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This article is from the In-Depth Report The Crisis of Antibiotic Resistance

Strange but True: Antibacterial Products May Do More Harm Than Good

Antibacterial soaps and other cleaners may actually be aiding in the development of superbacteria.
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Tuberculosis, food poisoning, cholera, pneumonia, strep throat and meningitis: these are just a few of the unsavory diseases caused by bacteria. Hygiene—keeping both home and body clean—is one of the best ways to curb the spread of bacterial infections, but lately consumers are getting the message that washing with regular soap is insufficient. Antibacterial products have never been so popular. Body soaps, household cleaners, sponges, even mattresses and lip glosses are now packing bacteria-killing ingredients, and scientists question what place, if any, these chemicals have in the daily routines of healthy people.

Traditionally, people washed bacteria from their bodies and homes using soap and hot water, alcohol, chlorine bleach or hydrogen peroxide. These substances act nonspecifically, meaning they wipe out almost every type of microbe in sight—fungi, bacteria and some viruses—rather than singling out a particular variety.

Soap works by loosening and lifting dirt, oil and microbes from surfaces so they can be easily rinsed away with water, whereas general cleaners such as alcohol inflict sweeping damage to cells by demolishing key structures, then evaporate. "They do their job and are quickly dissipated into the environment," explains microbiologist Stuart Levy of Tufts University School of Medicine.

Unlike these traditional cleaners, antibacterial products leave surface residues, creating conditions that may foster the development of resistant bacteria, Levy notes. For example, after spraying and wiping an antibacterial cleaner over a kitchen counter, active chemicals linger behind and continue to kill bacteria, but not necessarily all of them.

When a bacterial population is placed under a stressor—such as an antibacterial chemical—a small subpopulation armed with special defense mechanisms can develop. These lineages survive and reproduce as their weaker relatives perish. "What doesn't kill you makes you stronger" is the governing maxim here, as antibacterial chemicals select for bacteria that endure their presence.

As bacteria develop a tolerance for these compounds there is potential for also developing a tolerance for certain antibiotics. This phenomenon, called cross-resistance, has already been demonstrated in several laboratory studies using triclosan, one of the most common chemicals found in antibacterial hand cleaners, dishwashing liquids and other wash products. "Triclosan has a specific inhibitory target in bacteria similar to some antibiotics," says epidemiologist Allison Aiello at the University of Michigan School of Public Health.

When bacteria are exposed to triclosan for long periods of time, genetic mutations can arise. Some of these mutations endow the bacteria with resistance to isoniazid, an antibiotic used for treating tuberculosis, whereas other microbes can supercharge their efflux pumps—protein machines in the cell membrane that can spit out several types of antibiotics, Aiello explains. These effects have been demonstrated only in the laboratory, not in households and other real world environments, but Aiello believes that the few household studies may not have been long enough. "It's very possible that the emergence of resistant species takes quite some time to occur…; the potential is there," she says.

Apart from the potential emergence of drug-resistant bacteria in communities, scientists have other concerns about antibacterial compounds. Both triclosan and its close chemical relative triclocarban (also widely used as an antibacterial), are present in 60 percent of America's streams and rivers, says environmental scientist Rolf Halden, co-founder of the Center for Water and Health at Johns Hopkins Bloomberg School of Public Health. Both chemicals are efficiently removed from wastewater in treatment plants but end up getting sequestered in the municipal sludge, which is used as fertilizer for crops, thereby opening a potential pathway for contamination of the food we eat, Halden explains. "We have to realize that the concentrations in agricultural soil are very high," and this, "along with the presence of pathogens from sewage, could be a recipe for breeding antimicrobial resistance" in the environment, he says.

Triclosan has also been found in human breast milk, although not in concentrations considered dangerous to babies, as well as in human blood plasma. There is no evidence showing that current concentrations of triclosan in the human body are harmful, but recent studies suggest that it acts as an endocrine disrupter in bullfrogs and rats.

Further, an expert panel convened by the Food and Drug Administration determined that there is insufficient evidence for a benefit from consumer products containing antibacterial additives over similar ones not containing them.

"What is this stuff doing in households when we have soaps?" asks molecular biologist John Gustafson of New Mexico State University in Las Cruces. These substances really belong in hospitals and clinics, not in the homes of healthy people, Gustafson says.

Of course, antibacterial products do have their place. Millions of Americans suffer from weakened immune systems, including pregnant women and people with immunodeficiency diseases, points out Eugene Cole, an infectious disease specialist at Brigham Young University. For these people, targeted use of antibacterial products, such as triclosan, may be appropriate in the home, he says.

In general, however, good, long-term hygiene means using regular soaps rather than new, antibacterial ones, experts say. "The main way to keep from getting sick," Gustafson says, "is to wash your hands three times a day and don't touch mucous membranes."

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