The need for medical drug regulation = we are breeding 'super' bacteria

[a_unique_person]

http://www.theage.com.au/articles/2003/03/10/1047144896686.html



Doctors have sounded the alarm after discovering that two strains of drug-resistant "superbugs" are spreading like wildfire across the United States, and one of the bacteria may already have reached Europe.

The bugs are Streptococcus pneumoniae, blamed for thousands of cases of meningitis, sinusitis, ear infections and pneumonia each year, and Staphylococcus aureus, which is spread through skin abrasions and, if untreated, can cause abscesses and boils and lead to pneumonia or fatal blood poisoning.

Reporting today in the monthly journal Nature Medicine, epidemiologists led by Marc Lipsitch of the Harvard School of Public Health found that strains of S. pneumoniae that are resistant to the conventional antibiotics, penicillin and erythromycin, are advancing fast across the United States.

In 1995, the proportion of penicillin-resistant strains in the US was 21 per cent, and that of erythomycin was 10.6 per cent.

On present trends, by mid-2004 41 per cent of S. pneumoniae infections will be resistant to both antibiotics, the team believes. The data is derived from eight locations across the country.

The finding is a serious worry, for the loss of those two antibiotics will leave physicians with only a few drugs left in their arsenal, notably amoxicillin and fluoroquinones -- and even these are now showing early resistance problems.

Lipsitch says there is now an "urgency" in limiting unnecessary use of antibiotics in order to brake the rate of resistance spread, and in finding a new generation of drugs to tackle these hardened strains.

Meanwhile, a drug-resistant strain of S. aureus has infected thousands of people in the United States and may now have reached Europe, the British weekly New Scientist reported yesterday.

[corplinx]

Tonight I heard someone mention that we are overmedicated and that is the reason for these resistant strains. I had a few questions in my mind about this:

A. When I think overmedicated, I think of zoloft, prozac, xanax. I don't know many people who get strong antibiotics for the hell of it.

B. It would make sense that if strains that are not resistant are being wiped out by anti-biotics (and hence people are less susceptible later in life) that the strains that _would_ make people sick and thrive are the resistant ones.

So, are we seeing true adaption or merely natural selection? Are the strains adapting to antibiotics or are the weaker strains just being weeded out?

[Reginald]

The public in the UK are gradually being made aware that anti-biotics will not help with viral infections. In the past they have been asked for, and generally given, far too easily. This approach has not helped the situation you describe.

Also if people were to finish the course of medication they were given, rather than take the first three days of 5 and then feel better and stop, it would help also.

I hold out hope that research into Bacteriophages could lead to some form of fall back option in the case of superbugs.

[Reginald]

Posted by Coplinx

So, are we seeing true adaption or merely natural selection? Are the strains adapting to antibiotics or are the weaker strains just being weeded out?

As I understand it, what happens is, given the millions of infecting bacteria in the body, at the start of treatment the less resistant of that type die first, continuation of treatment kills more and more untill, hopefully they are removed completely.

However, if you stop your treatment you leave behind a slightly more resistant group, that can subsequently infect another, and so the cycle goes on, requiring greater dosage, longer treatment.

Sooner or later (and given the number of generations present in any infection) completely resistant strains of a bug will emerge.

In UK hospitals there are (as AUP points out) reserved anti-biotics that are only used when all else fails, for fear that these anti-biotics will be rendered less effective and leaving doctors with no treatment at all.

[corplinx]

Sounds good to me Reginald, I guess the answer to my question is really "unnatural" selection.

[Segnosaur]

Originally posted by corplinx
I don't know many people who get strong antibiotics for the hell of it.

I remember reading that the biggest source of antibiotic resistant bacteria is in the Detroit area. The reason for that is that intervenous drug users there tend to use antibiotics to sterilize their needles. (Of course, not all bacteria get killed during this treatment, leading to resistance.)

Cheers.
Allan

[a_unique_person]

Originally posted by Segnosaur

I remember reading that the biggest source of antibiotic resistant bacteria is in the Detroit area. The reason for that is that intervenous drug users there tend to use antibiotics to sterilize their needles. (Of course, not all bacteria get killed during this treatment, leading to resistance.)

Cheers.
Allan

haven't they ever heard of a needle exchange program?

Whats that name of that flesh eating bacteria the UK hospital seem to get ot breaks of.

As for anti biotics a lot is down to over prescription when it is not needed and down also to not finishing the entire perscription.

Bacteria and viruses have survived zillions of years they will out live most if not all things.

[Reginald]

Pie....

Necrotizing fasciitis.

And MRSA.

[Dymanic]

Alliance for the prudent use of antibiotics: (http://www.healthsci.tufts.edu/apua/apua.html)

Bacteria have a little trick that makes things even worse: they can share resistence with each other.

[Denise]

I generally don't go to the doctor unless I am really sick. I know a lot of women who take their kids to the doctor at the slightest indication of a cold. And most of these doctors give them antibiotics. The mothers expect it, and the doctors know if they don't they will lost patients. This is just from my personal life experience, I don't know what it's like in other regions.

[Agammamon]

Originally posted by corplinx
Tonight I heard someone mention that we are overmedicated and that is the reason for these resistant strains. I had a few questions in my mind about this:

A. When I think overmedicated, I think of zoloft, prozac, xanax. I don't know many people who get strong antibiotics for the hell of it.

B. It would make sense that if strains that are not resistant are being wiped out by anti-biotics (and hence people are less susceptible later in life) that the strains that _would_ make people sick and thrive are the resistant ones.

So, are we seeing true adaption or merely natural selection? Are the strains adapting to antibiotics or are the weaker strains just being weeded out?

A. Unfortunately, patients tend to ask for antibiotics for every little sniffle and doctors prescribe them for all sorts of things that a little endurance would take care of. Add in the appearance of antibiotics in soaps, etc and A/B's are appearing everywhere.

B. Yes the strains that are not resistant are being wiped out, letting the organisms with a resistance mutation survive and breed since they are now better fitted for their environment.

Natural Selection and Adaptation go hand in hand. natural Selection is the mechanism that allows you to tell who is best Adapted.

[a_unique_person]

Originally posted by Denise
I generally don't go to the doctor unless I am really sick. I know a lot of women who take their kids to the doctor at the slightest indication of a cold. And most of these doctors give them antibiotics. The mothers expect it, and the doctors know if they don't they will lost patients. This is just from my personal life experience, I don't know what it's like in other regions.
one of the problems of a free enterprise system.

[corplinx]

Originally posted by Denise
I generally don't go to the doctor unless I am really sick. I know a lot of women who take their kids to the doctor at the slightest indication of a cold. And most of these doctors give them antibiotics. The mothers expect it, and the doctors know if they don't they will lost patients. This is just from my personal life experience, I don't know what it's like in other regions.

Who are these people? Name names. I am always hearing about how some mom somewhere takes her kid to doctor every time he coughs and gets antibiotics. I hear people say that moms everywhere are doing this. I doubt the problem of "sniffle-moms" is really as bad as people make it out to be.

[a_unique_person]

Originally posted by corplinx


Who are these people? Name names. I am always hearing about how some mom somewhere takes her kid to doctor every time he coughs and gets antibiotics. I hear people say that moms everywhere are doing this. I doubt the problem of "sniffle-moms" is really as bad as people make it out to be.


someone is doing it, the proof is out there.

[John Harrison]

one of the problems of a free enterprise system.

What does free enterprise have to do with the incorrect treatment of viral infections? I would be interested in your solution to this, if you have one. Thx

[corplinx]

Originally posted by John Harrison


What does free enterprise have to do with the incorrect treatment of viral infections? I would be interested in your solution to this, if you have one. Thx

In Soviet Union, infections treated with bullet instead!

[a_unique_person]

Originally posted by John Harrison


What does free enterprise have to do with the incorrect treatment of viral infections? I would be interested in your solution to this, if you have one. Thx

not enough state control. in australia, most drugs are available at a discount under a government scheme. this allows greater control of how drugs are prescribed and used.

[John Harrison]

not enough state control. in australia, most drugs are available at a discount under a government scheme. this allows greater control of how drugs are prescribed and used.

Hmm. I'm not sure I would be more comfortable with some government w@nker making medical decisions as opposed to a doctor. YMMV

[Plutarck]

Originally posted by a_unique_person


not enough state control. in australia, most drugs are available at a discount under a government scheme. this allows greater control of how drugs are prescribed and used.

Just so long as the government doesn't happen to develop a certain attraction or repulsion to certain activities - ie, birth control, abortion, recreational drug use, etc.

Control cuts both ways - it permits a greater degree of improvement, and an equally increased degree of destruction.

[a_unique_person]

Originally posted by John Harrison


Hmm. I'm not sure I would be more comfortable with some government w@nker making medical decisions as opposed to a doctor. YMMV

the board that runs the pbs is not run by w@nkers. there are representatives of the medical profession etc.

a lone doctor, as denise said, with mothers with kids with colds, is prey to pressure to stay in business.

the problem with the PBS is that the pharmaceutical industry is constantly pushing for more influence on it.

it's not just the mums, though. i have heard adults saying how they had a cold, went to the doc to get anti biotics, and they are better now.

[John Harrison]

the board that runs the pbs is not run by w@nkers. there are representatives of the medical profession etc.

I was speaking about how it would most likely turn out in the US, not Aus. Sorry about the confusion.

Our government isn't too swift at most things, so I have trouble believing they would handle medical issues very well, especially when they are trying to influence behavior. All it really takes is a doctor that takes just a bit of time to explain why an antibiotic would not be beneficial for a viral infection, as opposed to just writing a prescription and sending them out the door.

[tygirwulf]

You know what? I attended a medical conference with my mother that happened to deal with this very topic. Unfortunately, I was there for the free dinner and am not a member of the medical profession, so I didn't follow along too closely. I do remember the presenter was saying something to the effect that the level of bacteria that is in the body when its considered to be resistant to a certain antibiotic is so low, it could be there naturally. He was for a campaign to get this amount of bacteria raised to what he felt was a more reasonable level, something that could not occur in the body naturally and would be a better indicator of whether that bug is resistent to a certain medicine or not.

However, feel free to ignore this. Like I said, I was there for the free dinner and was more concerned with my roasted halibut covered with a red currant sauce. I'll see if my mother still remembers anything of this conference, since I know she was paying attention.

On the other hand, I think I was hit with a nasty strain of resistant pneuomona a few years ago. I was in the hospital for a week, getting three brands of the "-mycin" drugs intravenously before I was declared fit to go home. I remember they had to switch hands on the IV on the fourth day, since the antibiotics are so powerful they will eat away at your veins. That was definitely not a case of a "sniffle mom."

[Shane Costello]

Originally posted by a_unique_person:
not enough state control. in australia, most drugs are available at a discount under a government scheme. this allows greater control of how drugs are prescribed and used.

Have you any evidence to suggest that countries withstate controlled public health systems are any less susceptible to the emergence of superbugs?

Surely if you make drugs cheaper then they'll be more reasily prescribed?

[a_unique_person]

Originally posted by Shane Costello
Originally posted by a_unique_person:


Have you any evidence to suggest that countries withstate controlled public health systems are any less susceptible to the emergence of superbugs?

Surely if you make drugs cheaper then they'll be more reasily prescribed?

they are also more easily controlled. Note where the superbug has originated.

[Reginald]

As it happens I went to the docs this morning and picked up this leaflet which from a graphical standpoint I rather like....and I think it's cool that the UK NHS is addressing the problem.

http://www.doh.gov.uk/antibioticresistance/

[PygmyPlaidGiraffe]

This corperation has decided to err on the side of caution


http://www.cbc.ca/stories/2003/06/19/Consumers/antibioticsmcdonalds_030619

There will be critics, some suppliers are saying the decision was not based on science.

If the verdict is not in yet on antibiotics and their danger/safety, would it not be prudent to err on the side of caution until the evidence is in?

[Dymanic]

Originally posted by PygmyPlaidGiraffe


There will be critics, some suppliers are saying the decision was not based on science.
Right. The companies that supply antibiotics to the cattle and poultry industry said that. Reminiscent of the tobacco industry's claims that smoking is not harmful. I'd like to take a look at exactly what they said about the concerns not being based on science.If the verdict is not in yet on antibiotics and their danger/safety, would it not be prudent to err on the side of caution until the evidence is in?The evidence is in.

Hooray for MacDonald's. In support of their decision, I might even force myself to choke down one of their ghastly hamburgers sometime.

[Boo]

The problem of "super bugs" has been around for decades.

When Penicillin first became widely availabe after WWII it was the wonder drug. Cured everything, or so the medical profession believed and was encouraged to do so by the scientific/research community. After a few years it stopped working on everything, so they gave us Ampicillin(a 2nd generation cillin). Next came the allergies to Cillins as well as bacteria resistant to it. Out come the Sulfa drugs. The cycle starts all over again. And so on and so forth.

Last time I checked the latest and greatest was a 5th generation Mycin.

Who are these people? Name names. I am always hearing about how some mom somewhere takes her kid to doctor every time he coughs and gets antibiotics. I hear people say that moms everywhere are doing this. I doubt the problem of "sniffle-moms" is really as bad as people make it out to be.

I have seen this first hand many times over the last 18 years working in emergency rooms. Mom comes in, kids have runny nose, low grade fever, cough, ear ache, etc. She wants antibiotics and does not want to hear that it is a virus. Make them/me better now! The medical profession is consumer driven in the US. Keep the customer happy. I have personally witnessed some truly nasty behavior when a Dr refuses to give antibiotics for a viral infection. Most Dr's will give in. To avoid losing customers, Dr's in private practice will automatically perscribe antiobiotics. An HMO, health plan PCP, or independant practioner needs customer's to survive, don't give them what they want and they will go somewhere else.

Other aspects of the problem include the need our society has to sterilize EVERYTHING and people that take antibiotics incorrectly. Bacteria is necessary for the proper function of the human organism. Not enough of it and you can be sicker than if you have too much. Take medication other than prescribed and you may feel better but the bacteria left are now resistant to that drug. Sneeze or cough in public and now you've passed it on.


Whether it is a form of natural selection, or the end process of man meddling in nature doesn't really matter. It is a problem that will not go away and will only get worse.



Boo