Maine Voices: How antibiotics can make us sicker

Maine Voices: How antibiotics can make us sicker

Sun. Nov 11, 2012

By Dr. Stephen Sears, state epidemiologist 

AUGUSTA – The Maine Center for Disease Control and Prevention, Maine doctors and Maine hospitals have news for parents this cold and flu season: Antibiotics don't work for a cold or the flu.

Antibiotics kill bacteria, not viruses. And colds, flu and most sore throats are caused by viruses. Antibiotics don't touch viruses – never have, never will. And it's not really news. It's a long-documented medical fact.

But tell that to parents seeking relief for a child's runny nose. Research shows that most Americans have either missed the message about appropriate antibiotic use or they simply don't believe it.

According to public opinion research, there is a perception that "antibiotics cure everything."

Americans believe in the power of antibiotics so much that patients go to the doctor expecting to get a prescription. And many do. Three out of 10 children who visit an outpatient provider with the common cold receive an antibiotic. This is an improvement from previous years, but antibiotics are not indicated for a common cold.

Why does this happen? Physicians often are too pressured for time to engage in lengthy explanations of why antibiotics won't work. And when the diagnosis is uncertain – as many symptoms for viral and bacterial infections are similar – doctors are more likely to yield to patient demands for antibiotics.

The problem is, taking antibiotics when they are not needed can do more harm than good. Widespread inappropriate use of antibiotics is one of the major reasons for an increase in drug-resistant bacteria. Families and entire communities feel the impact when disease-causing germs become resistant to antibiotics.

The most obvious consequence of inappropriate antibiotic use is its effect on the sick patient. When antibiotics are incorrectly used to treat children or adults with viral infections, such as colds and flu, they aren't getting the best care for their condition. A course of antibiotics won't fight the virus, make the patient feel better, yield a quicker recovery or keep others from getting sick.

Antibiotics also can have serious side effects ranging from nausea, vomiting and diarrhea to life-threatening allergic reactions.

A less obvious consequence of antibiotic overuse is the boost it gives to drug-resistant disease-causing bacteria. Almost every type of bacteria has become less responsive to antibiotic treatment when it really is needed. These antibiotic-resistant bacteria can quickly spread to relatives, classmates and co-workers – threatening the community with a new strain of infectious disease that is more difficult to cure and more expensive to treat.

For example, cases of H1N1 flu have shown resistance to oseltamivir, one of only two antivirals that work against it. Methicillin-resistant Staphylococcus aureus, known as MRSA, remains a problem in many health care settings and can be life-threatening for patients who have weakened immune systems. Even the common sexually transmitted disease gonorrhea is now showing potential for resistance to cephalosporins, the only recommended antibiotic left to treat this infection.

Antibiotic resistance increases the economic burden on the entire health care system. Resistant infections are often more severe, leading to longer hospital stays and increased costs for treatment.

According to the latest available data, antibiotic resistance in the United States costs an estimated $20 billion a year in excess health care costs, $35 million in other societal costs and more than 8 million additional days that people spend in the hospital.

The U.S. Centers for Disease Control and Prevention has stated that antibiotic resistance is one of the world's most pressing public health problems. For this reason, the Maine CDC, the Maine Medical Association, the Maine Hospital Association, the Maine Osteopathic Association and the Maine Public Health Association have joined with the U.S. CDC to recognize Nov. 12-18 as Get Smart About Antibiotics Week.

Americans of all ages can lower this risk by talking to their doctors and using antibiotics appropriately during this cold and flu season.

Maine Sunday Telegram

Comparative urinary bactericidal activity of oral antibiotics against gram-positive pathogens.

May-June 2012

[Article in Croatian]

Bedenić B, Budimir A, Gverić A, Plecko V, Vranes J, Bubonja-Sonje M, Kalenić S.

Source

Zavod za mikrobiologiju, Medicinski fakultet Sveucilista u Zagrebu. branka.bedenic@zg.t-com.hr

Abstract

In routine bacteriological laboratories the antibacterial activity of antibiotics is determined by in vitro testing, usually by disk-diffusion test. However, in vitro testing does not always reflect antibacterial efficiency of antibiotics in vivo. In this investigation, the urine samples obtained in a single oral dose pharmacokinetic study were examined for their bactericidal activity against a range of relevant Gram-positive urinary tract pathogens. Urinary bactericidal activity of linezolid had been previously compared with ciprofloxacin but not with other oral antibiotics such as beta-lactams. Linezolid showed satisfactory urinary bactericidal titres throughout the whole testing period against all Gram-positive cocci. Fluoroquinolones displayed high and persisting levels of urinary bactericidal activity against staphylococci, but their activity against enterococci was weaker. According to the results of ex-vivo testing amoxycillin could be recommended only for infections caused by E. faecalis. Amoxycillin combined with clavulanic acid can be considered as a therapeutic option for infections caused by S. saprophyticus and E. faecalis. Older cephalosporins had high titres only against S. saprophyticus. Their drawback is a short elimination half-time in urine resulting in rapid decrease of urinary bactericidal titers during dosing interval. Furthermore, they do not show activity against enterococci due to their intrinsic resistance to cephalosporins.

PubMed

How Using Antibiotics in Animal Feed Creates Superbugs

How Using Antibiotics in Animal Feed Creates Superbugs

Many livestock groups say there's no evidence that antibiotics in livestock feed have caused a human health problem, but researchers beg to differ.

Researchers have nailed down something scientists, government officials and agribusiness proponents have argued about for years: whether antibiotics in livestock feed give rise to antibiotic-resistant germs that can threaten humans.

A study in the journal mBio, published by the American Society for Microbiology, shows how an antibiotic-susceptible staph germ passed from humans into pigs, where it became resistant to the antibiotics tetracycline and methicillin. And then the antibiotic-resistant staph learned to jump back into humans.

"It's like watching the birth of a superbug," says Lance Price of the Translational Genomics Research Institute, or TGen, in Flagstaff, Ariz.

Price and colleagues in 19 countries did whole-genome analysis on a staph strain called CC398 and 88 closely related variations. CC398 is a so-called MRSA, or methicillin-resistant Staphylococcus aureus, that emerged within the past decade in pigs and has since spread widely in cattle and poultry as well as pigs.

The genetic analysis allowed the study authors to trace the lineage of the livestock bug back to its antibiotic-susceptible human ancestors. Price says it shows beyond a doubt that the animal bacterium jumped back into humans with close exposure to livestock.

This "pig MRSA" has been detected in nearly half of all meat sampled in U.S. commerce, according to the American Society for Microbiology. Most staph found in meat can be eliminated by cooking food well, but it can still pose a risk to consumers if handled unsafely or if it cross-contaminates with other things in the kitchen.

Price told The Salt that the new resistant human bug appears to be spreading beyond people with direct exposure to livestock.

"Initially we could always trace it back to livestock exposure," Price says. "But now we are starting to see cases of resistant strains that we can't trace back. So we think it may be changing gears, so to speak, and gaining the capacity to be passed from person to person."

Price says the new data provide an early warning of what might become a major public health problem.

"We're seeing this one coming," he says. "The question is how often will this occur in the future if we don't start controlling antibiotic use?"

So far, the proportion of human MRSA infections due to this livestock-derived strain is small. But in some areas of the Netherlands, it's causing as many as 1 in 4 human MRSA cases — suggesting that it has the potential to spread extensively.

Paul Keim, another study author, says the report shows that "our inappropriate use of antibiotics ... is now coming back to haunt us." He says the solution is clear — banning antibiotics in livestock feed, as the European Union has done.

Most antibiotics sold in the U.S. go to animals, mostly in their feed, where they act as a growth promoter and damp down infection outbreaks in large feedlots.

Many livestock groups say there's no evidence that using antibiotics in livestock feed creates a human health problem.

"Most informed scientists and public health professionals acknowledge that the problem of antibiotic resistance in humans is overwhelmingly an issue related to human antibiotic use," the American Meat Institute says.

The new report adds fuel to the long-running debate about antibiotic use for livestock, and the government's responsibility to regulate it. In December, the FDA withdrew a 1977 proposal to remove approvals for two antibiotics, penicillins and tetracyclines, used in livestock and poultry feed. It said it would focus instead on "voluntary reform" by the meat industry to limit use.

Then in a partial reversal in January, the agency said it would ban one class of antibiotics called cephalosporins from animal feed.

NPR

Antibiotic choices by paediatric residents and recently graduated paediatricians for typical infectious disease problems in children.

Antibiotic choices by paediatric residents and recently graduated paediatricians for typical infectious disease problems in children.

Paediatr Child Health. 2006 Dec

Smart K, Lemay JF, Kellner JD.
Pediatric Emergency Medicine.

OBJECTIVE: To evaluate antibiotic choices and recommendations for duration of therapy made by paediatric residents (PRs) and recently graduated paediatricians (RGPs) in several typical infectious disease conditions.

METHODS: In autumn 2002, a two-page questionnaire was sent to 276 core PRs in Canadian residency programs and to a random selection of 276 RGPs from across Canada. The questionnaire described 10 scenarios: otitis media, pharyngitis, sinusitis, bronchopneumonia, lobar pneumonia, meningitis, pyelonephritis, osteomyelitis, cellulitis, and fever and neutropenia. The participants were asked primarily about initial antibiotic selection and duration of treatment for each scenario.

RESULTS: There were 251 participants (overall response rate of 45%). The two most common antibiotic recommendations constituted 85% or more of the total for all scenarios except acute otitis media, sinusitis, cellulitis, and fever and neutropenia. There was a twofold or more difference in the range of recommended duration of treatment for all scenarios and a threefold or more difference for sinusitis, meningitis and osteomyelitis. PRs were more likely than RGPs to use broader spectrum cephalosporins for pneumococcal pneumonia (33% versus 15%, respectively; P=0.001) and to treat sinusitis for just five to 10 days (39% versus 22%, respectively; P=0.01). Also, 33% of all participants recommended amoxicillin/clavulanate or a cephalosporin rather than amoxicillin for sinusitis.

CONCLUSION: PRs and RGPs made similar and reasonable recommendations, largely in line with published guidelines, for most of the infectious disease scenarios presented. For some conditions, a significant minority of respondents unnecessarily recommended broad-spectrum antibiotics. The most variable responses were for duration of treatment, reflecting the lack of certainty in the published evidence base for many conditions.

PMID: 19030247 [PubMed - in process]