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Potential Cure For Antibiotic Resistant Infections
kpw10 writes to let us know about research to be published this week that offers hope in the battle against multi-drug-resistant bacteria. "Researchers at the University of North Carolina at Chapel Hill have discovered that two drugs used to treat bone loss in old folks can both kill and short-circuit the 'sex life' of antibiotic-resistant bacteria blamed for nearly 100,000 hospital deaths across the country each year."
Always a concern, but the trend in medicine over the past decade or so has been to reduce the number of times we prescribe, even as we increase both the dose and duration of care when we do pull the trigger. Antibiotic resistance has been strongly linked to inadequate dosing (killing only the susceptible bugs, while letting the borderline-resistant clones reinforce themselves), as well as to courses too short or patient noncompliance.
Patients are part of the problem too, since there is a tendency (cultural in some cases, personal in others) to demand that a doctor "do something" to fix the problem. Antibiotics were perceived for a long time as something harmless to give in those circumstances, but that perception is fading fast. If anything, the trend now is to err on the side of letting things play out a little more to see if antibiotic therapy is really needed.
This has also caused physicians to have to explain the situation better. I know for myself that when I am explaining to a suspicious parent the reason that I'm not going to give their child an antibiotic for their viral infection, I don't waste a lot of time explaining resistance. If they already understand resistance, they're not asking for antibiotics. If they don't, it just sounds like I'm making things up. I focus instead on side effects and cost, and my typical (true) statement is "about all I can do with antibiotics would be to give your child diarrhea to go with her cold." This is surprisingly effective, especially in the parents of non-potty-trained toddlers.
None of which stops me from pulling out the stops when I'm faced with a septic kid or a real infection that needs to be nuked. In those cases, though, I'm very careful to make sure that the regimen I use is appropriate, considering the resistance patterns and the risk of making them worse.
Now if we could only get the idiots who lace animal feed with antibiotics to do the same. Ever wonder where resistant strains start? Hint: it ain't just in the hospitals.
It's easy to be a sceptic and ask about 'and what about when the bugs become resistant to this'. As a person who had his life ruined by MRSA, I know too well the impact these types of infection have on individuals and families. Anything that can extend the reach of antibiotics (particularly the less toxic ones - I was only 2 or 3 days off being killed by the antibiotic that beat my infection) and decrease the chance of resistance is a good thing.
Hopefully this won't be used promiscuously, and I hope they'll work out the interactions with other treatments, as quite often treatment is multi-modal.
I wouldn't wish what I go through due to MRSA on anyone (except my stepfather, but that's another story altogether.
Yep. I've got patients who do the same (I live in an area where we have a lot of Hispanic immigrants, legal and otherwise). Nothing I can do about it except to talk with them, which I do. I try to encourage them to be reasonable and to take an entire course when they start one (nothing's worse than an occasional antibiotic pill). I have mixed success, but I don't expect perfection and I think my attitude helps the situation. I do get a lot of "do you suggest I start this" kinds of calls and questions and I treat those calls as victories.
This gets me into the whole doctor-as-gatekeeper-for-pills thing that drives me nuts. I challenge colleagues once in a while: in an environment where all medications were available at retail, could they still justify their fees? Could they market themselves well enough to avoid starvation? I think I could, because of the kind of medicine I practice (and because I can sometimes go a dozen patients between giving a prescription), but it's definitely something honest physicians should be asking themselves.
In the no-Rx-required environment, though, there's no question that resistance emerges rapidly. Fortunately, the antibiotics available in Mexico are a small subset of the ones we use here, and most of the ones that patients can buy OTC have broad therapeutic indices (overdose doesn't hurt you much) and are from antibiotic classes (penicillins, macrolides) where we have later-generation alternatives that avoid the common resistances. It's a fluid situation, though, and one that has infectious disease specialists always a little on edge.