Peak antibiotics – Aug 14

August 14, 2010

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Are you ready for a world without antibiotics?

Sarah Boseley, Guardian
… The era of antibiotics is coming to a close. In just a couple of generations, what once appeared to be miracle medicines have been beaten into ineffectiveness by the bacteria they were designed to knock out. Once, scientists hailed the end of infectious diseases. Now, the post-antibiotic apocalypse is within sight.

Hyperbole? Unfortunately not. The highly serious journal Lancet Infectious Diseases yesterday posed the question itself over a paper revealing the rapid spread of multi-drug-resistant bacteria. "Is this the end of antibiotics?" it asked.

Doctors and scientists have not been complacent, but the paper by Professor Tim Walsh and colleagues takes the anxiety to a new level.

… Yesterday’s paper revealed that NDM 1 is widespread in India and has arrived here as a result of global travel and medical tourism for, among other things, transplants, pregnancy care and cosmetic surgery.

… "In many ways, this is it," Walsh tells me. "This is potentially the end. There are no antibiotics in the pipeline that have activity against NDM 1-producing enterobacteriaceae. We have a bleak window of maybe 10 years, where we are going to have to use the antibiotics we have very wisely, but also grapple with the reality that we have nothing to treat these infections with."

… For a long time now, doctors have known they were in a race to stay a few steps ahead of the rapidly growing resistance of bacterial infections to antibiotics. Ten years ago, the so-called superbug MRSA caused front-page panic.

… "The emergence of antibiotic resistance is the most eloquent example of Darwin’s principle of evolution that there ever was," says Livermore. "It is a war of attrition. It is naive to think we can win."

So the game now is to keep bacteria at bay. Hygiene is an obvious weapon. Better cleaning, hand gels and stern warnings to staff and public alike have helped reduce infection rates in hospitals.

… Beyond that, there is a real need to conserve those antibiotics we have. "To me, it has many parallels with the problems of energy in economies around the world," he says. Carbon trading was dreamed up to try to conserve oil and reduce its pollutant effects. There have now been a couple of interesting papers suggesting a Pigouvian tax – which he defines as one levied on an agent causing an environmental problem as an incentive to mitigate that problem – for antibiotics.

Like oil, he points out, antibiotic usefulness is finite. And the cost of drug resistance is not reflected in the price of the drug.

… "This report shows that the battle to control the emergence of antibiotic-resistant superbugs through appropriate use of antibiotics must be fought at an international level," says Kevin Kerr, consultant microbiologist at Harrogate district hospital. "It illustrates the importance of considering health issues as a world issue – how antibiotics are prescribed and controlled in one part of the world can very rapidly have consequences elsewhere," says Christopher Thomas, professor of molecular genetics at the University of Birmingham.
(12 August 2010)
The report implies that cheap air travle helps make possible the rapid spread of antibiotic-resistant bacteria. Not only bacteria, but plants and animals of all sorts spread rapidly throughout the world, hitchhiking on intercontinental ships and airplanes. Another unforeseen consequence of cheap energy. -BA


South Asia Superbug is Potential Global Problem

Voice of America
Scientists say they have discovered a new gene among bacteria that are highly resistant to even the most powerful antibiotics. Experts say the superbug, originally found in India and other parts of South Asia, is showing up in patients in Europe and the United States and is at the root of life-threatening pneumonia and urinary tract infections.

Scientists warn the superbug has already been identified in patients from Britain, The United States, Australia, Canada, and the Netherlands. All of these patients had traveled to India for more affordable medical care.

The discovery was made in a new gene, called New Delhi metallo-beta-lactamase or NDM-1. NDM-1 is carried in bacteria that are resistant to almost all existing antibiotics including the most powerful group called carbapenems.

British Scientist David Livermore, who helped identify the gene, says the bacteria will be difficult to treat if they spread. "What we’re seeing here isn’t the spread of a single superbug, rather it’s the spread of resistance between bacteria. And this resistance includes the carbapenems, which have been the most powerful, the most reliable antibiotics in many infections," he said.

With increasing international travel and medical tourism in search of cheaper medical procedures, this superbug has traveled with patients back to their home countries.
(13 August 2010)


Fears of a new superbug from Asia may be overblown, experts say

Thomas H. Maugh II, Los Angeles Times
British researchers said Tuesday that a new bacterium resistant to most antibiotics is becoming more common in India and Pakistan and that it has been identified in 37 people in the U.K., primarily among people who have traveled to that region to receive cheaper medical care. U.S. authorities say that three cases of the infection have also been detected in this country. The outbreak is concerning, the researchers reported online in the journal Lancet Infectious Diseases, because the bug is resistant to a family of newer antibiotics called carbapenams, which are generally reserved for treating bacteria resistant to most other antibiotics.

However, experts said there is no evidence that the new resistant organisms, powered by a mutant gene called NDM-1 that confers resistance, is any more dangerous that the methicillin-resistant Staphylococcus aureus (MRSA) that has become widespread in the United States or any of a number of other carbapenam-resistant organisms that have been observed previously. The new organism is simply "one of a number of very serious bugs we’re tracking," Dr. Alexander J. Kallen of the Centers for Disease Control and Prevention told the New York Times.
(13 August 2010)
Actually, it’s not very reassuring to know that the mew bacterium is only one of many antibiotic-resistant species that the researchers are watching. -BA


Conflict of interest in ‘superbug’ report: Azad

The Times of India
NEW DELHI: Health minister Ghulam Nabi Azad pointed to a conflict of interest behind the controversial Lancet report of an "Indian" superbug, saying the research was part funded by pharma major Wyeth that had developed an antibiotic meant to combat high resistance bacterial infections.

Speaking to media on Friday, he said not only had one of the report’s authors disagreed with its findings, it was unclear whether the patient in London who was infected by the superbug had contracted it in India. "It was funded by one pharma company and associates of pharma companies," he said.

Wyeth has developed a drug Tygacil, meant to help doctors treat hospital infections that need a special type of broad spectrum antibiotics. "This bug can be present in the instestines of humans and animals. There is no
reason to believe it is specific to India," he said.

According to ICMR, bugs with similar plasmids — a DNA molecule that replicates independently within a suitable host — have been reported from Israel, US, Greece and Scotland. Therefore, to link the bug’s existence and spread to surgeries taking place in India was wrong. What’s most interesting is that many of the authors of the study have declared a conflict of interest. The health ministry on Thursday said the study was funded by the European Union, Wellcome Trust and pharma company Wyeth which produces antibiotics for treatment of such cases.
(14 August 2010)
I don’t find this argument from tne Indian health minister convincing. He does not direclty address the question of whether the bug originated in India, but instead argues about the financing of the research. On the other hand, the suspicion that research is financially motivated makes a good case for research independent of the drug companies. -BA

Tags: Health, Transportation