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Thread: When antibiotics don't help

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    When antibiotics don't help

    When antibiotics don't help
    Program seeking remedy for problem of resistant bacteria
    By Bill Scanlon, Rocky Mountain News
    December 30, 2002

    It started with a sore back, then stomach flu, and within 48 hours, Duncan Kenney had spiraled from perfect health to near death.

    Today, the eighth-grader is back in top form, playing basketball for Graland Country Day School in Denver.

    But doctors at Presbyterian/St. Luke's Medical Center had to pump the powerful intravenous antibiotic Vancomycin into his body for two days to save his life this July. His infection proved to be resistant to every other antibiotic doctors tried.

    Duncan's story is not uncommon.

    Infectious-disease doctors worry about the alarming increase in the number of bacteria resistant to antibiotics - synthetic drugs that attack dangerous bacteria that invade the body.

    Twenty years ago, only 2 percent of people who showed up in doctors' offices with pneumonia-like bacterial infections were unable to be helped by antibiotics. That number now stands at 25 percent, said Dr. Shale Wong, assistant professor for pediatrics at University of Colorado Health Sciences Center.

    "Duncan's case is a fantastic but horrible example of how this is really starting to affect our communities," said Wong, who also is an investigator for the MARC Project, which stands for Minimizing Antibiotic Resistance in Colorado.

    MARC hopes to be a national model for raising awareness of what some call a crisis.

    "People are developing much more serious illnesses from simple bacteria," she said.

    The reason: Too many people are taking antibiotics for the wrong reasons. In fact, Wong estimates that at least half the antibiotic prescriptions written today are unnecessary.

    And the cost is huge: The more antibiotics are used, the more opportunity bacteria have to learn the tricks of mutation and become resistant to their healing power.

    Even the powerful Vancomycin that finally controlled Duncan's infection is losing its effectiveness, according to the Centers for Disease Control and Prevention. Eight years ago, Vancomycin failed only one time in 300 in treating infections caused by the enterococci family of bacteria. Now, it fails one time in 12.

    Wong said Americans have come to rely on antibiotics as silver bullets.

    "Patients have grown accustomed to the idea that antibiotics can treat everything. They say, 'I feel terrible. Give me an antibiotic so I'll feel better.' "

    And doctors too often comply.

    Dr. Connie Price, chief of infectious diseases at Denver Health Medical Center, said the pressure is probably strongest on primary care physicians.

    Their patients "don't want to feel sick and don't want to hear that there's nothing they can do for the illnesses. There's a very large pressure on physicians because physicians do like to make people feel good."

    In Duncan's case, the pressure doctors felt must have been intense.

    "They were giving him every antibiotic available, and were losing him," recounted Duncan's mother, Pamela Kenney Basey. "In 48 hours, he went from his back hurting to being on the edge of life, which is very sobering."

    Duncan first went to Rose Medical Center, but soon was transferred to Presbyterian/St. Luke's Medical Center, which has specialists in infectious diseases. An MRI found a massive infection.

    The bacteria, which made it difficult for him to breathe, then spread to his liver. Duncan's temperature rose to 104 degrees, and his blood had difficulty clotting.

    At that point, doctors didn't know if it was a staphylococcus or streptococcus infection. Fearful that he would go into respiratory arrest, surgeons removed some highly inflamed muscle.

    After two days on Vancomycin, doctors confirmed it was a staphylococcus infection that was resistant to normal antibiotics. In Duncan's case, the source is unknown.

    Duncan had to stay on an intravenous medication drip for eight weeks. Because he didn't want to miss school, he hooked the IV bag to a bulletin board and sat very still in class.

    "He was two days on the maximum doses of Vanco before (the bacteria)cleared out of his blood stream," Basey said.

    His mother shudders, recounting a girl in Minnesota who had the same symptoms and ultimate diagnosis as Duncan.

    "They waited an extra day to take her in, and 12 days later, she didn't make it," she said.

    Dr. Ralph Gonzales is trying to head off such tragedies, starting with the campaign to stop antibiotic overuse.

    A recent study he headed at the University of Colorado found that among adults who see a doctor for upper-respiratory viral infections, more than half leave with a prescription for an antibiotic, which is powerless against viruses.

    "That's 20 million excess prescriptions" nationally, said Gonzales, now a professor of internal medicine at University of California at San Francisco.

    "There's no doubt this is one of the very top public health concerns and priorities for modern medicine," Gonzales said. "If we lose antibiotics, it will be just a tremendous problem.

    "We're a lot closer than people realize, but we're not over the cliff yet."

    After eight consecutive years of the resistance rate increasing in Colorado, it went down slightly last year, probably because of MARC's efforts, Gonzales said.

    Many clinics and hospitals are peppered with posters warning about the dangers of antibiotic overuse, particularly for respiratory infections, Wong said.

    "We want people to recognize that the majority of the coughs, colds and flu they have all season long are viral infections that should never be treated with antibiotics," Wong said.

    Patients, she added, play another critical role in the battle against antibiotic resistance: If you've been given antibiotics, you need to take them all, even if you feel fine by the time you still have a few pills left in the bottle. Those last few pills kill all traces of the bacteria, so a few of them can't survive in a mutated form -
    and be resistant to the next blast of antibiotic.

    People also shouldn't use a stronger antibiotic than they need, because that attacks several kinds of bacteria. While it might kill most, it gives some the opportunity to mutate and grow stronger, Wong said.

    Doctors need to get the message out that there are plenty of things, short of antibiotics, that can help ease pain. "Tylenol and ibuprofens help, dramatically taking away fever and a lot of the achiness of the flu," Wong said. Inhalers can ease chronic coughs or bronchitis.

    Gonzales said the human body has effective ways to handle infections. But before the introduction of antibiotics in the 1950s, about half of the people who were hospitalized for pneumonia died of it.

    Today's rate is 5 percent or 10 percent.

    He has seen America slip back to the pre-antibiotic days in dealing with sinus and ear infections. Before antibiotics, doctors would have to drain the infections, sticking needles in the ears. Today, a lot of them are having to do that again because of resistance to antibiotics.

    MARC's message to parents and patients is to ask the doctor if antibiotics are truly necessary.

    "Doctors are known to misread cues from their patients," Wong said. "If patients say, 'I've heard antibiotics can be harmful,' that would be a huge turn," leading to fewer prescriptions written.

    Patients also should simply try to stay healthy, said Price. The best advice is still Mom's: Wash your hands frequently and cover your mouth when you sneeze.

    If antibiotics continue to be abused, the nation may fall back to the pre-antibiotic era, when a simple ear infection or staph infection could be life-threatening, doctors said. At the very least, it may mean more people will have to be hospitalized so they can get antibiotics more quickly through their veins, Price said.

    http://www.rockymountainnews.com/drm...640027,00.html

  2. #2
    Senior Member alan's Avatar
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    Gee, maybe antibiotics should be more of s focus of politicos than opiates!

    That would make too much sense.

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