Idea #314 for December 29th, 2009: The Link Between Disinfectants And Resistant Pathogens

Misuse of antibiotics has been associated with the rise of resistant strains of pathogens that have plagued hospitals in the US. New research suggests that misuse of disinfectants may also play a role in the spread of superbugs. Researchers examined whether benzalkonium chloride, a common disinfectant, might lead to resistant strains of a certain bacterium known to cause disease in people with weakened immune systems.

Their results showed that the bacteria eventually became resistant to the disinfectant, as well as the antibiotic Cipro. Since the research took place in a lab, we shouldn’t necessarily jump to conclusions about its relevance to real-life situations. However, the scientists behind the research have a few recommendations about household use of disinfectants. For one, they should not be diluted, as that may allow some bacteria to survive and breed other resistant bacteria. Also, ample time should be afforded to let the disinfectants work so that the vast majority of bacteria are killed. Disinfectants shouldn’t be avoided altogether, they should just be used more wisely to avoid contributing to the superbug epidemic.

Read more about this issue here.

Idea #286 for December 1st, 2009: Keep Those Meds To Yourselves or The Problem With Sharing Prescription Drugs

There’s a large problem in the US with people selling prescription medications on the black market for recreational use. But there’s another problem involving people who are sharing their medications with others to provide assistance. Twenty percent of teens admit to have given some of their prescription drugs to friends. They might think they’re just helping out a friend by sharing their prescription, like giving some antibiotic pills, but the results can be more harmful than helpful.

Of the people surveyed who had received medications from another person’s prescription, a quarter experienced some side effects. People who receive the drugs may not be informed of potential interactions or allergies that may come into play. Side effects aren’t the only problems; sharing things like eye drops can spread infections rather than contain them. And misusing antibiotics can contribute to drug resistant bacteria strains like MRSA. Two ways to address this problem are: better informing patients of the risks involved in sharing meds, and increasing access to programs that take back expired and unwanted medications, so that patients do not have to accumulate old medications.

Read more about this issue here.

Idea #284 for November 29th, 2009: Hidden Risks or Some Pregnant Women Unaware of Medications’ Dangers

Pregnant women are often unaware of the possible effects that medications can have on their unborn children. Certain drugs used to treat acne, anxiety, as well as antibiotics can all be detrimental to fetal health. Yet a study shows that some women continue taking those, and other risky drugs, during pregnancy.

A Canadian study of over 100,000 pregnant women found that over half filled at least one prescription during pregnancy, and 6% took a medication that can be problematic for unborn children. Potential risks include miscarriage and birth defects. There is a need for greater awareness among pregnant women about the side effects their medication may pose. The best way to inform them is to make sure that their healthcare providers review their medications as soon as they are aware of the pregnancy.

Read more about this study here.

Idea #279 for November 24th, 2009: Unwelcome Visitors or Fighting The Rise in Community-Acquired MRSA

MRSA, the antibiotic resistant pathogen we often hear about in the news, is usually thought of as a problem that only occurs in hospitals. New data suggests that a growing number of patients are picking up MRSA in the community and then bringing the pathogen into hospitals, rather than the other way around. The incidence of MRSA in outpatient units has grown rapidly. This is dangerous because doctors often travel between outpatient and inpatient units, potentially spreading the bacteria that’s carried into the hospital during outpatient visits.

Strains of MRSA that originate outside of hospitals are considered less dangerous than the deadly ones often cited in the media. That doesn’t mean the threat should be ignored, though. Hospitals now have to concentrate not only on containing and eliminating MRSA from their inpatient units, but also must contend with battling strains that are introduced by new patients. Healthcare facilities will probably require more resources to fight the outside waves of MRSA now. They will also need to increase surveillance and find better diagnostic tools to ensure that their response can be rapid.

Read more about this story in the LA Times.

Idea #242 for October 18th, 2009: Big Bucks or The Cost of Antibiotic Resistant Infections

The dire effects that antibiotic resistance can have on public health have been covered in this blog in the past, but there’s another consequence that is a little fuzzier. The economic impact of antibiotic resistance is difficult to pin down, but researchers have come up with an estimate at one Chicago hospital. The cost: $18,000 to $29,000 per infected patient.

The study looked at data from over 1,000 patients at Cook County Hospital in Chicago and found that patients who had antibiotic resistant infections spent on average 6-13 extra days in the hospital. They estimate that the patients and their families were on the hook for an additional $10-15 million in total, for the cost of treating the infections. Also, they found that the death rate for those patients was 6.5%, which is twice that of other patients.

The authors also extrapolated the costs to estimate what the entire nation is spending to treat antibiotic resistant infections. The number is somewhere between $16-26 billion annually, they say. And that’s a conservative estimate. Further, the authors point out that reducing the incidence of these infections by just 20% would save the nation $3-5 billion a year. We have to keep those numbers in mind when we’re developing ways to fight the problem. If a solution costs us a few billion dollars, politicians and the public will balk, but the cost of doing nothing is far greater, both in money and in our health.

Read more about the study here.

Idea #240 for October 16th, 2009: An Endless Battle or Keeping Antibiotic Resistance Under Control

Antibiotic resistance is a huge concern in healthcare, with strains of bacteria like MRSA especially troublesome. Despite our efforts, we cannot expect the issue of antibiotic resistance to ever go away completely. Instead, we have to consider ways to lessen its effect, says a new report. The American Academy of Microbiology report makes the point that we can’t expect to win a battle against trillions of microbes and the forces of evolution, but we can employ better ways of managing the inevitable.

The report outlines several suggestions that can reduce the threat of antibiotic resistance. For one, if we have better diagnostic tools available, patients can be treated more promptly with the correct antibiotics, reducing the amount of mis-prescribed medications. The scientists recommend more comprehensive surveillance to ensure we have accurate data on the spread of resistant bacteria. They also want more research into the role that ubiquitous antimicrobial agents found in household products like soap are playing in the rise of resistant strains. And they believe that more time and resources be spent trying to develop new antibiotics that will keep us one step ahead of the bacteria. These methods won’t solve the problem of antibiotic resistance, but they could give us our best chance of keeping it under control.

Read the report from the American Academy of Microbiology here.

Idea #231 for October 7th, 2009: Scaling Up or Adjusting Antibiotics Dosages for Obese ER Patients

In an ER environment, patients are often given standard doses of antibiotics regardless of their weight and other factors, a study has found. As a result, many obese patients are not receiving high enough doses of antibiotics, which means their infections are not being sufficiently treated. That in turn can lead to antibiotic resistance, a major problem in the realm of healthcare.

The study specifically looked at how doctors at Washington University Medical School treated emergency room patients with BMIs over 40. For the three antibiotics they focused on, researchers found that proper dosing guidelines were followed less than 10% of the time among obese patients. If those numbers of indicative of how emergency departments across the nation are functioning, then we really need to implement stronger guidelines for this. Considering how many Americans are obese, this poses a real danger, both to the patients themselves and to the public, who will have to deal with more resistant strains of bacteria in existence.

To read more about this study, read this article from ABC News.

Idea #209 for September 15th, 2009: Prescription For Trouble or Online Drug Sales Contribute to Antibiotic Resistance

Antibiotics resistance is a big problem in healthcare. Over-prescription of antibiotics and patients’ reluctance to take the drugs for the full course of treatment both contribute to the problem. Another major factor is the growing industry of internet-order antibiotics, which is done without a prescription from a doctor and is illegal. Researchers scouring the internet found that about a third of sites selling prescription drugs did not actually require a prescription to complete an order.

When antibiotics are readily available without a prescription, patients will misuse the drug, which contributes to the rise of resistant strains of bacteria. Not only that, but researchers found that the mean delivery time for internet-order antibiotics was eight days, which means infections have already worsened or cleared up by the time the buyer receives the shipment.

Beyond the internet, it’s estimated that 30% of migrant workers are buying antibiotics without prescriptions from corner stores that are trafficking them illegally. There needs to be a larger crackdown on illegal sales of these drugs if we want to preserve the effectiveness of existing antibiotics. If researchers can easily buy prescription antibiotics online from multiple sources, then clearly not enough has been done to deter the sellers from continuing the practice.

Read about this issue further in this news story.

Idea #145 for July 13th, 2009: One Step Closer or FDA Urging Ban On Antibiotics In Livestock

Today the principal deputy commissioner of food and drugs, Dr. Joshua Sharfstein, recommended the banning of antibiotics for use in healthy livestock. He also said farmers should only be able to administer antibiotics to animals under the supervision of a veterinarian. Sharfstein and the FDA are backing a bill introduced by Representative Louise Slaughter that would ban seven classes of antibiotics from being used on livestock.

Possibly 70% of antibiotics in this country are used on farms, and often on healthy animals as a means of prevention. But using antibiotics in this fashion also breeds resistant strains of bacteria, and those pathogens can end up in our food supply. Farm lobbies will certainly resist any attempt to change the law, which is unfortunate. They argue that antibiotics keep the animals healthier and safer for us to consume. The European Union effected a similar ban years ago, though, and their animals have not become less healthy. Hopefully, this bill will pass because it will not only improve our food safety, but it will also improve the effectiveness of antibiotics we need to use on humans.

For more coverage see these two news stories.

Idea #87 for May 16th, 2009: Free is Not Always a Good Thing or Pharmacies Giving Away Free Antibiotics

Since the onset of the current recession, some companies started offering incentives or freebies to customers to ease their financial burden. Pfizer, for instance, is providing free drugs to existing patients who have lost their job this year, as mentioned in yesterday’s post. But giveaways are not always the great help they may seem.

The New York Times points out that several large pharmacy chains are offering free antibiotics to patients, provided they have a prescription. On the surface, it seems like a generous offer to patients struggling to make ends meet, but the program could have some negative effects. For one, the CDC has concerns that free antibiotic programs can drive patients to put pressure on doctors to prescribe the drugs unnecessarily. Also, offering free antibiotics may create the perception that they are to be taken lightly — in other words, that the prescription of antibiotics is not a serious matter.

All of this contributes to the problem of antibiotic resistance, which occurs when antibiotics are over- or mis-prescribed, and when they are not taken for the full duration of treatment. There is a push on the behalf of some infectious diseases advocacy groups to get pharmacies to promote antibiotic education alongside antibiotic giveaways. That seems like a perfectly reasonable step. While pharmacies should continue to help patients with drug costs, they should do so in a way that makes patients aware of the dangers of misusing antibiotics.

Read the story in the NY Times here.