Tag Archives: antibiotics

Megan McArdle: Why are there no new antibiotics?

Approached by the Antibiotic ResistanceMegan McArdle spoke on antibiotic resistance at the Economic Bloggers Forum yesterday. McArdle is a journalists who writes for the The Atlantic, primarily on economics, finance, and government policy.

Her presentation, “Antibiotics: The world’s most broken market,” was interesting. Notice (in the video below) that she never questions the market-driven premise of pharmaceuticals – and by extension, the for-profit nature of medicine and health care. That’s not her politica/economic persuasion.

Here’s an excerpt from the talk where she discusses the patient/doctor end of the antibiotic resistance problem. What she says is already quite familiar. What’s interesting is her frank description of how doctors behave and how patients in turn regard doctors.

People love to get antibiotics. They go to their doctor and they’re like, “My kid has an earache. Give him antibiotics.” Now the doctor could say, “No we shouldn’t. We should wait and find out if it’s bacterial. Almost all ear infections are bacterial. Due to throat infections. Due to almost anything you can name. But to do that, the doctor has to sit down and deal with an angry patient who may pick up and leave their practice.

If you look at the way that the current insurance industry is organized, right, what do doctors need? They need volume. They get paid by volume. Reimbursements for primary care physicians, who are where a lot – by no means all – but where a lot these vaccines go through, are very low. They’ve made up for that, and you all know this, right. You go into your doctor, and the minute you start talking, your doctor exudes an almost visible — like — desire for you to leave now. So that they can go on to the next patient. So what do they do? They give antibiotics to patients to shut them up. It takes too much time to explain and the risk of losing the patient is high.

Where have all the unattractive people gone?

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Links of interest: Can honey combat MRSA?

How honey kills bacteria (The FASEB Journal)

Honey bee on flowerTo characterize all bactericidal factors in a medical-grade honey, we used a novel approach of successive neutralization of individual honey bactericidal factors. All bacteria tested, including Bacillus subtilis, methicillin-resistant Staphylococcus aureus, extended-spectrum β-lactamase producing Escherichia coli, ciprofloxacin-resistant Pseudomonas aeruginosa, and vancomycin-resistant Enterococcus faecium, were killed by 10–20% (v/v) honey, whereas ≥40% (v/v) of a honey-equivalent sugar solution was required for similar activity.

Secret Ingredient That Kills Bacteria Identified In Honey (Medical News Today)

“We’ve known for millennia that honey can be good for what ails us, but we haven’t known how it works,” said Gerald Weissmann, M.D., Editor-in-Chief of the FASEB Journal, “Now that we’ve extracted a potent antibacterial ingredient [defensin-1] from honey, we can make it still more effective and take the sting out of bacterial infections.”

A sweet solution to antibiotic-resistance? (Time)

The researchers are hopeful that they can build on these initial findings to develop new uses for this potent ingredient in honey, and in light of an alarming trend of antibiotic-resistance, ultimately even put defensin-1 to use as an alternative to current antibiotics.

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Links of interest: Antibiotic resistance

Rising Plague (Brad Spellberg)

Children and chickens in peruBefore getting to the numerous recent news items on antibiotic resistance and urinary tract infections, let me quote from Dr. Brad Spellberg’s Rising Plague: The Global Threat from Deadly Bacteria and Our Dwindling Arsenal to Fight Them. (In the following, “community-acquired” means an infection that begins outside a hospital, and fluoroquinolones are commonly used broad-spectrum antibiotics. Emphasis added.)

[R]esistance of E. coli to fluoroquinolone antibiotics (such as ciprofloxacin) is making it increasingly difficult to treat urinary tract infections with oral antibiotics. Unfortunately E. coli are by far the most common cause of urinary tract infections, accounting for 80 percent or more of them. As the resistance to fluoroquinolones begins to approach 50 percent in community strains of E. coli, it is possible that tens of thousands of women per year will have to be hospitalized to receive intravenous antibiotics just to treat urinary tract infections! How close are we to this nightmare scenario? A recent international study has reported that up to 30 percent of E. coli isolates [separated pure strains of bacteria] from urinary tract infections are now resistant to fluoroquinolones. That compares to less than 5 percent only a decade earlier. Although the resistance rates are lower for community-acquired infections as compared to hospital-acquired infections, the resistance rate among community-acquired E. coli infections has still risen fiftyfold in just the last decade. It is expected that a continued increase is going to occur in the coming decade, which means we may reach 50 percent resistance of community-acquired E. coli to fluoroquinolones within the next ten to twenty years.

Drug-resistant urinary infections (NHS)

A study in Hong Kong concludes that antibiotic resistance may arise from the overuse of antibiotics in food-producing animals. When researchers examined bacteria resistant to the antibiotic gentamicin, 84% of human samples and 75% of animal samples had an identical gene for antibiotic resistance.

The study, published in the Journal of Medical Microbiology, asserts that “Consumers may acquire antibiotic-resistant bacteria from contaminated food,” and ”Good personal and food hygiene are the best ways to prevent this.”

The National Health Service draws a different conclusion:

This was a small study, which found that resistance to the antibiotic gentamicin was granted by the same gene sampled from both animals and humans. However, it did not look at the possible routes by which this resistance may be transmitted between animals and humans. For example, it could not say whether consuming animals with antibiotic-resistant E. coli in their guts is a possible route of transmission.

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Overuse of antibiotics: A remote study (part 2)

conolophus-pallidus-iguana-galapagosThe controversy about the overuse of antibiotics in raising livestock (see the last post) is background for an interesting scientific study that took place in the Galapagos. It looked at the spread of antibiotic resistant strains of bacteria among animals that were totally removed from antibiotics.

Would antibiotic resistance become widespread in the absence of antibiotics?

The immediate motivation for the research was two contradictory studies. In a wooded area of northwest England, researchers had found that wildlife developed antibiotic resistance even though they had not been exposed to antibiotics. This would argue against the idea that antibiotic use in animals should be restricted, since it suggests that antibiotic resistance would develop anyway.

Another study, however, found that wildlife in a remote area of Finland had an almost complete absence of antibiotic resistance. This would argue that resistance could be reduced by restricting antibiotics.

So which was it? How could you design an experiment that controlled possibly confounding factors, such as climate, animal interaction, and human interference?

Coprophagial iguanas

The researchers chose to study a species of iguanas (Conolophus pallidus) on an isolated island (Santa Fe) in the Galapagos . Unlike the English countryside, the island was uninhabited by humans, though tourists made daytime excursions to a restricted area. It offered an example of what life was like in a pre-antibiotic era. This tropical island, which was near the equator, was also unlike the remote area of Finland, where winters were long and cold, the population density of animals was low, and there was limited interaction among animal species.

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Overuse of antibiotics: Follow the money (part 1)

sleeping-pigUnlike climate change, where there’s a large contingent of denialists who spread doubt about the scientific evidence, no one denies that antibiotic resistance is a problem. There is controversy, however, on the question of just how much the widespread use of antibiotics contributes to the problem.

The mechanism is not in dispute: If you expose bacteria to antibiotics, they will mutate to become resistant. But “overuse” of antibiotics is not the only thing that creates antibiotic resistance. Is there irrefutable scientific evidence that the overuse of antibiotics in raising livestock, for example, is harmful to human health? It’s not easy to prove direct cause and effect. If you feed a pig a steady diet of antibiotics, can you irrefutably prove that this results in the illness or death of someone who later eats that pig?

Follow the money

The speed with which we address the increasingly urgent problem of antibiotic resistance will depend on financial interests, not just scientific evidence or common sense. Just as with climate change, we can follow the money to identify the opponents. Who has a financial interest in convincing the public — and in turn politicians — that the overuse of antibiotics is not a problem?

It’s not the medical profession, which understands that overprescribing antibiotics contributes to the increase in antibiotic resistant bacteria. The financial interests of doctors are a little complex here. Unfortunately, because the public is not well educated about the subject, doctors find they need to satisfy the demands of their patients by offering prescriptions. Otherwise patients would simply take their business elsewhere. It takes time for doctors to educate their patients, and today’s doctors are very short of time. This is not sufficient grounds, however, to say that doctors have a financial incentive to overprescribe. Although doctors practicing today have no personal memory of the pre-antibiotic era, they are certainly among the first to appreciate that practicing medicine would become a nightmare without antibiotics.

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Antibiotic resistance genes in soil microbes

Forest soil microbesWe’ve known for years that antibiotic resistant bacteria (ARB) are increasingly a problem in hospital settings. As the recently published (and excellent) book Superbug describes, ARB are also increasingly common in the community – in sports teams, prisons, and on pig farms, for example.

A recent study finds that antibiotic resistance is on the increase in the very ground we walk on. Microbes in soil samples collected in the Netherlands over a sixty year period were analyzed to see if antibiotic resistance genes (ARG) had become more abundant. Resistance was tested for four classes of antibiotics, including tetracyclines and penicillins.

The study reports: “Results show that ARG from all classes of antibiotics tested have significantly increased since 1940, but especially within the tetracyclines, with some individual ARG being >15 times more abundant now than in the 1970s.” Also: “Seventy-eight percent of detected resistance genes, associated with four classes of antibiotics, showed increasing levels since 1940.”

Gene transfer can happen in the food and water supply

The authors of the study expressed concern for the public health implications of their findings. The concern stems from the ability of bacteria to transfer their genes to other bacteria in their surroundings, not just to their own offspring. Humans pass their genes vertically, from parent to child. But single-celled microbes can pass genetic material to another living microbe. It’s called horizontal (or lateral) gene transfer. In fact, this may be the most common form of gene transfer in single-celled microbes.

So we’re not talking about picking up disease-causing bacteria while walking in the woods, the way athletes contract MRSA from towels in the locker room. The significance of an increase in ARG in soil microbes is the ability to transfer resistance genes to bacteria that make us sick.

As lead researcher David Graham explains: “The genes themselves do not get passed directly to humans per se. The genes get passed from exposed bacteria to bacteria … [that] might ultimately end up in humans, some of which might be pathogenic. An example is on food or in water that has been exposed to resistance bacteria.”

Like food that’s grown in soil. Or water that comes in contact with the earth.

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Do houseflies spread antibiotic resistance?

HouseflyThere was a one-day Congressional hearing last week on antibiotic resistance and industrial agriculture. Members of congress were looking for evidence that would link agricultural use of antibiotics to human illness. One Republican specifically asked for research done in the US, implying European studies would not be good enough. Medical experts from the CDC and NIH were evidently unable to cite an American study.

It’s almost impossible to connect the bacteria in a specific individual with an animal that received an antibiotic. But there’s certainly a case to made for the use of antibiotics in agriculture and the spread of antibiotic resistance. And that’s based on research done right here in the US.

A poultry house and its 30,000 flies

Chicken houses are very attractive to flies. A Danish study estimated that, over a six-week period, as many as 30,000 flies may enter a poultry house. The Johns Hopkins Bloomberg School of Public Health (Baltimore, MD) just released a study on antibiotic resistant bacteria found in houseflies who make their home on industrialized chicken farms.

The study collected houseflies and poultry litter from chicken farms in an area of Maryland, Delaware and Virginia. Poultry litter is the absorbent material on the floor of a chicken farm. By the time it’s been used, it consists primarily of chicken manure, which is rich in bacteria.

When scientists compared the antibiotic resistant bacteria found in both flies and litter, they found striking similarities. The bacteria from both sources had very similar resistance characteristics and very similar resistance genes. “Resistance characteristics” refers to exactly which antibiotics can no longer destroy the bacteria. Characteristics of the mechanism of resistance can now be identified on the genes themselves.

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Links of interest 4/26

Chocolate lovers ‘are more depressive’, say experts (BBC News)

Absence of racial, but not gender, stereotyping in Williams syndrome children (Current Biology)

Raising a child with Williams Syndrome (NPR)

Andrew O’Hagan on Self-Helponauts: You have only one chance to be happy (London Review of Books)

Harnessing older people as a resource in the coming population crash (Salon – Be prepared to close obnoxious loud audio ad on loading)

Daily Kos interviews Maryn McKenna, author of Superbug: The Fatal Menace of MRSA (Daily Kos)

Hospital patients most likely to carry MRSA: Long-term elder care, HIV-infected, kidney dialysis (HealthDay)

Putting bacterial antibiotic resistance into reverse (Physorg)

Dying man sells ad space on his urn (myFOXla)

Image Source: BBC News


Pig dignity: Animal welfare in Europe

baby-pigsThe European Parliament, the governing body of the EU (European Union), met last week to consider (among many other things) a new animal welfare action plan. Last December animal welfare became a core value for the EU, right up there with opposing discrimination, promoting gender equality, and protecting human health and welfare. The new animal welfare treaty states that EU members “shall, since animals are sentient beings, pay full regard to the welfare requirements of animals.” How civilized.

BBC News has a lengthy discussion of the implications of the treaty for animal experimentation. And here’s the complete Animal Welfare Action Plan, which was presented on April 19.

Seeking to capitalize on animal welfare sentiment during an election campaign, the UK’s Labour Party announced: “And we will maintain our proud record on improving animal welfare, including the ban on fox hunting.” How British.

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Why are there no new antibiotics?

antibiotic-resistance-mrsaWithout new antibiotics, we’re at the mercy of antibiotic resistant bacteria – MRSA, Clostridium difficile, Acinetobacter baumannii, etc. Unfortunately, pharmaceutical companies lack a financial incentive to develop new antibiotics.

One reason is that most patients get better when they use antibiotics. Many are prescribed for only a few weeks. It’s much more profitable for drug companies to develop medications that will be used by large numbers of people to suppress the symptoms of lifelong conditions: acid reflux, erectile dysfunction, arthritis, high blood pressure, diabetes, heart conditions.
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A brief history of antibiotics


* 2000 B.C. – Here, eat this root
* 1000 A.D. – That root is heathen. Here, say this prayer.
* 1850 A.D. – That prayer is superstition. Here, drink this potion.
* 1920 A.D. – That potion is snake oil. Here, swallow this pill.
* 1945 A.D. – That pill is ineffective. Here, take this penicillin.
* 1955 A.D. – Oops….bugs mutated. Here, take this tetracycline.
* 1960-1999 – 39 more “oops”…Here, take this more powerful antibiotic.
* 2000 A.D. – The bugs have won! Here, eat this root.
— Anonymous

From the World Health Organization, “How Resistance Develops and Spreads” (emphasis added):

Twenty years ago physicians in industrialized nations believed that infectious disease were a scourge of the past. With industrialization came improved sanitation, housing and nutrition, as well as the revolutionary development of disease-fighting antimicrobials. Populations living in those nations were not only enjoying an unprecedented decrease in mortality and morbidity, but a corresponding increase in life expectancy. …

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Gonorrhea bacteria: The next superbug?

Bad Bugs No Drugs

After chlamydia, gonorrhea – also known as the “clap” — is the second most common bacterial STD (sexually transmitted disease). It’s easily transmitted. Women have a 60-80 % chance of becoming infected after a single sexual encounter with an infected male partner. Left untreated, the disease not only causes unpleasant symptoms – painful urination, urethral and vaginal discharge, projectile urination – but can lead to sterility.

Superbugs are bacteria that have become resistant to multiple antibiotics. The organism that causes gonorrhea (Neisseria gonorrhoeae) is very versatile and quick to develop resistance.

A few decades ago, gonorrhea became resistant to penicillin. Tetracycline is no longer effective. The disease is rapidly becoming resistant to the fluoroquinolone family of broad-spectrum antibiotics (ciprofloxacin, ofloxacin, levofloxacin). Currently, doctors use cefixime or ceftriaxone to treat gonorrhea, but there are now signs of resistance to these drugs as well, particularly to cefixime.

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Global challenge: 10 new antibiotics by 2020

Bad Bugs No Drugs

The Infectious Diseases Society of America (IDSA) has issued a statement challenging global leaders to develop 10 new antimicrobial drugs by 2020.

The time has come for a global commitment to develop new antibacterial drugs. Current data document the impending disaster due to the confluence of decreasing investment in antibacterial drug research and development concomitant with the documented rapid increase in the level of resistance to currently licensed drugs. Despite the good faith efforts of many individuals, professional societies, and governmental agencies, the looming crisis has only worsened over the past decade. …

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