Month: January 2014

Post-Antibiotic Might Look Like Pre-Antibiotic

An article at Matter looks into what we could reasonably expect when antibiotics fail en masse. It begins with the death of a fireman, less than 80 years ago:

I had always heard Joe had been injured at work: not burned, but bruised and cut when a heavy brass hose nozzle fell on him. The article revealed what happened next. Through one of the scrapes, an infection set in. After a few days, he developed an ache in one shoulder; two days later, a fever. His wife and the neighborhood doctor struggled for two weeks to take care of him, then flagged down a taxi and drove him fifteen miles to the hospital in my grandparents’ town. He was there one more week, shaking with chills and muttering through hallucinations, and then sinking into a coma as his organs failed. Desperate to save his life, the men from his firehouse lined up to give blood. Nothing worked. He was thirty when he died, in March 1938.

Penicillin-resistant staph emerged in 1940, while the drug was still being given to only a few patients. Tetracycline was introduced in 1950, and tetracycline-resistant Shigellaemerged in 1959; erythromycin came on the market in 1953, and erythromycin-resistant strep appeared in 1968. As antibiotics became more affordable and their use increased, bacteria developed defenses more quickly. Methicillin arrived in 1960 and methicillin resistance in 1962; levofloxacin in 1996 and the first resistant cases the same year; linezolid in 2000 and resistance to it in 2001; daptomycin in 2003 and the first signs of resistance in 2004.

Without the protection offered by antibiotics, entire categories of medical practice would be rethought:

  • transplants
  • the use of ventilators, catheters, and ports
  • kidney dialysis
  • Caesarean sections
  • surgery on intestines and the urinary tract
  • bone marrow transplant
  • implantable devices
  • hip replacements
  • botox injections
  • liposuction
  • prostate biopsies
  • open-heart surgery

British health economists with similar concerns recently calculated the costs of antibiotic resistance. To examine how it would affect surgery, they picked hip replacements, a common procedure in once-athletic Baby Boomers. They estimated that without antibiotics, one out of every six recipients of new hip joints would die.

Antibiotics are administered prophylactically before operations as major as open-heart surgery and as routine as Caesarean sections and prostate biopsies. Without the drugs, the risks posed by those operations, and the likelihood that physicians would perform them, will change.

Medical procedures may involve a high risk of infections, but our everyday lives are pretty risky too. One of the first people to receive penicillin experimentally was a British policeman, Albert Alexander. He was so riddled with infection that his scalp oozed pus and one eye had to be removed. The source of his illness: scratching his face on a rosebush. (There was so little penicillin available that, though Alexander rallied at first, the drug ran out, and he died.)

Before antibiotics, five women died out of every 1,000 who gave birth. One out of nine people who got a skin infection died, even from something as simple as a scrape or an insect bite. Three out of ten people who contracted pneumonia died from it. Ear infections caused deafness; sore throats were followed by heart failure.

AntiBacterial Crackdown in USA

An estimated 75% of the anti-bacterial liquid soaps and body washes sold in the United States contain triclosan, a germ-killing ingredient. The only problem is, the Food and Drug Administration has no idea whether it actually works — and there’s some evidence it may pose health risks. [USA Today]

Consequently the FDA has “proposed rule requiring manufacturers to prove that their antibacterial cleaners are safe and more effective than plain soap and water”. That’s because when a product is promoted as killing 99.9% of germs, that’s the same result you get from soap and water. However, Antibacterial products can increase resistance in antibiotics.

The advertising used for these products makes consumers think if they wash with them they won’t get sick, said Kweder. “You’ll see pictures of people sneezing and coughing and looking pretty ill.”

But many of those images “look like people who have viral illnesses” such as the common cold, she said. Viruses are the most common cause of infections in the United States and antibacterial agents have no effect on them.

In Australia Dettol, presumably to counter the backlash they see coming, has been heavily promoting their hand wash product via Sophie’s story:

Tuberculosis – still a major threat

I just came across a thoroughly interesting article from last year about a journalist who, whilst reporting on tuberculosis in Papua New Guinea, ended up catching the disease herself:

We spent some days poking around overflowing wards and diseased shanties for The Age, investigating the insidious reach of deadly, drug-resistant tuberculosis across Papua New Guinea. More than 60 per cent of the global burden of TB occurs in the Asia-Pacific region, and PNG bears some of the worst of it.

…Tuberculosis retains the distinction of being the greatest infectious killer in human history, claiming an estimated billion lives in the past 200 years. Its toll today is still second only to HIV (and it is the major killer of people with HIV). In 2011, 8.7 million people fell sick with TB.

…many are poorly nourished and dozens might share a room at night. TB thrives in such conditions.

…Some of the other children’s limbs are shrivelled, their heads misshapen and eyes vacant in a way I have come to recognise. They are survivors of TB meningitis, the infection having found its way into their brains, rotting away physical and intellectual capacity.

…TB is invisible because the people who suffer it are already on the margins, says Hewison. “They are the poor, the prisoners, alcoholics, refugees, Aboriginals, drug users, old people. And the drug companies forgot it because there is no money to be made there,”

…“Rising rates of multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB threaten global control efforts in both developing and developed countries,” The Lancet authors – Ben Marais among them – warned. The rise of drug-resistant TB and the ease of international travel means “the threat and range and spread of untreatable TB is very real …

…A chest tube is installed to drain fluid and I’m pumped with antibiotics that burn like fury as they flow through the cannulas in my wrists …I move to the Royal Melbourne Hospital where I’m put into the care of an infectious disease team and isolated… at least two years of aggressive drug treatment, including four months of intravenous drips.

———

Extensively drug-resistant tuberculosis (XDR-TB) is a form of tuberculosis caused by bacteria that are resistant to some of the most effective anti-TB drugs. XDR-TB strains have arisen after the mismanagement of individuals with multidrug-resistant TB (MDR-TB).

One in three people in the world is infected with TB bacteria. Only when the bacteria become active do people become ill with TB. Bacteria become active as a result of anything that can reduce the person’s immunity, such as HIV, advancing age, or some medical conditions. TB can usually be treated with a course of four standard, or first-line, anti-TB drugs. If these drugs are misused or mismanaged, multidrug-resistant TB (MDR-TB) can develop. MDR-TB takes longer to treat with second-line drugs, which are more expensive and have more side-effects. XDR-TB can develop when these second-line drugs are also misused or mismanaged and therefore also become ineffective.

XDR-TB raises concerns of a future TB epidemic with restricted treatment options, and jeopardizes the major gains made in TB control and progress on reducing TB deaths among people living with HIV/AIDS. It is therefore vital that TB control be managed properly and new tools developed to prevent, treat and diagnose the disease.

The true scale of XDR-TB is unknown as many countries lack the necessary equipment and capacity to accurately diagnose it. It is estimated however that there are around 40,000 cases per year. As of June 2008, 49 countries had confirmed cases of XDR-TB. By 2013, that number had risen to 84. [Wikipedia]