly mechanical. Soap contains chemicals that lower water´s surface tension and make it "wetter," so the water covers more area, mixes well with whatever is on your skin and carries it off during rinsing.

In the kitchen, handle raw meat and eggs with care, using separate utensils for uncooked food. You can sterilize sponges and dishrags--ideal breeding grounds for bacteria--by soaking them in a bleach solution. Wash counters and cutting boards with soap and hot water.

When practical, wash fruit and vegetables with mild soap and water, which also helps remove some pesticide residue. Washing only with water removes most bacteria, but not all of it. Microbiologist Susan S. Sumner of Virginia Polytechnic Institute and State University found recently that a rinse of hydrogen peroxide and vinegar will kill bacteria on produce. She suggests putting the two substances in spray bottles and moistening produce with both sprays, which are nontoxic to people and need not be rinsed off unless you don´t like the taste. If you try that tactic at home, keep in mind that it doesn´t leave all food in an equally appetizing state. It works well on apples, for example, but turns lettuce brown.

When you do get sick, don´t take antibiotics without your doctor´s approval. If you take the drugs, finish the entire prescription as instructed or you could encourage the development of resistant strains. And remember that if you have a virus, such as a cold, antibiotics won´t help at all.

Last, if all of this leaves you wishing you could sterilize your world, you might like to keep in mind that bacteria thrive in our own guts. And without them, we couldn´t digest the very food we want to keep germ-free.

Adam Rogers reports for Newsweek in New York.