Category: Statistics

A study of patients in Belgium found that when people have a sore throat, what they want is pain relief, but what they ask for is antibiotics.

The conclusion of the authors is that:

Trials are needed to test whether exploring patients’ expectations about pain management and offering adequate analgesia can assist physicians in managing sore throats without prescribing antibiotics.

Personally, I think every consulting room should have a poster listing all the things antibiotics cannot fix, and telling us the long-term risks of overprescription (millions of deaths from scratches…)

We all know about the terrible problem of AIDS in Africa. Well, a study shows that in 2019, antimicrobial-resistant (AMR) infections killed more than a million people – twice as many as who died from AIDS.

It used actual records and extrapolated the data across places that are lacking in hard data.

On the basis of our predictive statistical models, there were an estimated 4·95 million (3·62-6·57) deaths associated with bacterial AMR in 2019, including 1·27 million (95% UI 0·911-1·71) deaths attributable to bacterial AMR. At the regional level, we estimated the all-age death rate attributable to resistance to be highest in western sub-Saharan Africa, at 27·3 deaths per 100 000 (20·9-35·3), and lowest in Australasia, at 6·5 deaths (4·3-9·4) per 100 000.

So, even in wealthy countries like Australia, it is also a problem, just not as bad.

 

The answer to typhus is antibiotics, specifically Doxycycline. But the more you use an antibiotic, the more likely the disease will mutate.

There were 167 cases of typhus from January 1, 2018, through February 1 of this year, up from 125 in 2013 and 13 in 2008, according to the California Public Health Department.
https://www.theatlantic.com/health/archive/2019/03/typhus-tuberculosis-medieval-diseases-spreading-homeless/584380/

Mostly homeless people. A growing illness and potentially no more medicine that works = potential plague.

 

When doctors fail to adhere to guidelines set to keep the public safe in the future, there are two possible next steps:

• make it illegal to prescribe antibiotics for viral illnesses
• run a public information campaign in the media, that says doctors who wrongly prescribe antibiotics are not the trusted

Australian GPs are overprescribing antibiotics for respiratory infections, even when their use is not recommended, research shows.

Antibiotics are prescribed for acute respiratory infections (ARI) at rates four to nine times higher than recommended by national guidelines, the researchers found.

…They found an estimated mean of 5.97 million ARI cases per year were managed in general practice with at least one antibiotic.

Had GPs adhered to widely consulted antibiotic prescribing guidelines, they would have prescribed antibiotics for 650,000 to 1.36 million cases a year or 11-23 per cent of the current prescribing rate, they said.

The researchers found GPs are prescribing antibiotics in 85 per cent of acute bronchitis/bronchiolitis cases and 11 per cent of influenza cases, despite guidelines recommending they not be used.
http://www.sbs.com.au/news/article/2017/07/10/gps-overprescribing-antibiotics-research

 

A new study says that doctors have been prescribing antibiotics more than twice as often as needed to children suffering from acute respiratory infection [Source: NPR].

Even though only 27% of these infections are caused by bacteria, doctors have still been prescribing antibiotics 57% of the time.

“Last year the American Academy of Pediatrics recommended that doctors use caution when prescribing antibiotics for ear infections. That included giving parents a “contingency” prescription to use if the child doesn’t get better in a few days.”

I came across this article in Mother Jones – it is not available online.

Researchers looked at the demographics of the states within the USA, looking for increased antibiotic use in states like Florida (higher percentage of elderly folk). Race, education, health care coverage and income didn’t correlate with increased usage either. Only one demographic did – obesity. Fat people use more antibiotics.

Now it could be because fat people get sicker more – but so do the elderly, so do the poor. Or could it be that antibiotics add to your weight. It sounds crazy but that is why they are fed to cattle.

Key snippets:

Hicks was surprised to find that states with higher rates of antibiotic use also were very likely to have significantly more obese people. The research team can’t yet explain the connection, and they suspect a chicken-and egg effect might be at work: “There might be reasons that more obese people need antibiotics,” she says. “But it also could be that antibiotic use is promoting weight gain.”

Meat producers have long dosed livestock with low levels of antibiotics to bulk up their animals, and recent studies suggest that the antibiotics your doc prescribes may have similar effects. A 2012 New York University study found that use of the drugs in the first six months of life correlates with obesity later in childhood. Another 2012 study from the same lab found that mice given antibiotics gained more weight than their drug free counterparts. No one knows exactly how antibiotics help animals-and perhaps humans-pack on the pounds, but some researchers think that it has to do with their effect on the gut microbiome, the intestinal community of microorganisms that scientists and doctors are just beginning to understand.

Researchers from the University of Pennsylvania investigated UK data covering over 1.5 million visits to doctors by 800,000 people with upper respiratory infections over a period of 20 years.

Just over 65% of the patients, who were all adults, received antibiotics for their infections. The patients were studied over 15 days following their first doctor visit to see how many were admitted to the hospital with pneumonia or any adverse event that might be related to the administration of the drugs, such as heart problems, liver or kidney toxicity, diarrhea and seizures.

Overall, there were 296 people admitted to the hospital with a case of pneumonia within 15 days of the initial doctor visit. That was 22 people admitted to a hospital with pneumonia for each 100,000 doctor visits if they did not receive an antibiotic – and 18 people per 100,000 who were treated with antibiotics.

Researchers said that “12,255 or more people would have to be treated with antibiotics to prevent one person from being hospitalized.” We aren’t even talking about saving lives, just saving hospitalization. Considering the harm that antibiotics do to an individual’s gut health, and the rise of super bugs, it is immediately obvious that prescribing antibiotics for upper respiratory infections should be made illegal.

But no, we’ll keep on trusting that doctors know best.

Governments, and a few people, are taking notice of antibiotic resistance and doing something about it. Primarily that simply means using less antibiotic drugs for humans and animals. In some countries it’s looking like it’s just too late, while others might have a chance.

So the future is not necessarily black and white – we are all doomed vs new drugs and remedies being invented. A hybrid future may arise where some countries won’t be affected too much, and other countries are in a bad way. Which begs the question – would you move somewhere safer, knowing that it could improve your expected lifespan by decades?

This map, as an example, show resistance of MRSA in Europe – note the big differences. If the numbers were to stay like that, across illnesses, surely Mediterranean folk would be wanting to move to Scandinavia.