Honey Helps Problem Wounds: "Medihoney" Is Often More Effective Than Antibiotics

A household remedy millennia old is being reinstated: honey helps the treatment of some wounds better than the most modern antibiotics. For several years now medical experts from the University of Bonn have been clocking up largely positive experience with what is known as medihoney. Even chronic wounds infected with multi-resistant bacteria often healed within a few weeks. In conjunction with colleagues from D�sseldorf, Homburg and Berlin they now want to test the experience gained in a large-scale study, as objective data on the curative properties of honey are thin on the ground. The fact that honey can help wounds to heal is something that was known to the Ancient Egyptians several thousand years ago. And in the last two world wars poultices with honey were used to assist the healing process in soldiers' wounds. However, the rise of the new antibiotics replaced this household remedy. 'In hospitals today we are faced with germs which are resistant to almost all the current anti-biotics,' Dr. Arne Simon explains. 'As a result, the medical use of honey is becoming attractive again for the treatment of wounds.' Dr. Simon works on the cancer ward of the Bonn University Children's Clinic. As far as the treatment of wounds is concerned, his young patients form part of a high-risk group: the medication used to treat cancer known as cytostatics not only slows down the reproduction of malignant cells, but also impairs the healing process of wounds. 'Normally a skin injury heals in a week, with our children it often takes a month or more,' he says. Moreover, children with leukaemia have a weakened immune system. If a germ enters their bloodstream via a wound, the result may be a fatal case of blood poisoning. For several years now Bonn paediatricians have been pioneering the use in Germany of medihoney in treating wounds. Medihoney bears the CE seal for medical products; its quality is regularly tested. The success is astonishing: 'Dead tissue is rejected faster, and the wounds heals more rapidly,' Kai Sofka, wound specialist at the University Children's Clinic, emphasises. 'What is more, changing dressings is less painful, since the poultices are easier to remove without damaging the newly formed layers of skin.' Some wounds often smell unpleasant - an enormous strain on the patient. Yet honey helps here too by reducing the smell. 'Even wounds which consistently refused to heal for years can, in our experience, be brought under control with medihoney - and this frequently happens within a few weeks,' Kai Sofka says. In the meantime two dozen hospitals in Germany are using honey in their treatment of wounds. Despite all the success there have hitherto been very few reliable clinical studies of its effectiveness. In conjunction with colleagues from D�sseldorf, Homburg and Berlin, the Bonn medical staff now want to remedy this. With the Woundpecker Data Bank, which they have developed themselves, they will be recording and evalu-ating over 100 courses of disease over the next few months. The next step planned is comparative studies with other therapeutic methods such as the very expensive cationic silver dressings. 'These too are an effective anti-bacterial method,' says Dr. Arne Simon. 'However, it is not yet clear whether the silver released from some dressings may lead to side-effects among children.' Effective bacteria killer It has already been proved that medihoney even puts paid to multi-resistant germs such as MRSA. In this respect medihoney is neck and neck in the race to beat the antibiotic mupirocin, currently the local MRSA antibiotic of choice. This is shown by a study recently published by researchers in Australia. In one point medihoney was even superior to its rival: the bacteria did not develop any resistance to the natural product during the course of treatment. It is also known today why honey has an antiseptic effect: when producing honey, bees add an enzyme called glucose-oxidase. This enzyme ensures that small amounts of hydrogen peroxide, an effective antiseptic, are constantly being formed from the sugar in the honey. The advantage over the hydrogen peroxide from the chemist's is that small concentrations are sufficient to kill the germs, as it is constantly being produced. As a rule much larger quantities of hydrogen peroxide would have to be used, as hydrogen peroxide loses its potency over time. However, in large concentrations it not only damages the bacteria, but also the skin cells. Furthermore, medihoney consists of two different types of honey: one which forms a comparatively large amount of hydrogen peroxide, and another known as 'lepto-spermum honey'. Leptospermum is a species of tree which occurs in New Zealand and Australia. Honey from these trees has a particularly strong anti-bacterial effect, even in a 10% dilution. 'It is not yet known exactly why this is,' Dr. Arne Simon says. 'Probably it is a mix of phenol-type substances which come from the plant and make life particularly difficult for the bacteria in the wound.'

Fewer Heart Patients Need Antibiotics Before Dental Procedures

Based on a review of new and existing scientific evidence, most dental patients with heart disease do not need antibiotics before dental procedures to prevent infective endocarditis (IE), a rare, but life-threatening heart infection.According to revised guidelines from the American Heart Association (AHA) with input from the American Dental Association (ADA), antibiotics are now only recommended for patients at greatest risk of negative outcomes from IE including those with artificial heart valves or certain congenital heart conditions, heart transplant recipients who develop cardiac valve problems, recipients of an artificial patch to repair a congenital heart defect within the past six months and patients with a history of IE.The AHA's latest guidelines were published in its scientific journal, Circulation, in April. The Guidelines apply to a range of medical and dental procedures. The ADA is publishing those portions of the new guidelines relevant to dentistry on its Web site (http://www.ada.org/goto/endocarditis) today and in the June issue of the Journal of the American Dental Association (JADA).For decades, the AHA recommended that patients with certain heart conditions take antibiotics shortly before dental treatment. This was done with the belief that antibiotics would prevent IE, previously referred to as bacterial endocarditis. IE is an infection of the heart's inner lining or valves, which results when bacteria enter the bloodstream and travel to the heart. Bacteria are normally found in various sites of the body including on the skin and in the mouth.The ADA participated in the development of the new guidelines and has approved those portions relevant to dentistry. The guidelines are also endorsed by the Infectious Diseases Society of America and by the Pediatric Infectious Diseases Society.The new guidelines are based on a growing body of scientific evidence that shows the risks of taking preventive antibiotics outweigh the benefits for most patients. The risks include adverse reactions to antibiotics that range from mild to potentially severe and, in rare cases, death. Inappropriate use of antibiotics can also lead to the development of drug-resistant bacteria.Scientists also found no compelling evidence that taking antibiotics prior to a dental procedure prevents IE in patients who are at risk of developing a heart infection. Their hearts are already often exposed to bacteria from the mouth, which can enter their bloodstream during basic daily activities such as brushing or flossing. The new guidelines are based on a comprehensive review of published studies that suggests IE is more likely to occur as a result of these everyday activities than from a dental procedure.The guidelines say patients who have taken prophylactic antibiotics routinely in the past but no longer need them include people with mitral valve prolapse, rheumatic heart disease, bicuspid valve disease, calcified aortic stenosis, or congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.The new recommendations apply to many dental procedures, including teeth cleaning and extractions.The guidelines emphasize that maintaining optimal oral health and practicing daily oral hygiene are more important in reducing the risk of IE than taking preventive antibiotics before a dental visit.

Tailor-made Antibiotics, Protein Clue

Scientists at the University of York have made a huge leap forward in the search for 'smarter' antibiotics. A research group in the Department of Biology has made a significant advance in understanding how bacteria use proteins to conduct a type of biological warfare. Bacteria like E. coli frequently try to kill each other when resources are scarce using protein antibiotics called colicins, which are potent toxins. The research led by Professor Colin Kleanthous has discovered a critical element in the mode of action of a class of colicins (so-called DNases) that kill cells by destroying their DNA. Though most proteins have a folded structure, DNase colicins are only partially so. The scientists have found that the unfolded part of DNase colicin structure makes its way into an unsuspecting bacterium and blocks a key process that lowers the cell's defences and allows the toxin to enter. Professor Kleanthous said: "Antibiotic resistance is on the increase throughout the world. Understanding how bacteria have evolved to kill each other with protein toxins might offer ways of constructing new, tailor-made antibiotics that target particular microorganisms." Researchers are now trying to establish what it is about this blocking mechanism (which they've christened 'competitive recruitment') that lowers the cells' defences toward the colicin.

Controlling Antibiotics And Antibiotic Resistance In Hospitals

In one of the first national studies on guidelines that control antibiotics and antibiotic resistance in hospitals, researchers from the Indiana University School of Medicine, the Regenstrief Institute, Inc. and the Richard Roudebush Veterans Administration Medical Center report that hospitals that follow national guidelines on controlling antibiotic use have lower rates of antibiotic resistance. In a study published in the October issue of Infection Control and Hospital Epidemiology, the researchers studied four major types of antibiotic resistance at almost 450 hospitals, looking at what each hospital did to control antibiotic use and how this affected the rate of antibiotic resistance. "We saw in this study, as in other work we have done, that antibiotic resistance is increasing rapidly. This increase is seen in all types of hospitals across the country - large and small, teaching and non-teaching, VA and non-VA," said Bradley N. Doebbeling, M.D., M.Sc., who led the study. He directs the IU Center for Health Services and Outcomes Research at the Regenstrief Institute and the IU School of Medicine. He also directs the VA Center for Implementing Evidence-Based Practice. The study looked at measures to prevent development of antibiotic resistance as well as ways to stop its spread. The researchers reported that if hospitals implemented specific measures to control the use of antibiotics they were more likely to have succeeded in controlling antibiotic resistance. Surprisingly, use of information technology didn't seem to have an impact. "We think that's because so few hospitals have the necessary technology available to support decisions related to prescribing antibiotics such as start and stop rules and how to use the best drug," said Dr. Doebbeling. Prescription of antibiotics fall into three categories (1) preventive, often administered before or during surgery; (2) empiric - prescribed before the physician knows the specific nature of the bacteria; and (3) targeted - prescribed after bacterial culture results identify the bacteria actually causing the infection. The study found that if a hospital had implemented measures to control the duration of administration of an empiric antibiotic, the institution had lower antibiotic resistance rates. Having a restricted hospital formulary that limited the antibiotics available in the hospital was associated with a higher prevalence of antibiotic resistance, while simply limiting broad spectrum drugs helped prevent resistance. "We think this may be because wrong decisions are made about which antibiotics are made available. Other studies have shown evidence that restricting formularies to previously effective antibiotics can actually help control antibiotic resistance," said Dr. Doebbeling.

Are Antibiotics Being Used For Too Long?

Taking antibiotics for three days is just as effective for community acquired pneumonia as continuing treatment for the recommended 7-10 days, finds a study in this week's BMJ. Shorter treatment can also help contain growing resistance rates. The study raises questions about the optimal duration of antibiotic therapy for common infections. Community acquired pneumonia is one of the most important indications for antibiotic prescriptions in hospitals. But a lack of evidence to support short course therapy means it has become accepted practice to continue treatment for days after symptoms have improved. Researchers in the Netherlands compared the effectiveness of discontinuing treatment with amoxicillin after three days or eight days in adults admitted to hospital with mild to moderate-severe community acquired pneumonia. 119 patients who substantially improved after the conventional three days' treatment with intravenous amoxicillin were randomly assigned to oral amoxicillin (63 patients) or placebo (56 patients) three times daily for five days. Patients were assessed at days 7, 10 (two days after treatment ended), 14, and 28. In the three day and eight day treatment groups, the clinical success rate at day 10 was 93% for both, and at day 28 was 90% compared with 88%. Both groups had similar resolution of symptoms, x-ray results, and length of hospital stay. These findings show that discontinuing amoxicillin treatment after three days is not inferior to discontinuing it after eight days in adults with mild to moderate-severe community acquired pneumonia who have substantially improved after an initial three days' treatment, say the authors. A shorter duration of treatment can also help to reduce overall antibiotic consumption and resistance rates for respiratory infections, they conclude. This study suggests that current guidelines recommending 7-10 days should be revised, says Dr John Paul from the Royal Sussex County Hospital, in an accompanying commentary. Not only does the study yield strong evidence in favour of short course therapy for a subset of patients with community acquired pneumonia, but also shows how centres can cooperate to tackle longstanding areas of uncertainty in clinical microbiology and infectious diseases, he writes. Many other common clinical situations would repay the efforts of comparable approaches.

Targeted Antibiotics Lead To Prolonged Improvement In IBS Symptoms

Researchers at Cedars-Sinai Medical Center have found that a nonabsorbable antibiotic - one that stays in the gut - can be an effective long-term treatment for irritable bowel syndrome (IBS), a disease affecting more than 20 percent of Americans.The study, which appears in the October 17 issue of the Annals of Internal Medicine, is the first to demonstrate benefits from antibiotic use even after the course of treatment has ended, supporting previously published research that identified small intestine bacterial overgrowth as a cause of the disease.The randomized, double-blind, placebo-controlled study involved 87 participants, all of whom met specific multinational guidelines for diagnosis of IBS. They received 400 mg of the antibiotic rifaximin three times a day for 10 days or a placebo. Participants completed an extensive symptom questionnaire at the start of the study and then weekly for 10 weeks following treatment. The questionnaire measured the severity of nine symptoms (abdominal pain, diarrhea, constipation, bloating, urgency, incomplete evacuation, mucus, sense of incomplete evacuation, and gas). Patients were also asked to provide a percent global improvement from 0 to 100 percent in their overall IBS symptoms.Researchers found that the rifaximin not only led to significant improvement in global IBS symptoms during the 10 days it was administered, but also that the benefit continued for the 10 weeks of follow up when no antibiotic was given, showing sustained benefit."The fact that the benefit of the targeted antibiotic continued even after it was stopped provides evidence that the antibiotic was acting on a source of the problem: excess bacteria in the gut," said Mark Pimentel, M.D., director of the GI Motility Program at Cedars-Sinai and the study's principal investigator. "This finding offers a new treatment approach - and a new hope - for people with IBS."Irritable Bowel Syndrome is one of the top 10 most frequently diagnosed conditions by U.S. physicians. It is an intestinal disorder that causes abdominal pain, cramping, bloating and diarrhea and/or constipation and is a long-term condition that usually begins in early adult life. Episodes may be mild or severe and may be exacerbated by stress. IBS is more common in women than in men."While this study being released today demonstrates that the non-absorbed antibiotic rifaximin has great promise in the clinical improvement of IBS, more research is needed," said Pimentel. "Next steps include multi-center studies to further assess short- and long-term benefits of this drug. Tests comparing rifaximin to other types of antibiotics that have been used to treat the disease should also be conducted."Because the cause of IBS has been elusive, treatments for the disease have historically focused on reducing its symptoms - diarrhea and constipation - by giving medications that either slow or speed up the digestive process. In The American Journal of Gastroenterology (Dec. 2000), Pimentel linked bloating, the most common symptom of IBS, to bacterial fermentation by giving lactulose breath tests to participants. The test, which monitors the level of hydrogen and methane (the gases emitted by fermented bacteria) on the breath, showed evidence that small intestine bacteria overgrowth may be a causative factor in IBS.Participants in the current Annals study also took the breath tests, which showed similarly increased levels of hydrogen and methane.Rifaximin, an antibiotic that is FDA-approved for travelers' diarrhea in this country, is made by Salix Pharmaceuticals, Inc. Funding for the study was also provided by Salix. The discovery related to the use of rifaximin for IBS was made at Cedars-Sinai by Pimentel. Cedars-Sinai holds patent rights to this discovery and has licensed rights to the invention to Salix.Other authors from Cedars-Sinai include Sandy Park, James Mirocha, and Yuthana Kong. Sunanda V. Kane from the University of Chicago also participated in the study.

Antibiotic Resistant Bacteria In Poultry Could Threaten Human Health

A surprising finding by a team of University of Georgia scientists suggests that curbing the use of antibiotics on poultry farms will do little - if anything - to reduce rates of antibiotic resistant bacteria that have the potential to threaten human health. Dr. Margie Lee, professor in the UGA College of Veterinary Medicine, and her colleagues have found that chickens raised on antibiotic-free farms and even those raised under pristine laboratory conditions have high levels of bacteria that are resistant to common antibiotics. Her findings, published in the March issue of the journal Applied and Environmental Microbiology, suggest that poultry come to the farm harboring resistant bacteria, possibly acquired as they were developing in their eggs. "The resistances don't necessarily come from antibiotic use in the birds that we eat," Lee said, "so banning antibiotic use on the farm isn't going to help. You have to put in some work before that." Lee and her team sampled droppings from more than 140,000 birds under four different conditions: 1.) commercial flocks that had been given antibiotics; 2.) commercial flocks that had not been given antibiotics; 3.) flocks raised in a lab that had been given antibiotics; and 4.) flocks raised in a lab that had not been given antibiotics. The researchers examined levels of antibiotic resistance in normal intestinal bacteria that do not cause human illness and - in a companion study published in May in the same journal - also examined levels of drug resistant campylobacter bacteria, a common foodborne cause of diarrhea, cramping and abdominal pain. They found that even birds raised in the pristine laboratory conditions had levels of antibiotic resistance levels comparable to what was seen on farms that used antibiotics. Even when the levels were lower, Lee adds, they were still well above the reasonable comfort zone for antibiotic resistance - roughly five to 10 percent. Seventy-three percent of the bacteria from one flock in the antibiotic-free commercial group were resistant to the drug oxytetracycline, for example, while 90 percent were resistant to the drug in a commercial flock that used antibiotics. Ninety-seven percent were resistant in the experimental flock that was given antibiotics, while forty-seven percent were resistant in the experimental group that was not given antibiotics. Strikingly, they even found bacteria resistant to streptomycin, a common human antibiotic that is rarely used in poultry and was not used on the farms the researchers studied. Bacteria swap genes relatively easily, and Lee explained that the concern is that drug resistance genes from bacteria that infect poultry could be passed on to bacteria that cause human illness. With these resistance genes, human bacterial illness could become harder to treat. These concerns led the European Union to ban the use of antibiotics for growth promotion in chickens in 2006. In 2005, the U.S. Food and Drug Administration banned the use of the drug Baytril - the brand name for enrofloxacin, a fluoroquinolone antibiotic - in poultry, citing concerns that it could lead to resistance in human antibiotics such as Cipro, also a fluoroquinolone. Several advocacy groups are pushing for a more comprehensive animal antibiotic ban in the United States, but Lee said her research plus the evidence from the Baytril ban suggests that approach won't help. "They banned Baytril in 2005, and if you look at Baytril resistance in campylobacter now it's essentially unchanged," Lee said. In previous studies, Lee has tried to recreate experimentally conditions that should lead to the swapping of resistance genes among bacteria. Lee said these events - known as the horizontal transfer of genes - do occur, but they may not be as common as initially thought. What may be driving the antibiotic resistance that Lee has observed in her studies is what's known as vertical transfer - from parent to child - of bacteria carrying resistance genes. In short, the birds may come to the farm harboring antibiotic resistant bacteria. "This issue of antibiotic resistance is more complicated than once thought," Lee said. "These findings suggest that banning antibiotics at the farm level may not be as effective as assumed. We need further studies to identify which management practice would be effective" Lee stresses that for consumers, the advice on poultry is the same that it's always been. Cook meat thoroughly and use proper food handling and preparation techniques - washing your hands regularly and keeping other foods away from raw chicken, for example - to minimize the risk of illness. "All foods have the potential to contain pathogens - all of them," Lee said. "There's no substitute for good food handling and preparation."

Antibiotics Over-Prescribed By GPs

GPs are unnecessarily giving patients antibiotics for respiratory tract (RT) infections which would clear up on their own. Doctors tend to over-emphasise symptoms such as white spots in the throat, rather than looking at factors such as old age and co-morbidity, which would affect a patient's recovery, according to an article published in the online open access journal, BMC Family Practice.Huug J. van Duijn and his team at the Julius Center for Health Sciences and Primary Care from the University Medical Center Utrecht, The Netherlands, looked at the practice records of 163 GPs from 85 Dutch practices over a 12 month period, and carried out a survey of the doctors' attitudes to prescribing antibiotics for RT infections. Diagnostic labelling (the tendency to encode RT episodes as infections rather than as symptoms) seemed to be an arbitrary process, often used to justify antibiotic prescribing. GPs may give out antibiotics unnecessarily to defend themselves against unforeseen complications, even if these are unlikely to materialize.Although Dutch GPs prescribe relatively small antibiotic volumes and international colleagues often envy the quality assurance system in Dutch primary care with guidelines and peer review groups, Van Duijn suggests that the results of his study should be used to update quality assurance programs and postgraduate courses, to emphasise the use of evidence-based prognostic criteria (e.g. chronic respiratory co-morbidity and old age) as an indication to prescribe antibiotics instead of single signs of inflammation or diagnostic labels. "Even in the Netherlands there is an over-prescribing of antibiotics; about 50% of the antibiotic prescriptions for acute RT episodes are not in accordance with Dutch national guidelines," says van Duijn. "Considering costs, side-effects and the growing resistance to pathogens, it is important to rationalise antibiotic prescribing as much as possible."

Alternative To Antibiotics May Be More Effective And Less Harmful

Photodynamic therapy (PDT) may be an effective way to treat the bacteria associated with periodontal diseases, and could provide a better option than antibiotics or other mechanical methods for treating periodontal diseases, according to a new study published in the March issue of theJournal of Periodontology. Researchers at São Paulo State University found that using PDT was an effective method to minimize destruction of periodontal tissue which can accompany treatment for periodontal diseases. In a rat population, PDT did minimal damage to periodontal tissues, in comparison to other techniques including scaling and root planing and antibiotic therapy. "We found that PDT is significantly less invasive than other treatments for periodontal diseases," said study author Dr. Valdir Gouveia Garcia, from the Department of Periodontology at São Paulo State University. "It can provide improved dentin hypersensitivity, reduced inflammation of the tissues surrounding the teeth, and allows tissues to repair faster." PDT may be an alternative to antibiotic treatment, which is becoming increasingly important as antibiotic resistance increases. PDT involves two stages; first, a light-sensitive drug is applied to the area. Second, a light or laser is shone on that area. When the light is combined with the drug, phototoxic reactions induce the destruction of bacterial cells. PDT was first approved by the Food and Drug Administration in 1999 to treat pre-cancerous skin lesions of the face or scalp. "This is an exciting finding," said Preston D. Miller, Jr., DDS and President of the American Academy of Periodontology. "PDT may be an effective therapy for the treatment of periodontal diseases. While patients have many options for treating their periodontal diseases, PDT could prove to be a preferable alternative to antibiotic therapy. Unfortunately, long term antibiotic therapy not only decreases the drug's effectiveness, but also may lead to the development of drug resistant organisms. Our Academy supports future research to further define the application of PDT as a means to treat periodontal disease."

Research May Lead To New Classes Of Antibiotics

Scientists have what could be some very bad news for disease-causing bacteria. All three major classes of antibiotics that kill infectious bacteria do so in part by ramping up the production of harmful free radicals, researchers report in Cell a publication of Cell Press. Because those different types of antibiotics each initially hit different targets, it had been believed they worked by independent means. The findings could point the way to new classes of antibiotics and to a common method by which existing antibiotics could be made to stamp out bacteria even better, according to the Boston University researchers. Such advances are particularly critical at a time when, according to the Centers for Disease Control and Prevention, nearly all significant bacterial infections in the world are becoming resistant to the most commonly prescribed antibiotic treatments. "Hydroxyl radicals damage DNA, which turns on the S.O.S. repair response," said James Collins. "Therefore, our findings suggest that if you could shut off the bacteria's repair response, you might make all bactericidal antibiotics more effective and effective at lower doses. You could in essence create a super-Cipro, super-mycins, and so on." Current antimicrobial therapies fall into two general categories: (1) bactericidal drugs, which kill bacteria with almost complete efficiency, and (2) bacteriostatic drugs, which inhibit their growth, allowing the immune system to clear the infection, Collins's group explained. The targets of bactericidal antibiotics are well studied and predominantly fall into three classes: (1) those that hit DNA, (2) those that hit proteins, and (3) those that hit the bacterial cell wall. In contrast, most bacteriostatic drugs work by blocking the function of ribosomes, which are the sites of protein synthesis. While antibiotics' ability to kill bacteria had been attributed solely to those class-specific drug-target interactions, "our understanding of many of the bacterial responses that occur as a consequence of the primary drug-target interaction remains incomplete," the researchers said. Collins and his colleagues recently uncovered some evidence that at least some antibiotics might have some other deadly tricks. They showed that one type of antibiotics, including quinolones, which block DNA's replication and transcription into messenger RNA, also causes a breakdown that leads to the production of free radicals. Moreover, they found that those highly reactive chemicals help finish the bacteria off. In the new study, the researchers wanted to know whether other antibiotics also drive the toxic brew. Indeed, they show, drugs that kill bacteria all do cause a rise in free radicals, and all in the same manner. This is not so for drugs that only stunt bacteria's growth, they report. "The ever-increasing prevalence of antibiotic-resistant strains has made it critical that we develop novel, more effective means of killing bacteria," the researchers concluded. "Our results indicate that targeting bacterial systems that remediate hydroxyl radical damage, including proteins involved in triggering the DNA damage response… is a viable means of potentiating all three major classes of bactericidal drugs. Moreover, pathway analyses and systems biology approaches may uncover druggable targets for stimulating hydroxyl radical formation, which could result in new classes of bactericidal antibiotics."

APhA Calls For Appropriate Use Of Antibiotics - Pharmacists And Other Healthcare Professionals Can Educate The Public

The American Pharmacists Association (APhA), the national professional society of pharmacists, encourages patients to talk to their pharmacist and healthcare professional about proper antibiotic use, prevention of antibiotic resistance, and appropriate infection control. Tens of thousands of deaths and an estimated 1 million hospital infections are blamed on antibiotic resistant bacteria each year. According to an article in the October 17, 2007 issue of the Journal of the American Medical Association (JAMA), inappropriate and overuse of antibiotics is a major contributing factor to the development of antibiotic resistant bacteria. "Pharmacists, as the medication use specialists, have the knowledge and skills to assist with the selection and appropriate use of antibiotics," according to John Gans, APhA Executive Vice President. "The battle against drug-resistant infections requires a commitment by healthcare providers and patients to protect the public's health." Drug-resistant bacteria include methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, and resistant strains of Streptococcus pneumonia. Infections caused by MRSA appear to be more prevalent than previously believed and are being found more often outside of health care settings, according to the JAMA study. MRSA has become the most frequent cause of skin and soft tissue infections among patients presenting to emergency departments in the United States, and can also cause severe, sometimes fatal invasive disease. APhA, in accordance with the Centers for Disease Control and Prevention, recommends the following antibiotic use and infection prevention tips: Appropriate Antibiotic Use- Know how to take your medication. Complete prescribed courses of treatment (don't skip doses) even if you are feeling better. - Do not demand antibiotics when a health care provider has determined they are not needed. - Do not take antibiotics prescribed for someone else. The antibiotic may not be appropriate for your illness. Taking the wrong medicine may delay correct treatment and allow bacteria to multiply. - Do not save any antibiotics for the next time you get sick. Appropriately discard any leftover medication once you have completed your prescribed course of treatment. - Do not take an antibiotic for a viral infection like a cold, a cough or the flu. - Ask your pharmacist if you have questions about your medication therapy. Prevention of Infection- Be up-to-date on your immunizations. - Watch for signs of infection (unexpected pain, chills, or fever or drainage or increased inflammation from wounds), especially if recently discharged from hospitals. - See a physician promptly if you have a suspicious skin sore or boil. - Wash hands thoroughly and often with soap and water. - Ask health care workers to wash their hands before examinations. - Keep cuts and abrasions clean and covered with a bandage until healed. - Avoid contact with other people's wounds or material contaminated by wounds. - Do not share items such as razors, soap, ointments and balms, towels or wash cloths, clothing or uniforms. - If participating in contact sports, cover cuts, scrapes and other wounds with a bandage. - Shower with soap immediately after each practice or game. Wipe down all nonwashable equipment (mats, head protectors, gymnastics equipment, etc.) with alcohol or antibiotic solution after each person uses it. - If caring for someone with an infection at home, wash hands with soap after each physical contact and before going outside. Only use towels for drying hands once. Change and launder linens frequently, right away if they are soiled.

Too Many Antibiotics Prescribed For Sinus Infections

US scientists researching treatments for sinus infections suggest that antibiotics are overprescribed to treat the condition. And they are concerned this could be increasing the drug resistance and virulence of infectious bacteria.The study is published in the March issue of Archives of Otolaryngology-Head & Neck Surgery.According to the study, by Hadley J. Sharp and colleagues at the University of Nebraska Medical Center, Omaha, US, antibiotics were prescribed for 82 per cent of acute sinus infections and nearly 70 per cent of chronic sinus infections.This is surprising because most sinus infections are caused by viruses, and antibiotics only kill bacteria. The scientists used national data from 1999 and 2002 to find out which drugs were being prescribed for sinus infections by general practitioners, outpatient and emergency departments. The data was representative of the US population and came from two national surveys collected by the National Center for Health Statistics.Rhinosinusitis, commonly known as sinus infection or sinusitis, is an inflammation of the sinus cavities that connect with the nasal passage. According to the study, it is a common and expensive medical condition in the US.Acute sinusitis occurs for up to 4 weeks and is thought to be caused mostly by infectious agents. Chronic sinusitis is thought to be affected mostly by allergies, hormone changes and facial anatomy and symptoms persist for 12 or more weeks.In 2002, of all the antibiotic prescriptions that year in the US, 21 per cent were for adults with sinus infections and 9 per cent was for children.According to the survey data, over 14 million visits are paid to health care facilities in the US every year are for chronic sinusitis, while over 3 million are for acute sinusitis. As a proportion of all ambulatory care in the US per year, chronic sinusitis represents 1.39 per cent of visits and acute sinusitis 0.30 per cent.In 69.95 percent of visits for chronic sinusitis at least one antibiotic was prescribed. For acute sinusitis this figure was 82.74 per cent.Sharp and colleagues assessed that "The most frequently recommended medications for treatment of both acute and chronic rhinosinusitis are antibiotic agents, followed by antihistamines; nasal decongestants; corticosteroids; and antitussive, expectorant and mucolytic agents, respectively".The most commonly used antibiotics for both chronic and acute bacterial infections were penicillins (mainly amoxicillin and amoxicillin-clavulanate potassium, brand name Augmentin). These were prescribed appropriately, they said, with 30.35 per cent of chronic and 27.18 per cent of acute infection visits mentioning penicillin prescriptions.However, the researchers questioned the use of the stronger antibiotics such as erythromycins, lincosamides, and macrolides, amongst others. These were mentioned in 24.32 per cent of acute sinusitis visits, which, in order, makes them more frequently prescribed than cephalosporins, sulfonamides and trimethprim, and tetracyclines.The authors assessed the relative proportions of the causes of sinusitis from other studies. Comparing these proportions with the relative proportions of what is actually being prescribed to treat sinusitis they found major discrepancies.They concluded that "Prescription antibiotic drugs are being used far more than bacterial causes studies would indicate." Sharp and colleagues also assessed that "Nasal and inhaled corticosteroids are prescribed more frequently to treat acute rhinosinusitis than published studies imply is necessary". However, they estimated that where antihistamines were prescribed, this was roughly in proportion with estimated prevalence of allergic sinusitis.In trying to fathom why the use of antibiotics is so high, the authors suggest that some doctors could be trying to treat secondary infections. On the other hand, it could be because doctors think antibiotics are working because patients get better while taking them, whereas they could be getting better anyway.They express concern about the problems that overuse of antibiotics bring, including drug resistance and increased virulence of bacteria.They conclude, "When two-thirds of patients with sinus symptoms expect or receive an antibiotic and as many as one-fifth of antibiotic prescriptions for adults are written for a drug to treat rhinosinusitis, these disorders hold special pertinence on the topic."

Hearing Loss Due To Antibiotics May Be Prevented By Genetically Screening Patients Beforehand

Some patients have a genetic mutation which means they are more at risk of hearing loss after taking antibiotics called aminoglycosides. Experts, writing in the British Medical Journal (BMJ) believe that screening patients for this genetic mutation may prevent this. The writers, Maria Bitner-Glindzicz and Shamima Rahman, the Institute of Child health, London, England, explain that aminoglycosides are valuable antibiotics for such serious infections as complicated urinary tract infections, tuberculosis and septicemia. They are known to potentially cause damage to the ear (otoxicity). However, what isn't well known is that there are people who have an inherited predisposition that makes them extremely sensitive to the effects - they can end up with severe and permanent hearing loss. Approximately 5% of deafness in children in the UK is caused by this mutation, known as m.1555A-G. About 1 in 40,000 people in the UK have this mutation. Studies in other countries have indicated much higher incidences, in New Zealand it is thought to occur in 1 in 206 cases of newborns, and 1 in 1,161 in the USA (also newborns). Families carrying this mutation, even if they never take aminoglycosides, may develop some degree of deafness later in life. A study carried out in Spain found that 27% of families which included two deaf people were positive for this mutation. It was also found that everybody who had this mutation in Spain and took aminoglycosides suffered from hearing loss. A person who had taken aminoglycosides had a 96.5% of becoming deaf by the age of 30 if he/she had been exposed to aminoglycosides, while 38.9% of those who had never taken it became deaf. The authors write that aminoglycosides are a major environmental modifier of the m.1555A-G mutation. The writers ask whether it is cost effective to screen for this mutation before deciding whether to prescribe aminoglycosides. A test in the UK costs approximated £35 ($70). This cost would probably go down considerably if they were carried out in much larger numbers. It costs the NHS £61,000 ($122,000) for every child who becomes deaf (over his/her lifetime), plus about £18,000 ($36,000) in educational costs. US estimates have placed the lifetime cost to society for a child who loses his/her hearing before acquiring language at one million dollars. It is possible to prevent deafness brought on by aminoglycosides in individuals who have this genetic mutation, explain the authors. Doctors who have patients who are deaf are well aware of this mutation. Many doctors, however, do not know about this susceptibility, and many others do not know that mutation testing is available. The authors propose that the true prevalence of this mutation be ascertained for the UK, so that the cost-effectiveness of screening everyone who is prescribed aminoglycosides can be determined. Until this is done, people who are likely to be receiving multiple courses of aminoglycosides should be screened, such as leukemia patients and infants admitted to special care baby units. They conclude that test results should be produced rapidly, and until they appear the patient should be given some other type of antibiotic.

Antibiotic Resistance In Humans Researched Using Pig Model

Pigs could be the key to understanding how antibiotic resistant bacteria persist in Intensive Care Units in hospitals. NSW Department of Primary Industries (NSW DPI) Immunology & Molecular Diagnostic Research Unit Team Leader, Dr James Chin, says it is commonly believed that each time an antibiotic is used only pathogens or disease-causing bacteria will be killed. "Antibiotic use in hospitals is often perceived to be solely directed against only bad bacteria. "In reality, antibiotics also act against entire microbial communities, including the good bacteria which can protect patients from pathogenic bacteria. "Antibiotics do not just eliminate bad bacteria", Dr Chin said. "They also maintain a pool of antibiotic resistance genes within the microbial community of patients treated with antibiotics." Using pigs as a model, Dr Chin and Dr Toni Chapman at NSW DPI's Elizabeth Macarthur Agricultural Institute have examined how E.coli bacteria -- a common cause of diarrhoea in pigs and humans -- respond to treatment by antibiotics. Dr Chin told the 2007 Australian Society for Microbiology's annual conference in Adelaide in July that: "The current theory of antibiotic resistance is that the 'fittest' bacteria, that is, those carrying genes for resistance, are the most likely to survive. "Because antibiotic treatment will never kill all bacteria, bad or good, there will always be a pool of antibiotic resistance bacteria that can potentially transfer resistance to incoming pathogens. "It is important to identify the antimicrobial resistant gene pool in entire microbial communities before antibiotic treatment. Dr Chin said this has been tested with E. coli in pigs. "Our research shows clearly that use of one antibiotic to treat E. coli not only increases resistance against that antibiotic but also increases the carriage of resistance genes against other classes of antibiotics. "This creates a real problem because subsequent therapy with a second antibiotic may be ineffective because resistance against the second antibiotic had already been increased by the first antibiotic." In the United States an estimated 10 percent of patients get sick because of infections acquired whilst being treated in hospital. More careful use of antibiotics is regarded as vital. Dr Chin said the use of antibiotics for disease prevention is critical in patients admitted to intensive care. However there is currently a major bottleneck when it comes to deciding which antibiotics to use. "Current protocols require pathogens to be cultured, leading to delays of some days before the bacteria to be targeted can be accurately identified. Dr Chin said for this reason it is important to develop a molecular detection method that can identify antibiotic resistance signatures of entire microbial communities. "Our hope is that this kind of information will equip clinicians to better manage prescribing of antibiotics." This latest research is being planned in collaboration with clinical microbiologists and intensive care specialists at Westmead Hospital.