antibiotics
mikethemadbiologist | December 22, 2006At a recent conference I attended (pdf file), one speaker (Dominique Monnet) presented a very interesting observation about the relationship between the number of different antibiotics available and the amount of antibiotics prescribed.
Quite simply, as the number of potential competiting drugs increases, the amount of drugs prescribed increases:
(from here; the y-axis is the number of daily doses per 1000 residents)
There are at least two reasons for this pattern:
1) Advertising aimed at doctors and hospitals is more likely to increase use simply because doctors will be influenced to use…
mikethemadbiologist | December 20, 2006At a recent conference (pdf), I heard Dr. Rebecca Roberts describe the economic cost of antibiotic resistant infections at Cook County's Stroger Hospital. In a nutshell, it's terrifying.
The average cost per patient at that hospital is $10,000. The cost of treating an antibiotic resistant infection excluding acute respiratory infections ('ARI')--this does not include the average cost of antibiotic sensitive infections--is $1,934. That is, of the $10,000 average cost, $1,934 goes to 'subsidize' the cost of antibiotic resistant infections. The $1,934 figure is the low estimate: the average…
mikethemadbiologist | December 19, 2006...or at least, I was mentioned in Cell. Currently, we have very few new antibiotics in the pipeline, particularly for Gram-negative bacteria such as Acinetobacter. One of the things I'm involved with is a project to develop a not-for-profit screening library to find new antibiotics. From Cell:
Resistance of microbial pathogens to an increasing number of antibiotics is a serious problem. In the US alone, 90,000 people die every year from infections acquired while in the hospital. According to the Infectious Disease Society of America (IDSA), 70% of these deaths have been attributed to…
mikethemadbiologist | December 17, 2006Well, we do it for narcotics. From Yahoo News:
International experts debated whether antibiotics merit a separate regulatory drug category at a World Congress held on December 11 and 12 at the Hyatt Regency Boston Hotel. "We proposed this drastic action because antibiotic resistance is undermining infectious disease treatment worldwide and many large pharmaceutical companies are leaving the antibiotic field," explains Stuart B. Levy, MD, a Tufts Medical School professor and president of APUA, the global public health organization convening the meeting. Pharmaceutical companies spend an…
mikethemadbiologist | December 16, 2006In the past week, over 400 students and teachers in the Boston area have contracted norovirus, which causes nausea, vomitting and diarrhea:
"In close settings like a school or a nursing home or a family, the failure to adequately follow good hygiene will manifest itself with spread of this type of disease," said Dr. Bela Matyas of the Massachusetts Department of Public Health.
At Simmons, the outbreak traveled swiftly, although it was not concentrated in any single location, said Dr. Kay Petersen , medical director of the college's health center. To stem the spread, e-mails were sent to…
mikethemadbiologist | December 15, 2006I was recently at a conference (pdf file) where one speaker (Dr. Thomas O'Brien) suggested 'VRSA hospital insurance' to prevent the spread of vancomycin resistant Staphylococcus aureus outbreaks ('VRSA'). Before I get into the plan, let's talk about VRSA.
VRSA are staphylococci which are not only resistant to vancomycin, which is one of the last effective drugs against methicillin resistant Staphylococcus aureus ('MRSA'), but are also resistant to most (or usually) all other available antibiotics. While tigecycline can be used to treat some infections (skin and abdomindal), it is not used…
mikethemadbiologist | December 7, 2006I know with a war on, the using of the Constitution for toilet paper, and so on, this concern of mine is trivial, but it is so very symbolic. By way of digby, we find out that the White House sells hand soap. And, you guessed it, it contains triclosan. Really. Why don't they just put cadmium in it? It would be so much faster. What morons.
mikethemadbiologist | December 5, 2006In Las Vegas, the SEIU nurses were recently locked out during contract negotiations (they're back to work now). The nurses don't want pay increases or better benefits, but a lower patient-to-nurse ratio. Universal Health Services, the for-profit hospital chain, claims the nurses are trying to expand the union membership. The nurses claim that they simply want to improve patient care. Regardless of the motives involved, there is one indisputable fact: having fewer patients per nurse decreases the likelihood that a patient will become infected while in the hospital.
I've blogged about…
mikethemadbiologist | December 5, 2006I've posted before about the possible approval of cefquinome in agriculture, and why this is a stupid thing to even consider. So some colleagues and I got cranky and wrote a letter to the FDA.
Here's the letter:
Andrew C. von Eschenbach, M.D.
Acting Commissioner
U.S. Food and Drug Administration
5600 Fishers Lane,
Rockville MD 20857-000
Dear Acting Commissioner von Eschenbach,
We are writing to support the recommendation of the VMAC to reject and not approve the use of cefquinome, a fourth-generation cephalosporin antibiotic, for use in animal agriculture. One area that is critical in…
mikethemadbiologist | December 4, 2006The story about Kenyan religious leaders who are attempting to stifle evolutionary biology at the Kenyan National Museum is making the rounds of the progressive political blogs (interesting, how the right-wing blogs aren't covering this...). Within this story, there is a real tragedy: Kenya has a serious problem in treating certain types of bacterial dysentery due to the evolution of antibiotic resistance.
sporte | November 29, 2006What's the difference between a synthetic drug and an antibiotic?
Sometimes there's no difference at all.
Let's take a look at chloramphenicol and couple of pencillins.
Chloramphenicol kills many different kinds of bacteria by interfering with their ability to make new proteins. Here's a point where language gets tricky. Originally, chloramphenicol was isolated and purified from Streptomyces (a kind of bacteria). But, chloramphenicol is small and chemists are able to synthesize it. So even though we consider antibiotics to be natural products, they don't have to be made in a "natural…
sporte | November 28, 2006Antibiotics are molecules of biological warfare.
Produced by bacteria and some fungi, in response to extracellular signals, antibiotics represent a diverse group of compounds that inhibit bacterial growth at different points and different stages of the life cycle.
We will get around to antibiotic resistance, but in these few words, I think I already wrote quite a bit. Admittedly, some of these ideas need a bit of chewing, if they are to be properly digested. Already, I can imagine hands raised and questions waiting to be asked.
What are antibiotics made of?
I'm confused about this idea…
sporte | November 27, 2006A few years ago, I heard an interesting thing from another mother when I picked my oldest daughter up from daycare. The other mother was suffering from a head cold and confessed to me her fear that she had become "antibiotic resistant."
I found this statement pretty funny at the time, especially since I was teaching microbiology to college students.
Over the years, though, the joke quit being funny. Now I suspect that the worry voiced by the "antibiotic resistant" mother is shared by many people. It should also be noted that my anxious friend is an educated professional and at the time,…
mikethemadbiologist | November 26, 2006As a part of the Carnival of the Liberals, I wrote a post about our failing political discourse. Here's something related from the archives.
In an excellent post on news reporting, Thoughts from Kansas writes (italics mine):
The same thing is a major part of the ongoing creationism battles. A good reporter with a background in science would not feel obliged to go to a scientist and get a quote to balance a story about creationists. Nor would such a reporter feel obliged to troll the waters for some bottom-feeding creationist to "balance" some claim about actual science.
But that's what many…
mikethemadbiologist | November 25, 2006One topic that I don't discuss enough is the role that the agricultural use of antibiotics plays in the evolution (and ecology) of antibiotic resistance. A recent review in Clinical Microbiology and Infection describes how the illegal use of nitrofuran antibiotics in Portugese agriculture led to an increase in highly virulent Salmonella.
What are nitrofurans? There are several different nitrofuran antibiotics (furazolidone, nitrofurazone, and nitrofurantoin), but the one drug some readers might have heard of (or taken) is nitrofurantoin, which is used to treat urinary tract infections, in…
mikethemadbiologist | November 24, 2006Here's some follow-up thoughts on my Salmonella-related moment of fame that I reposted yesterday
So while on vacation, I was mentioned in a NY Times article about diseases that can be caught from your fish tank. The moral of the story is when cleaning your fish tank, pretend it's toilet water, clean everything including the sink that comes in contact with the aquarium water, and you'll be fine. (Here's the Emerging and Infectious Disease article that led to the NY Times story).
I'm happy with the coverage: the issue of antibiotic resistance needs it. But one important message-that…
mikethemadbiologist | November 23, 2006Ok, so after complaining about how no one reads my posts on antibiotic resistance, one reader read this post about the FDA overriding an expert panel that advised against using cefquinome in agriculture, and then went and read the recently released minutes of the hearing (all eight gajillion pages). Here's what the director of the Center for Veterinary Medicine of the FDA said (p. 211; italics mine):
And so from the FDA standpoint, what we did was we said to the company after vetting it through the VMAC, that you will be judged -- the microbial safety of your product will be judged based on…
mikethemadbiologist | November 22, 2006While I'm hardly the first blogger to ever wonder about what the bloggysphere likes and dislikes, I'm curious to find out if anyone actually reads the posts about antibiotic resistance.
Typically, I get the occasional comment or email from someone who has suffered personally from these infections. But other than that, I don't get many site hits or comments (this post was one exception). Mind you, this won't stop me from commenting on this problem, but I still wonder: does anyone actually read this stuff? Would there be issues related to this topic people would like to hear about?
Because…
mikethemadbiologist | November 16, 2006A few weeks ago, an FDA expert panel by a vote of 6-4 decided against the approval of the use of the antibiotic cefquinome in cattle. Unfortunately, I've heard through the grapevine that the political appointees at the FDA plan to overrule the expert panel and approve the use of cefquinome. The chairman of the panel is under pressure to alter the panel's findings, and the FDA has not posted the minutes of the meeting, which is apparently required by law.
About the post title: cefepime, like cefquinome, is what is known as a fourth-generation cephalosporin antibiotic. While cefquinome is…
mikethemadbiologist | November 14, 2006...then what we think makes community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) so infectious might be wrong. A to-be published article in the Journal of Infectious Diseases (Dec. 15) asks "Is Panton-Valentine Leukocidin the major virulence determinant in community-associated methicillin-resistant Staphylococcus aureus disease?" Before everyone wanders off due to boredom, let me translate: we don't really understand how CA-MRSA can kill you.
The study, conducted by Jovanka Voyich and colleagues, examined the assumption that the Panton-Valentine Leukocidin toxin ('…