Wednesday, November 30, 2022

New York Times Antibiotic Resistance

How Has Antibiotic Resistance Changed Medicine

Drug-resistant superbug fungus sickens hundreds across the U.S.

Dr. Johnson from Minnesota says the spread of resistant bugs means doctors are having to blast patients infections with increasingly stronger antibiotics. That has led to more patients coming in with infections caused by the C. difficile, a gut germ that flourishes when the patient has taken a lot of antibiotics. Doctors now frequently send patients home with setups for intravenous antibiotics because pills no longer do the trick. Sometimes the specter of resistant infections can delay or cancel surgeries.

Has The Food And Drug Administration Regulated The Use Of Antibiotics In Agriculture

Under F.D.A policies that will take effect Jan. 1, antibiotics that are considered medically important for humans will no longer be approved for use to promote growth in livestock.

The policies also require that a veterinarian supervise the use of antibiotics in feed or water for livestock. Currently, many of the drugs are sold over the counter and do not require the involvement of a veterinarian.

Compliance is voluntary. But the 25 drug companies that manufacture about 283 antibiotics approved for use in livestock have all agreed to change their drug labels to reflect the requirements.

Some critics, however, say they are concerned that the new policies will leave loopholes that could allow food producers to circumvent them.

In A Poor Kenyan Community Cheap Antibiotics Fuel Deadly Drug

Overuse of the medicines is not just a problem in rich countries. Throughout the developing world antibiotics are dispensed with no prescription required.

Heaps of garbage in Kibera, Nairobi one of Africas largest slums.Credit…Andrew Renneisen for The New York Times

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By Andrew Jacobs and Matt Richtel

NAIROBI, Kenya Four days after her toddlers health took a turn for the worse, his tiny body racked by fever, diarrhea and vomiting, Sharon Mbone decided it was time to try yet another medicine.

With no money to see a doctor, she carried him to the local pharmacy stall, a corrugated shack near her home in Kibera, a sprawling impoverished community here in Nairobi. The shops owner, John Otieno, listened as she described her 22-month-old sons symptoms and rattled off the pharmacological buffet of medicines he had dispensed to her over the previous two weeks. None of them, including four types of antibiotics, were working, she said in despair.

Like most of the small shopkeepers who provide on-the-spot diagnosis and treatment here and across Africa and Asia, Mr. Otieno does not have a pharmacists degree or any medical training at all. Still, he confidently reached for two antibiotics that he had yet to sell to Ms. Mbone.

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What Accelerates The Emergence And Spread Of Antimicrobial Resistance

AMR occurs naturally over time, usually through genetic changes. Antimicrobial resistant organisms are found in people, animals, food, plants and the environment . They can spread from person to person or between people and animals, including from food of animal origin. The main drivers of antimicrobial resistance include the misuse and overuse of antimicrobials lack of access to clean water, sanitation and hygiene for both humans and animals poor infection and disease prevention and control in health-care facilities and farms poor access to quality, affordable medicines, vaccines and diagnostics lack of awareness and knowledge and lack of enforcement of legislation.

Drug Resistance In Mycobacterium Tuberculosis

Is drug resistant bacteria a major public health issue?

Antibiotic resistant Mycobacterium tuberculosis strains are threatening progress in containing the global tuberculosis epidemic. WHO estimates that, in 2018, there were about half a million new cases of rifampicin-resistant TB identified globally, of which the vast majority have multi-drug resistant TB , a form of tuberculosis that is resistant to the two most powerful anti-TB drugs. Only one-third of the approximately half a million people who developed MDR/RR-TB in 2018 were detected and reported. MDR-TB requires treatment courses that are longer, less effective and far more expensive than those for non-resistant TB. Less than 60% of those treated for MDR/RR-TB are successfully cured.

In 2018, an estimated 3.4% of new TB cases and 18% of previously treated cases had MDR-TB/ RR-TB and the emergence of resistance to new last resort TB drugs to treat drug resistant TB poses a major threat.

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Who Warns That Pipeline For New Antibiotics Is Running Dry

In two new reports, the global health agency says only government intervention can fix the broken market for new antimicrobial drugs.

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By Andrew Jacobs

With the pipeline for new antibiotics slowing to a trickle and bankruptcies driving pharmaceutical companies from the field, the World Health Organization on Friday issued a fresh warning about the global threat of drug-resistant infections.

Some 700,000 people die each year because medicines that once cured their conditions are no long effective. Yet the vast majority of the 60 new antimicrobial products in development worldwide are variations on existing therapies, and only a handful target the most dangerous drug-resistant infections, the agency said in a report.

We urgently need research and development, said Sarah Paulin, technical officer of Antimicrobial Resistance and Innovation at the W.H.O. and an author of two reports on the subject issued Friday. We still have a window of opportunity but we need to ensure there is investment now so we dont run out of options for future generations.

Without government intervention, the United Nations estimates that resistant infections could kill 10 million people annually by 2050 and prompt an economic slowdown to rival the global financial crisis of 2008.

I Dont Have Faith That We Will Solve This

Kenya has officially embraced what public health experts call antimicrobial stewardship, the effort to stem resistance by reducing the overuse of antibiotics, promoting vaccinations and encouraging better hygiene among hospital workers. Over the past two years many of the countrys medical institutions have established stewardship committees. Wall-mounted hand sanitizers have become a common sight in hospital hallways and patient waiting areas.

But the government has made little headway in enforcing laws that require prescriptions for buying antibiotics, nor has it done much to stem the flow of bootleg drugs that spill across the nations 400-mile border with Somalia.

Its proving more difficult than we thought, said Dr. Widdowson of the C.D.C., who has been advising the government.

Back at Kijabe Hospital, Mr. Thades condition was growing more dire. As nurses prepared him for yet another X-ray, Dr. Otieno talked about the challenges of tackling drug resistance.

A passionate man with wide, expressive eyes, Dr. Otieno, 36, is a driving force behind the hospitals newly established antimicrobial stewardship program. But he expressed frustration over the lack of progress, describing overworked nurses reluctant to embrace complex hygiene protocols and the hospitals own pharmacy, which he said continued to overprescribe antibiotics.

I worry about my country, but also about my own family. One day I could go home and infect my own children with one of these dangerous bugs.

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Availability Of Few New Antibiotics

The development of new antibiotics by the pharmaceutical industry, a strategy that had been effective at combating resistant bacteria in the past, had essentially stalled due to economic and regulatory obstacles .14 Of the 18 largest pharmaceutical companies, 15 abandoned the antibiotic field.14 Mergers between pharmaceutical companies have also substantially reduced the number and diversity of research teams.13 Antibiotic research conducted in academia has been scaled back as a result of funding cuts due to the economic crisis.13

Number of Antibacterial New Drug Application Approvals Versus Year Intervals

The number of new antibiotics developed and approved has decreased steadily over the past three decades , leaving fewer options to treat resistant bacteria.

* Drugs are limited to systemic agents. Data courtesy of the CDC5 and the FDA Center for Drug Evaluation and Research.

Another factor that causes antibiotic development to lack economic appeal is the relatively low cost of antibiotics. Newer antibiotics are generally priced at a maximum of $1,000 to $3,000 per course compared with cancer chemotherapy that costs tens of thousands of dollars.2,3,13,14 The availability, ease of use, and generally low cost of antibiotics has also led to a perception of low value among payers and the public.13

Revenge Of The Bacteria: Why Were Losing The War

Food For Tomorrow 2015 – Keynote: Farming, Antibiotics and Health

Bacteria are rebelling. Theyre turning the tide against antibiotics by outsmarting our wonder drugs. This video explores the surprising reasons.

The reports dire predictions seek to raise public awareness and shake political leaders into action. It proposes a series of measures that health officials say could help stem the rise of drug-resistant pathogens. The recommendations include a worldwide ban on the use of medically important antibiotics for promoting growth in farm animals financial incentives for drug companies to develop new antimicrobial compounds and more stringent rules to limit the sale of antibiotics in countries where drugs can often be bought at convenience stores without a prescription.

The report also highlights underappreciated factors in the spread of drug-resistant germs: the lack of clean water and inadequate sewage systems that sicken millions of people in the developing world. Many of them are too poor to see a doctor and instead buy cheap antibiotics from street vendors with little medical expertise. Sometimes they unknowingly purchase counterfeit drugs, a problem that leads to millions of deaths, most of them in Africa.

To reduce outbreaks of infectious disease, the report says, wealthier nations should help poor countries pay for improvements to public hygiene, and ensure greater access to vaccines and properly manufactured antibiotics.

Fear, he said, was the key to changing the status quo.

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Carefully Targeted Antibiotic Treatment For Urinary Tract Infections

So what do we do now? As a society and as individuals, we should reduce and carefully target antibiotic use. Both physicians and patients should be aware of the grave potential to lose effective antibiotics for all infections even simple UTIs. Its an opportunity that empowers individuals to have informed conversations with their doctors. Every time your doctor prescribes an antibiotic, ask: Do I need this? Why? Is there an antibiotic-free alternative? Talking about it might be enough to meaningfully reduce inappropriate antibiotic use.

If youre having UTI symptoms like burning with urination, more frequent urination, bloody or cloudy urine, low abdominal pain, or fever, you should see a medical provider to get tested. Youll have to urinate into a container and the medical office will test for products of bacterial metabolism. Make sure to tell your provider if youve had UTIs before, and what antibiotic you took. If you have a history of antibiotic-resistant infections, share that, too. There are alternatives to Cipro and Bactrim, but antibiotic choices are limited.

If antibiotic resistance continues to grow, more people will need intravenous treatment for UTIs we used to cure with simple oral antibiotic courses. Were also likely to see more complications, like kidney infections and sepsis, arising from ineffective treatment.

Can Animals Spread Antibiotic Resistance

  • Antibiotic use in animals and agriculture can lead to antibiotic resistance in bacteria that can spread to humans and other animals through direct contact or contaminated food. Therefore, appropriate use of antibiotics is an important part of veterinary practice to protect animal and human health. Safe food handling, storage, and preparation is something everyone should practice to prevent illness.

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How Bad Is The Problem

The Centers for Disease Control and Prevention estimates that each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics, and at least 23,000 people die each year as a direct result of these infections. We are approaching a time when once easily-treated infections are no longer easy to treat or may be untreatable because of antibiotic resistance. As Dr. Thomas Frieden, head of the CDC, puts it, “The medicine cabinet is empty for some patients. It is the end of the road for antibiotics unless we act urgently.”

Warning Of Pig Zero: One Drugmakers Push To Sell More Antibiotics

By the Numbers

Overuse of antibiotics in livestock has given rise to drug-resistant germs. Drugmakers say they want to be part of the solution. But a recent campaign urged farmers to administer the drugs to healthy animals daily.

A brochure by Elanco, one of the largest manufacturers of drugs for animals, urged farmers to give antibiotics to every pig in their herds, even as it told the public and policymakers it was aware of the hazards that the overuse of antibiotics poses to human health.Credit…

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By Danny Hakim and Matt Richtel

Facing a surge in drug-resistant infections, the World Health Organization issued a plea to farmers two years ago: Stop using antibiotics in healthy animals.

But at last years big swine industry trade show, the World Pork Expo in Des Moines, one of the largest manufacturers of drugs for livestock was pushing the opposite message.

Dont wait for Pig Zero, warned a poster featuring a giant picture of a pig peeking through an enormous blue zero, at a booth run by the drugmaker Elanco.

Were trying to be stewards and leaders at the same time, said Mr. Simmons, adding that the brochure wasnt misrepresentation, necessarily, relative to the label or the science, or how a farmer would look at it.

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Antibiotic Overuse Leads To Antibiotic Resistance

At some point, most people have taken a course of trimethoprim/sulfamethoxazole or ciprofloxacin , two common antibiotics used for UTIs. However, in the last few years it has become clear that the likelihood these antibiotics will kill most UTIs is dropping rapidly. You may have read the recent, frightening New York Timesarticle reporting one in three uncomplicated UTIs in young healthy women are Bactrim-resistant and one in five are resistant to five other common antibiotics. Pretty scary, since we used to feel confident that writing a prescription for Bactrim was a sure recipe for cure.

How is it that we are losing the antibiotic war with bacteria? Though many things drive bacterial resistance, giving antibiotics to animals and antibiotic overuse in humans top the list.

We use a lot of antibiotics in humans too much, and not always for the right reasons. When we prescribe antibiotics for viral illnesses like a cold, the flu, or common sinusitis, we create a massive shift in the bodys bacteria for no good reason .

After Cycles Of Antibiotics Limited Options

If Ntihinyuirwa Thade had been conscious, the doctors at Kijabe Mission Hospital would have asked about his medical history, including a list of antibiotics he had taken in recent years. But Mr. Thade, 25, a migrant laborer from Rwanda, was on a ventilator and unconscious, having fallen from the upper floor of a building project. He was not wearing a hard hat and suffered a grievous head injury.

A week after the accident, he was facing a more immediate threat: A Klebsiella pneumonia infection was blossoming in his lungs. Mr. Thades condition failed to respond to the three antibiotics already flushed into his veins, so his doctor, George Otieno , was preparing to administer the final drug in his limited arsenal, a relatively expensive antibiotic called meropenem. If that doesnt work, he said, his voice trailing off.

Klebsiella bacteria are omnipresent in the environment in the soil and in the human gut but they can turn deadly for people with frayed immunities.

Dr. Otieno acknowledged that Mr. Thade most likely acquired his through the plastic breathing tube that was keeping him alive.

Many of the worlds leading medical institutions struggle with resistant microbes and Kijabe, one of Kenyas best hospitals, is no different.

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Why Antibiotic Resistance Is A Concern

Antibiotic resistance causes a number of problems:

  • The need for stronger antibiotics with possibly severe side effects
  • Fewer choices of antibiotics to treat antibiotic resistant bacteria
  • More expensive treatment
  • Harder-to-treat illness can spread from person to person
  • More hospitalizations and longer stays
  • Serious health problems, and even death

Crisis Looms In Antibiotics As Drug Makers Go Bankrupt

Were Losing the War Against Bacteria, Heres Why | NYT

First Big Pharma fled the field, and now start-ups are going belly up, threatening to stifle the development of new drugs.

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By Andrew Jacobs

At a time when germs are growing more resistant to common antibiotics, many companies that are developing new versions of the drugs are hemorrhaging money and going out of business, gravely undermining efforts to contain the spread of deadly, drug-resistant bacteria.

Antibiotic start-ups like Achaogen and Aradigm have gone belly up in recent months, pharmaceutical behemoths like Novartis and Allergan have abandoned the sector and many of the remaining American antibiotic companies are teetering toward insolvency. One of the biggest developers of antibiotics, Melinta Therapeutics, recently warned regulators it was running out of cash.

Experts say the grim financial outlook for the few companies still committed to antibiotic research is driving away investors and threatening to strangle the development of new lifesaving drugs at a time when they are urgently needed.

This is a crisis that should alarm everyone, said Dr. Helen Boucher, an infectious disease specialist at Tufts Medical Center and a member of the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria.

These drugs are my babies, and they are so urgently needed, she said.

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