A recent article that examined the relationship between antibiotic use and antibiotic resistance in Finland made me realize one very sad fact: what is easy to do in Finland is nearly impossible in the U.S. because we lack a national healthcare system (note: I'm not talking about how healthcare is paid for which is an argument about reimbursement, but a uniform system of record keeping and informatics protocols).
Consider this from the introduction (italics mine; citations removed for clarity):
According to current Finnish care recommendations, the first-line antimicrobial agents for the treatment of uncomplicated cystitis are trimethoprim, pivmecillinam, nitrofurantoin, or a fluoroquinolone. Cephalexin (cefalexin) or cefadroxil, trimethoprim-sulfamethoxazole, and amoxicillin (amoxicilline) are recommended for use as second-line drugs. In Finland, 32% of UTIs are treated with trimethoprim, 18% with pivmecillinam, 16% with nitrofurantoin, and 16% with fluoroquinolones .
We have no way reliably determining use for various infections. We have estimates from a few hospitals, but the entire country's data? Are you kidding. Then there was this (italics mine):
A total of 754,293 E. coli isolates were tested for antimicrobial resistance in Finland during a 9-year study period from 1997 through 2005. The number of isolates tested in each central hospital district per year varied from 144 to 44,645, with the median being 3,625. Approximately 90% of the isolates were from urine samples. The isolates were from both hospitals and outpatient clinics. With the aid of computerized data management systems, all laboratories reported only one isolate per patient each year.
Sigh.
I hope healthcare overhaul involves the standardization of record keeping so we understand what all of this medical shit actually does. That requires movement to uniform electronic record keeping.
And if the Finns can do it, why can't we?
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The results of the study probably deserve some sort of comment too.
They found no strong association between use and antibiotic resistance.
This is interesting from an evolutionary perspective since, despite antibiotic resistance being a frequent example of micro-evolutionary change associated with simple antibotic use and microbial point mutation there is growing evidence that a lot of the resistance is acquired through horizontal gene transfer. The widespread use of antibiotics in agriculture is a likely culprit in this regard as it allows the selection for bacteria with multiresistance plasmids that subsequently get transferred to agents pathogenic for humans. In the long term, to prevent the spread of multiresistance, it might be better to concentrate on stopping agricultural misuse rather than simply telling patients to follow their entire course of medication.
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In the long term, to prevent the spread of multiresistance, it might be better to concentrate on stopping agricultural misuse
nice..