Coming To An Airplane Near You …
Posted by WhiteCoat on May 7, 2008
There was an “international uproar” when Andrew Speaker flew on an airplane after allegedly being told that he had drug resistant tuberculosis. Several passengers on the plane with him have since sued him for damages. Later, Speaker decided to have the diseased portion of his lung removed through surgery in order to treat the infection.
This article published yesterday by the Chicago Tribune shows how much we’re losing the battle against the bugs.
“Extremely drug resistant” TB now has a 50% mortality (death) rate. Andrew Speaker was a healthy 31 year old attorney when he found out he had the disease. The Tribune article described one 2006 World Health Organization report of a South African community where 52 out of 53 patients with this form of tuberculosis died. As in 98% mortality rate.
The Chicago Tribune article also states that “newly emerging strains of MRSA are causing life-threatening infections in otherwise healthy people.”
Those who regularly read this blog know that one of my peeves is when patients demand — and when doctors prescribe — antibiotics for viral illnesses or for illnesses upon which antibiotics have little or no effect. We’re prescribing so many antibiotics that the bacteria aren’t killed by them. Instead, some bacteria which are closely related to human pathogens now “eat the antibiotics for breakfast.”
How do these bugs develop?
If you have TB, only take your tuberculosis medications for a couple of months and then stop because you feel better. The bacteria you don’t kill then learn how to defeat the medications. You create stronger bacteria that will later kill you and have the possibility of infecting those who have been in repeated close contact with you.
If you’re talking about antibiotics, take amoxicillin, Zithromax, Levaquin, or some other random antibiotic that is of no benefit for your cough, runny nose, sinus congestion, or other random viral infection. The bacteria in your system will eventually learn how to resist the effects of the antibiotics. Later when you get MRSA, there will be few, if any, antibiotics left to treat you.
First it’s “flesh-eating” bacteria. Now it’s “antibiotic-eating” bacteria.
We are so screwed.
SeaSpray said
This is unnerving!
I had developed an e-coli infection back in 06 when I had the large stent in me. I became resistant to the various antibiotics he gave me and so the stent had to come out a month early. Levaquin was one of them. I had to be admitted prior to the stent removal so I could be given and IV but the name of the med escapes me at the moment. Although, it was one that you have written about as being questioned for use now… although you docs like it and it worked on me.
Does the immunity to the antibiotic ever go away? Or is Levaquin something that shouldn’t be used if I am resistant?
The doctor showed me the lab report but I never thought to ask him about it at the time.
So I am wondering is it a matter of “once resistant-ALWAYS resistant or are there exceptions?
If he knew he had TB… then why in the world did he get on the plane???!
Stephen said
It is not just antibiotics. I am trying to provide education/training within our industry (in NZ) for the use of antheminthics to treat internal and external parasites in ruminants. We just did a national survey of our association memebership, and found that nearly 40% of respondants were systematically under-dosing their animals. (which is of course one of the best ways to select for resistant strains)
And people wonder why resistance rates are soaring? I talked to one vet in the South Island who had to tell a farmer-clinet that he was “done”, and could not raise sheep anyone, as he had 90%+ resistance to all three families of drench on his farm.
When people look back at the 20th century they may mourn the loss of antibiotics (and other similar chemical treatments) more than they mourn the loss of oil or forests.
EE said
“We are so screwed.”
Yup.
SeaSpray said
I have to believe it will all work out and something better will come along….perfect world and all that
MM said
Devil’s advocate here… We can’t get antibiotics without a prescription, can we?
Another case of the “he made me do it” syndrome maybe?
You’re right – it’s a problem with unreasonable expectations and with doctors that don’t practice evidence-based medicine. At least in the US. Mexico is a different story.
Educating everyone is important. I also liked the idea of making antibiotics a controlled substance.
MM said
And another thing…
Why can’t you use some of your strong, assertive stance against the drug seekers with the antibiotics seekers too? Uh?
Becky said
Start talking to Peds. They drop antibiotics like candy. Now my kids can’t use any of the common drugs. I’ve learned a lesson a bit too late:(
Coming soon to a rant near you! Stay tuned …
Tex said
Try telling a worried mom that her sick child has a virus and doesn’t need antibiotics.
It’s a customer-care issue.
‘It won’t help, but it won’t hurt.’
Like hell it won’t!
lunafuriae said
Hey, maybe George Carlin is right……we have no defenses these days.
Beach Bum said
In some cases, bacteria can lose their antibiotic resistance. It depends on how they acquired the gene. If the gene that makes it resistant to an antibiotic is contained on a tiny piece of DNA called a plasmid, over time (with many generations) and with no reintroduction of that antibiotic, it’s possible that the bacteria will stop reproducing the plasmid and become susceptible to that particular antibiotic again. If I remember correctly, this process is called “curing.”
But if the antibiotic resistance gene is actually incorporated into the bacteria’s main genome, then it will always be resistant to that particular antibiotic.
The curing phenomenom suggests that if doctors rotate the classes of antibiotics they use in an individual, they can help keep the plasmids at a low level.
Madrocketscientist said
Picking a nit here
Bacteria don’t learn, they evolve.
Point taken. Just using the same language I harp on my patients with.
We Are So Screwed « Ten out of Ten said
[...] Posted by Ten out of Ten under ER, Life, Medicine Says Whitecoat, ranting about the indiscriminate use of antibiotics, and I couldn’t agree more. In the last five years I’ve seen cipro transform from a [...]
Dimitrios Matthaiou said
I would also like to point out another important aspect. Some colleagues support that emergence of resistance may lead to loss of virulence, i.e. the resistant bugs are not so aggressive and life-threatening, because these mutations are not”survival-effective”. However, there are data supporting the exact opposite; namely, resistant bacteria further mutate and these “compensatory mutations” lead to resistant bacteria which are as virulent as before the emergence of resistance.
On the bottom line, STOP PRESCRIBING ANTIBIOTICS WITHOUT A REASON! The burden of being a doctor is much bigger than many of us deem it to be…
Aaron in Florida said
Woo-hoo…. We’ve got a MRSA/VRSA case at my hospital right now… I’ve never seen that many warning signs! Bring on the Zyvox!
Jessica said
MM-
lawsuit in an extremely inlikely case?
mottsapplesauce said
This is scary stuff. And word is the avian flu has reared it’s ugly head again….
rogue medic said
Avian flu has not gone away. We have been lucky that it has not been easily spread. With SARS there were people stockpiling antiviral medications, just as with the anthrax scare there were people stockpiling Cipro.
Access to antibiotics should be severely restricted. There is no good reason why these should not be controlled substances with long prison sentences for the criminals.
The doctor who says, “If I don’t give them antibiotics, they will only go to someone who will,” is only using the same excuse as the corner drug pusher and should not be treated any better. These doctors are probably doing far more damage than the street corner drug dealers.
My experience has been that the doctors write a prescription even if you tell them you don’t want one. Patients tell me the same thing.
Another problem is doctors writing for Levaquin in spite of contraindications.
Unfortunately, none of this is new.
Joan S said
The administering of antibiotics to 85-100 yr. olds in nursing homes (often times indefinitely) and often times without notification of the family is a problem I’ve encountered.