ARTICLE #1 CDC Warns About Overuse of Antibiotics
ARTICLE #2 Antibiotic Overuse Act
ARTICLE #3 Consequences of Excessive Antibiotic Use
ARTICLE #4 The Rise of Antibiotic-Resistant Infections
ARTICLE #5 Doctors Ignore Antibiotics Plea
ARTICLE #8 Antibiotics Linked to Breast Cancer
ARTICLE #9 Early Antibiotics Tied to Asthma, Allergy
ARTICLE #10 Think You Need an Antibiotic? Think Again
ARTICLE #12 Natural Alternatives to Antibiotics
ARTICLE #13 ALTERNATIVES TO ANTIBIOTICS
By Eliza Bussey
WASHINGTON, May 09 (Reuters Health) - In an effort to reduce the growing numbers of drug-resistant bacteria, officials at the Centers for Disease Control and Prevention (CDC) are urging physicians to stop prescribing antibiotics where the drugs are not necessary.
Director of Antimicrobial Resistance for the CDC, Dr. Richard Besser, told an audience of physicians attending a medical conference that each year US physicians write $50 million worth of prescriptions that are ineffectual and unnecessary. A common reason for unnecessary prescriptions is patient demand for treatment.
"We are facing a crisis because doctors are pressured to prescribe antibiotics for the common cold and inner ear infection, yet we know that it is not prudent to do so," Besser said. "We must collectively inform our patients about the reasons why overprescribing antibiotics will not help patients return to work sooner, and that in the long run, could make them more susceptible to drug-resistant diseases."
Besser said that three fourths of all outpatients' antibiotics in the US have been prescribed for infections such as otitis media (ear infections), sinusitis, bronchitis, pharyngitis, or non-specific upper respiratory tract infection.
Besser presented research showing that if unnecessary antibiotic use is curtailed, drug resistance will diminish. In Japan, for example, 62% of group A streptococcal isolates were resistant to erythromycin in 1974. However, use of the antibiotic was scaled back, and in 1988, less than 2% of group A streptococcal isolates were resistant to erythromycin.
Senator Edward Kennedy, who spoke during the conference, said he and Senator Bill Frist will introduce legislation to Congress to address the "growing problems of antimicrobial resistance and its threat to public health."
"One of the most urgent priorities to halt the spread of drug-resistant pathogens is to improve the capacity of state and local public health agencies to monitor and combat infectious disease," Kennedy said. "We must also educate medical professionals and the public alike to reduce unnecessary prescriptions, and halt the improper dissemination of antimicrobial drugs."
H.R. 2932 and S. 1460
Sponsors: Representatives Sherrod Brown (D-OH) and Wayne Gilchrest (R-MD) and Senators Edward Kennedy (D-MA) and Olympia Snowe (R-ME)
NM co-sponsors: Sen. Bingaman
APV position: SUPPORT
Bill Status: S. 1460 has been referred to the Senate Health, Education, Labor and Pensions Committee
H.R. 2932 has been referred to the House Energy and Commerce Committee, Health Subcommittee
What the law would do. The Antibiotics Overuse Act calls for an end, within two years of enactment, to the massive, routine feeding of antibiotics to chickens, pigs, cows, and other animals in agriculture.
Why it is needed: The "non-therapeutic" use of antibiotics is a practice factory farms employ to make animals grow faster and keep them in inhumane, overcrowded, stressful, and often squalid conditions. As long as the antibiotic crutch is available to agribusiness, it will continue treating animals as machines and ignoring their basic welfare needs. Moreover, this wasteful use of the drugs renders them less effective for treating sick animals and people. Overuse of antibiotics leads to the development of antibiotic-resistant bacteria. An estimated 70% of all antibiotics used in this country are given to farm animals for non-therapeutic purposes. It's time to stop letting agribusiness squander these precious medicines in order to keep animals confined in horrible conditions!
By Jane Sheppard
Antibiotics have saved many lives over the past 45 years. We are truly fortunate to have them available for serious bacterial infections. Unfortunately, antibiotics are excessively prescribed, especially to children. The Center for Disease Control estimates that of the 235 million doses of antibiotics given each year, between 20 and 50 percent are unnecessary. Tragically, this overuse of antibiotics can cause devastating health consequences to children.
Antibiotics for Ear Infections
Antibiotic misuse is most likely to occur in children with ear infections (otitis media), the number one reason a child is brought to a doctor. Antibiotic therapy is the most common treatment of ear infections, with amoxicillin being the first choice by doctors. The side effects of amoxicillin include upset stomach, diarrhea, allergic reactions, and diaper rashes. These side effects may seem minor, but are these antibiotics actually necessary for otitis media? The purpose of antibiotics is to kill harmful bacteria. Otitis media means middle ear inflammation - not necessarily bacterial infection. Many cases are caused by allergies, particularly to milk and dairy products. In a significant number of cases of otitis media, the middle ear contains no harmful bacteria. In a Dutch study of 2,975 children, it was found that 88% of children with acute otitis media did not need antibiotics. Other studies in the U.S. and Scandinavia came to similar conclusions.
Antibiotics have been shown to increase the likelihood of repeat ear infections. One reason is when a doctor prescribes antibiotics the underlying cause of the ear infection is usually ignored and left untreated. For instance, Streptococcus pneumoniae, also known as pneumococcus is commonly found in the nose and throat. This bacterium is thought to be responsible for many cases of ear infections, which is why antibiotics are prescribed. However, your child can have pneumococcus and not be sick. It will only cause trouble if it gets trapped in the middle ear. Once trapped, the bacteria can reproduce rapidly and become an infection. This scenario could be the result of an allergic reaction to a certain food, which can cause congestion as well as significant pressure changes and obstruction to the eustachian tube. In the case of an allergy induced ear infection, eliminating the allergen from a child's diet or environment will also eliminate the obstruction, allowing the bacterial fluid to drain. However, if an allergic child continues to be exposed to the allergen, repeat ear infections are likely to occur.
Another cause of ear infection may be an obstruction to the eustachian tube, due to misalignment of the bones of the jaw, skull or neck. Craniosacral work, chiropractic care or osteopathy would be especially helpful to release the blockage to allow drainage of the fluid.
Nutritional deficiencies or a weakened immune system can also be factors leading to ear infections. Treating the child with antibiotics without correcting the cause will likely create a continuing cycle of repeat ear infections. Many children are dealing with this. A typical scenario is the child is diagnosed with acute otitis media and antibiotics are prescribed (whether a bacterial infection is present or not). The symptoms disappear in about a week or two, but return again in the near future, since the original cause was not addressed. The child goes back to the doctor for more antibiotics. The cycle continues. Some children spend months or even years on antibiotics, with recurring ear infections. Research has shown that when antibiotics are used at the beginning of an ear infection, the frequency of recurrence may be almost three times greater than if antibiotics are delayed or not used.
Antibiotics Don't Discriminate
Antibiotics do not just go after the pathogenic or bad bacteria. They also indiscriminately destroy the beneficial bacteria necessary and vital to good health. Among the more important beneficial bacteria are lactobacillus acidophilus and bifidobacterium bifidus. They help protect the body against infection. Depleting these organisms can disrupt the balance of the body, suppress immunity, and lead to increased susceptibility to infections by fungi, bacteria, viruses and parasites. Additionally, when antibiotics are used excessively, depleting the beneficial bacteria, there may be an overgrowth of yeast in the body. A yeast infection can suppress immunity, which may lead to recurrent infections.
What's more, antibiotics adversely affect many nutrients, particularly the ones needed by the immune system to fight infection, such as vitamins A and C. One of the most common side effects of antibiotics is diarrhea. This causes a loss of nutrients, especially magnesium and zinc. Some children are on antibiotics for months or even years. Nutritional loss over such a long period of time is debilitating for the body and sets up an environment for more infections.
Serious Infectious Diseases Resistant to Antibiotics
A very frightening consequence of indiscriminate use of antibiotics is the development of antibiotic-resistant bacteria. These bacteria have learned to outsmart the drugs and have reproduced a generation of stronger, more resistant bugs. Consequently, there are some serious infectious diseases that are no longer responding to antibiotics. If an infection does respond, it often requires five to ten times the amount of the drug that used to be effective.
When your child is continually treated with antibiotics, the bacteria in his or her body may eventually be able to survive the drugs, making it much harder to cure an infection. In the event of a serious bacterial infection, such as meningitis, a much higher dosage of antibiotic may be required or a doctor may have to try different drugs before finding one that will work. The time this takes can potentially be a matter of life or death, since meningitis can be fatal and needs to be treated immediately. Unfortunately, with each try at a different treatment, the bacteria are given another chance to build up their resistance against even more powerful drugs.
Antibiotic resistance can affect the whole family and everyone around the child with a history of frequent antibiotic use. If the child develops resistant bacteria, he or she can pass them along to others through coughing, sneezing, and kissing.
What Else is Your Child Ingesting with the Antibiotic?
Sweeteners, dyes, flavorings, and other unnamed additives are found in antibiotics prescribed to children. These may include saccharin, sucrose, red dye #40, FD & C yellow #5 and #6. These dyes are cross-reactive with aspirin and acetaminophen, which are commonly given to a child during an illness. Even tiny amounts of the chemical additives in antibiotics can cause an allergic reaction in a sensitive child. It's important to always get a full disclosure of the contents of the drug being considered if your child has allergies or environmental sensitivity. Ask the pharmacist for the insert that comes with the medication.
Treat Colds and Flu with Antibiotics?
A truly disturbing practice is the prescribing of antibiotics by some doctors to treat colds, coughs, runny noses or flu. Most upper respiratory infections are viral. Treating them with antibiotics is clear and blatant misuse, since the drugs kill only bacteria and are of no value at all in treating viral infections. There are treatments that can relieve the symptoms of a cold, but there is no drug (over-the-counter or prescription) that will cure a cold.
Save Antibiotics for the Serious Infections
In the book Beyond Antibiotics:50 Ways to Boost Immunity and Avoid Antibiotics, Drs. Schmidt, Smith and Sehnert suggest that you ask your doctor the following questions when antibiotics are being prescribed. It is good to get all the answers you can before making a decision.
Are you sure it is bacterial?
Are you sure it is the right antibiotic?
Should a culture be performed?
Are there alternatives to antibiotics?
What are the risks if we don't use them?
What are the risks if we wait one or two or four days?
Are there dietary or nutritional factors that need consideration?
Should vitamins be prescribed along with the antibiotic?
Should acidophilus supplements be given to minimize the intestinal effect of the antibiotic?
Have you considered or investigated the role of food allergy?
If your doctor is not willing to explore these questions, you are justified in getting another opinion. There are many doctors who will be your health partner and explore these issues with you.
Antibiotics may be absolutely necessary in certain situations, such as a life-threatening infection or when serious complications are present. For instance, if your child has symptoms of bacterial meningitis, there is no time to waste. He or she should be taken immediately to a doctor for antibiotics. We are very fortunate to have antibiotics for appropriate situations. However, antibiotics should be used in conjunction with methods that strengthen the immune system, and the depleted beneficial bacteria should always be replaced. Most importantly, the cause of the infection needs to be addressed for true healing to take place.
by Ricki Lewis, Ph.D.
When penicillin became widely available during the second world war, it was a medical miracle, rapidly vanquishing the biggest wartime killer--infected wounds. Discovered initially by a French medical student, Ernest Duchesne, in 1896, and then rediscovered by Scottish physician Alexander Fleming in 1928, the product of the soil mold Penicillium crippled many types of disease-causing bacteria. But just four years after drug companies began mass-producing penicillin in 1943, microbes began appearing that could resist it.
The first bug to battle penicillin was Staphylococcus aureus. This bacterium is often a harmless passenger in the human body, but it can cause illness, such as pneumonia or toxic shock syndrome, when it overgrows or produces a toxin.
In 1967, another type of penicillin-resistant pneumonia, caused by Streptococcus pneumoniae and called pneumococcus, surfaced in a remote village in Papua New Guinea. At about the same time, American military personnel in southeast Asia were acquiring penicillin-resistant gonorrhea from prostitutes. By 1976, when the soldiers had come home, they brought the new strain of gonorrhea with them, and physicians had to find new drugs to treat it. In 1983, a hospital-acquired intestinal infection caused by the bacterium Enterococcus faecium joined the list of bugs that outwit penicillin.
Antibiotic resistance spreads fast. Between 1979 and 1987, for example, only 0.02 percent of pneumococcus strains infecting a large number of patients surveyed by the national Centers for Disease Control and Prevention were penicillin-resistant. CDC's survey included 13 hospitals in 12 states. Today, 6.6 percent of pneumococcus strains are resistant, according to a report in the June 15, 1994, Journal of the American Medical Association by Robert F. Breiman, M.D., and colleagues at CDC. The agency also reports that in 1992, 13,300 hospital patients died of bacterial infections that were resistant to antibiotic treatment.
Why has this happened?
"There was complacency in the 1980s. The perception was that we had licked the bacterial infection problem. Drug companies weren't working on new agents. They were concentrating on other areas, such as viral infections," says Michael Blum, M.D., medical officer in the Food and Drug Administration's division of anti-infective drug products. "In the meantime, resistance increased to a number of commonly used antibiotics, possibly related to overuse of antibiotics. In the 1990s, we've come to a point for certain infections that we don't have agents available."
According to a report in the April 28, 1994, New England Journal of Medicine, researchers have identified bacteria in patient samples that resist all currently available antibiotic drugs.
Survival of the Fittest
The increased prevalence of antibiotic resistance is an outcome of evolution. Any population of organisms, bacteria included, naturally includes variants with unusual traits--in this case, the ability to withstand an antibiotic's attack on a microbe. When a person takes an antibiotic, the drug kills the defenseless bacteria, leaving behind--or "selecting," in biological terms--those that can resist it. These renegade bacteria then multiply, increasing their numbers a millionfold in a day, becoming the predominant microorganism.
The antibiotic does not technically cause the resistance, but allows it to happen by creating a situation where an already existing variant can flourish. "Whenever antibiotics are used, there is selective pressure for resistance to occur. It builds upon itself. More and more organisms develop resistance to more and more drugs," says Joe Cranston, Ph.D., director of the department of drug policy and standards at the American Medical Association in Chicago.
A patient can develop a drug-resistant infection either by contracting a resistant bug to begin with, or by having a resistant microbe emerge in the body once antibiotic treatment begins. Drug-resistant infections increase risk of death, and are often associated with prolonged hospital stays, and sometimes complications. These might necessitate removing part of a ravaged lung, or replacing a damaged heart valve.
Disease-causing microbes thwart antibiotics by interfering with their mechanism of action. For example, penicillin kills bacteria by attaching to their cell walls, then destroying a key part of the wall. The wall falls apart, and the bacterium dies. Resistant microbes, however, either alter their cell walls so penicillin can't bind or produce enzymes that dismantle the antibiotic.
In another scenario, erythromycin attacks ribosomes, structures within a cell that enable it to make proteins. Resistant bacteria have slightly altered ribosomes to which the drug cannot bind. The ribosomal route is also how bacteria become resistant to the antibiotics tetracycline, streptomycin and gentamicin.
How Antibiotic Resistance Happens
Antibiotic resistance results from gene action. Bacteria acquire genes conferring resistance in any of three ways.
In spontaneous DNA mutation, bacterial DNA (genetic material) may mutate (change) spontaneously (indicated by starburst). Drug-resistant tuberculosis arises this way.
In a form of microbial sex called transformation, one bacterium may take up DNA from another bacterium. Pencillin-resistant gonorrhea results from transformation.
Most frightening, however, is resistance acquired from a small circle of DNA called a plasmid, that can flit from one type of bacterium to another. A single plasmid can provide a slew of different resistances. In 1968, 12,500 people in Guatemala died in an epidemic of Shigella diarrhea. The microbe harbored a plasmid carrying resistances to four antibiotics!
A Vicious Cycle: More Infections and Antibiotic Overuse
Though bacterial antibiotic resistance is a natural phenomenon, societal factors also contribute to the problem. These factors include increased infection transmission, coupled with inappropriate antibiotic use.
More people are contracting infections. Sinusitis among adults is on the rise, as are ear infections in children. A report by CDC's Linda F. McCaig and James M. Hughes, M.D., in the Jan. 18, 1995, Journal of the American Medical Association, tracks antibiotic use in treating common illnesses. The report cites nearly 6 million antibiotic prescriptions for sinusitis in 1985, and nearly 13 million in 1992. Similarly, for middle ear infections, the numbers are 15 million prescriptions in 1985, and 23.6 million in 1992.
Causes for the increase in reported infections are diverse. Some studies correlate the doubling in doctor's office visits for ear infections for preschoolers between 1975 and 1990 to increased use of day-care facilities. Homelessness contributes to the spread of infection. Ironically, advances in modern medicine have made more people predisposed to infection. People on chemotherapy and transplant recipients taking drugs to suppress their immune function are at greater risk of infection.
"There are the number of immunocompromised patients, who wouldn't have survived in earlier times," says Cranston. "Radical procedures produce patients who are in difficult shape in the hospital, and are prone to nosocomial [hospital-acquired] infections. Also, the general aging of patients who live longer, get sicker, and die slower contributes to the problem," he adds.
Though some people clearly need to be treated with antibiotics, many experts are concerned about the inappropriate use of these powerful drugs. "Many consumers have an expectation that when they're ill, antibiotics are the answer. They put pressure on the physician to prescribe them. Most of the time the illness is viral, and antibiotics are not the answer. This large burden of antibiotics is certainly selecting resistant bacteria," says Blum.
Another much-publicized concern is use of antibiotics in livestock, where the drugs are used in well animals to prevent disease, and the animals are later slaughtered for food. "If an animal gets a bacterial infection, growth is slowed and it doesn't put on weight as fast," says Joe Madden, Ph.D., strategic manager of microbiology at FDA's Center for Food Safety and Applied Nutrition. In addition, antibiotics are sometimes administered at low levels in feed for long durations to increase the rate of weight gain and improve the efficiency of converting animal feed to units of animal production.
FDA's Center for Veterinary Medicine limits the amount of antibiotic residue in poultry and other meats, and the U.S. Department of Agriculture monitors meats for drug residues. According to Margaret Miller, Ph.D., deputy division director at the Center for Veterinary Medicine, the residue limits for antimicrobial animal drugs are set low enough to ensure that the residues themselves do not select resistant bacteria in (human) gut flora.
FDA is investigating whether bacteria resistant to quinolone antibiotics can emerge in food animals and cause disease in humans. Although thorough cooking sharply reduces the likelihood of antibiotic-resistant bacteria surviving in a meat meal to infect a human, it could happen. Pathogens resistant to drugs other than fluoroquinolones have sporadically been reported to survive in a meat meal to infect a human. In 1983, for example, 18 people in four midwestern states developed multi-drug-resistant Salmonella food poisoning after eating beef from cows fed antibiotics. Eleven of the people were hospitalized, and one died.
A study conducted by Alain Cometta, M.D., and his colleagues at the Centre Hospitalier Universitaire Vaudois in Lausanne, Switzerland, and reported in the April 28, 1994, New England Journal of Medicine, showed that increase in antibiotic resistance parallels increase in antibiotic use in humans. They examined a large group of cancer patients given antibiotics called fluoroquinolones to prevent infection. The patients' white blood cell counts were very low as a result of their cancer treatment, leaving them open to infection.
Between 1983 and 1993, the percentage of such patients receiving antibiotics rose from 1.4 to 45. During those years, the researchers isolated Escherichia coli bacteria annually from the patients, and tested the microbes for resistance to five types of fluoroquinolones. Between 1983 and 1990, all 92 E. coli strains tested were easily killed by the antibiotics. But from 1991 to 1993, 11 of 40 tested strains (28 percent) were resistant to all five drugs.
Towards Solving the Problem
Antibiotic resistance is inevitable, say scientists, but there are measures we can take to slow it. Efforts are under way on several fronts--improving infection control, developing new antibiotics, and using drugs more appropriately.
Barbara E. Murray, M.D., of the University of Texas Medical School at Houston writes in the April 28, 1994, New England Journal of Medicine that simple improvements in public health measures can go a long way towards preventing infection. Such approaches include more frequent hand washing by health-care workers, quick identification and isolation of patients with drug-resistant infections, and improving sewage systems and water purity in developing nations.
Drug manufacturers are once again becoming interested in developing new antibiotics. These efforts have been spurred both by the appearance of new bacterial illnesses, such as Lyme disease and Legionnaire's disease, and resurgences of old foes, such as tuberculosis, due to drug resistance.
FDA is doing all it can to speed development and availability of new antibiotic drugs. "We can't identify new agents--that's the job of the pharmaceutical industry. But once they have identified a promising new drug for resistant infections, what we can do is to meet with the company very early and help design the development plan and clinical trials," says Blum.
In addition, drugs in development can be used for patients with multi-drug-resistant infections on an "emergency IND (compassionate use)" basis, if the physician requests this of FDA, Blum adds. This is done for people with AIDS or cancer, for example.
No one really has a good idea of the extent of antibiotic resistance, because it hasn't been monitored in a coordinated fashion. "Each hospital monitors its own resistance, but there is no good national system to test for antibiotic resistance," says Blum.
This may soon change. CDC is encouraging local health officials to track resistance data, and the World Health Organization has initiated a global computer database for physicians to report outbreaks of drug-resistant bacterial infections.
Experts agree that antibiotics should be restricted to patients who can truly benefit from them--that is, people with bacterial infections. Already this is being done in the hospital setting, where the routine use of antibiotics to prevent infection in certain surgical patients is being reexamined.
"We have known since way back in the antibiotic era that these drugs have been used inappropriately in surgical prophylaxis [preventing infections in surgical patients]. But there is more success [in limiting antibiotic use] in hospital settings, where guidelines are established, than in the more typical outpatient settings," says Cranston.
Murray points out an example of antibiotic prophylaxis in the outpatient setting--children with recurrent ear infections given extended antibiotic prescriptions to prevent future infections. (See "Protecting Little Pitchers' Ears" in the December 1994 FDA Consumer.)
Another problem with antibiotic use is that patients often stop taking the drug too soon, because symptoms improve. However, this merely encourages resistant microbes to proliferate. The infection returns a few weeks later, and this time a different drug must be used to treat it.
Stephen Weis and colleagues at the University of North Texas Health Science Center in Fort Worth reported in the April 28, 1994, New England Journal of Medicine on research they conducted in Tarrant County, Texas, that vividly illustrates how helping patients to take the full course of their medication can actually lower resistance rates. The subject--tuberculosis.
TB is an infection that has experienced spectacular ups and downs. Drugs were developed to treat it, complacency set in that it was beaten, and the disease resurged because patients stopped their medication too soon and infected others. Today, one in seven new TB cases is resistant to the two drugs most commonly used to treat it (isoniazid and rifampin), and 5 percent of these patients die.
In the Texas study, 407 patients from 1980 to 1986 were allowed to take their medication on their own. From 1986 until the end of 1992, 581 patients were closely followed, with nurses observing them take their pills. By the end of the study, the relapse rate--which reflects antibiotic resistance--fell from 20.9 to 5.5 percent. This trend is especially significant, the researchers note, because it occurred as risk factors for spreading TB--including AIDS, intravenous drug use, and homelessness--were increasing. The conclusion: Resistance can be slowed if patients take medications correctly.
Narrowing the Spectrum
Appropriate prescribing also means that physicians use "narrow spectrum" antibiotics--those that target only a few bacterial types--whenever possible, so that resistances can be restricted. The only national survey of antibiotic prescribing practices of office physicians, conducted by the National Center for Health Statistics, finds that the number of prescriptions has not risen appreciably from 1980 to 1992, but there has been a shift to using costlier, broader spectrum agents. This prescribing trend heightens the resistance problem, write McCaig and Hughes, because more diverse bacteria are being exposed to antibiotics.
One way FDA can help physicians choose narrower spectrum antibiotics is to ensure that labeling keeps up with evolving bacterial resistances. Blum hopes that the surveillance information on emerging antibiotic resistances from CDC will enable FDA to require that product labels be updated with the most current surveillance information.
Many of us have come to take antibiotics for granted. A child develops strep throat or an ear infection, and soon a bottle of "pink medicine" makes everything better. An adult suffers a sinus headache, and antibiotic pills quickly control it. But infections can and do still kill. Because of a complex combination of factors, serious infections may be on the rise. While awaiting the next "wonder drug," we must appreciate, and use correctly, the ones that we already have.
If this bacterium could be shown four times bigger, it would be the right relative size to the virus beneath it. (Both are microscopic and are shown many times larger than life.)
Although bacteria are single-celled organisms, viruses are far simpler, consisting of one type of biochemical (a nucleic acid, such as DNA or RNA) wrapped in another (protein). Most biologists do not consider viruses to be living things, but instead, infectious particles. Antibiotic drugs attack bacteria, not viruses.
The Greatest Fear--Vancomycin Resistance
When microbes began resisting penicillin, medical researchers fought back with chemical cousins, such as methicillin and oxacillin. By 1953, the antibiotic armamentarium included chloramphenicol, neomycin, terramycin, tetracycline, and cephalosporins. But today, researchers fear that we may be nearing an end to the seemingly endless flow of antimicrobial drugs.
At the center of current concern is the antibiotic vancomycin, which for many infections is literally the drug of "last resort," says Michael Blum, M.D., medical officer in FDA's division of anti-infective drug products. Some hospital-acquired staph infections are resistant to all antibiotics except vancomycin.
Now vancomycin resistance has turned up in another common hospital bug, enterococcus. And since bacteria swap resistance genes like teenagers swap T-shirts, it is only a matter of time, many microbiologists believe, until vancomycin-resistant staph infections appear. "Staph aureus may pick up vancomycin resistance from enterococci, which are found in the normal human gut," says Madden. And the speed with which vancomycin resistance has spread through enterococci has prompted researchers to use the word "crisis" when discussing the possibility of vancomycin-resistant staph.
Vancomycin-resistant enterococci were first reported in England and France in 1987, and appeared in one New York City hospital in 1989. By 1991, 38 hospitals in the United States reported the bug. By 1993, 14 percent of patients with enterococcus in intensive-care units in some hospitals had vancomycin-resistant strains, a 20-fold increase from 1987. A frightening report came in 1992, when a British researcher observed a transfer of a vancomycin-resistant gene from enterococcus to Staph aureus in the laboratory. Alarmed, the researcher immediately destroyed the bacteria.
Ricki Lewis is a geneticist and textbook author.
Despite nearly 20 years of imploring doctors to control inappropriate use of antibiotics, an international group admitted there is little to show the average doctor has changed prescription habits.
But the Alliance for the Prudent Use of Antibiotics (APUA) hasn't given up the battle to restrict the use of the drugs - especially in face of growing bacterial resistance.
"There is no data that shows there has been any change in the number of antibiotic prescriptions being written by doctors," said Dr. Thomas Hooton, professor of medicine at the University of Washington, Seattle.
However, Hooton said that numerous reports of the dangers of antibiotic overuse may still have had an effect in preventing even greater inappropriate use of antibiotics, and he said he expects the use to slow as doctors realize the threat of resistant bacteria.
At the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), an infectious disease meeting of the American Society for Microbiology in San Francisco, experts met to formulate a stronger game plan to educate doctors and patients about the long-term consequences of overuse of antibiotics.
"The emergence of a resistant bacteria - particularly Staphylococcus aureus - to all antibiotics is terrifying to doctors," said Hooton, but he acknowledged that the general public seemed more nonchalant about the virulent strains of bacteria. Most alarming is the recent appearance of a lethal strain of a resistant S. aureus germ that resulted in the death of four children and sickness of over 200 people in Minnesota and North Dakota over a two-year period.
Hooton said doctors have to take the forefront in educating patients to the idea that antibiotics are not necessary for treatment every time a child has an infection. "We can treat the symptoms of fever and pain with aspirin and Tylenol," Hooton said. "Antibiotics aren't needed."
Hooton, co-chairman of a symposium on the topic at ICAAC, said, "We hope our meeting is the first step toward encouraging physicians and patients to make the necessary decision that will help control the resistance problem."
According to the Centers for Disease Control and Prevention (CDC), one-third of the 150 million outpatient antibiotic prescriptions every year are unneeded. Scientists have reported for years that unnecessary overuse of antibiotics creates "superbugs" that are resistant to the lifesaving medications, reducing the antibiotics' effectiveness.
The CDC reported that over the past 23 years, resistance of hospital- acquired infections to the most widely used antibiotics in all settings was up by nearly 50 percent.
At the symposium, doctors agreed that actions needed to control overuse of antibiotics include:
-Better patient-doctor communication to select best treatment.
-Recognition that antibiotics are ineffective against viral infections such as the common cold.
-Patients should not demand antibiotics.
-Doctors should use narrow-spectrum drugs when appropriate so broad- spectrum antibiotics can be used in more serious cases.
-Better hygiene by patients and physicians can reduce infections - such as washing hands regularly with soap and water.
APUA is a nonprofit organization found in 1981 with the goal of prolonging effective use of antibiotics.
Copyright 1999 by United Press International
All rights reserved
provided by KeepAntibioticsWorking.com
hroughout America, infectious diseases are emerging that we may not be able to cure because bacteria have become resistant to antibiotics.
For the past sixty years, the use of antibiotic drugs has turned bacterial infections into treatable conditions, rather than the life-threatening scourges they once were. Physicians depend on antibiotics such as penicillin, tetracycline, and erythromycin to treat many illnesses caused by bacteria, from ear and skin infections to pneumonia, food poisoning, meningitis, and other life-threatening infections. Antibiotics are crucial in treating infections that may result from medical procedures such as surgery, chemotherapy and transplants.
Today, however, doctors report increasing numbers of bacterial infections that fail to respond to antibiotic treatment. A federal government task force recently noted that antibiotic resistance is a growing menace to all people, cautioning that continued spread of resistance means that treatments for common infections will become increasingly limited and expensive and, in some cases, nonexistent.
The overuse of antibiotics
Although even the most careful use of antibiotics can result in the emergence of antibiotic-resistant bacteria, widespread and inappropriate use of these precious drugs greatly accelerates the process. The more often bacteria are exposed to antibiotics, the more likely that resistance will develop. Because bacteria reproduce rapidly, sometimes in as little as 20 minutes, it does not take long for antibiotic-resistant bacteria to spread.
A major source of antibiotic overuse is livestock producers unnecessarily feeding antibiotics to healthy farm animals to promote growth and compensate for unsanitary conditions found in industrial animal agriculture. The Union of Concerned Scientists estimates that 70% of all antibiotics in the United States are used in healthy pigs, poultry, and beef cattle.
Those antibiotics routinely given to healthy livestock and poultry include many that are identical, or nearly so, to drugs used in treating humans. Antibiotics have long been fed to animals because they allow the animals to grow slightly faster on the same amount of feed, thereby increasing profits for meat producers. The exact mechanism by which antibiotics promote growth is not known.
Human medical practices also contribute to the overuse of antibiotics. Often, antibiotics are prescribed for patients with illnesses like the flu or the common cold that can't be treated or cured with antibiotics. In 1995, the US Office of Technology Assessment estimated that up to half of all antibiotics prescribed by doctors were prescribed inappropriately. And in hospitals, antibiotic overuse has been a major factor in causing drug-resistant infections to skyrocket. Patients also contribute to the problem, by requesting antibiotics when they're not needed and by not completing the entire course of antibiotics when prescribed, which kills off the susceptible bacteria and leaves the more resistant bacteria to reproduce.
We're all at risk.
The spread of this new generation of infections resistant to antibiotic treatments has serious consequences for public health. Antibiotic-resistant bacteria may keep people sicker longer, and sometimes people are unable to recover at all. Children, the elderly, and those with weakened immune systems (including cancer, HIV/AIDS, and transplant patients) are particularly vulnerable because their immune systems are not as vigorous as those of healthy adults.
Antibiotic resistance on the rise
Resistant bacterial infections increase health care costs by at least $4 billion per year in the United States.
One out of six cases of Campylobacter infection, the most common cause of food poisoning, is resistant to fluoroquinolones, the drugs most often used to treat severe food-borne illness. Just six years ago, before fluoroquinolones were approved for use in poultry, such resistance was negligible. Campylobacter accounts for 2.4 million illnesses and over 120 deaths each year in the United States.
One out of three cases of human infection by a particular strain of Salmonella bacteria is resistant to more than five different antibiotics. Salmonella causes 1.4 million illnesses and 580 deaths annually in the United States
Nearly all strains of Staphlococcus infections in the United States are resistant to penicillin, and many are resistant to newer drugs.
Because of the growing health crisis of antibiotic resistance, the American Medical Association now opposes the use of antibiotics in healthy farm animals. In addition, the American College of Preventive Medicine, the American Public Health Association, the Council of State and Territorial Epidemiologists, and the World Health Organization have taken similar positions.
Drug-resistant bacteria transmission to humans
People can become infected by eating undercooked contaminated meat, or by eating other foods or using utensils that have come in contact with meat juices. In addition, farmers, farm families, and slaughterhouse workers are routinely exposed to antibiotics or antibiotic-resistant bacteria, or both. Finally, significant quantities of antibiotics and antibiotic-resistant bacteria enter the environment through the nearly two trillion pounds of animal wastes produced annually in the United States by animal agriculture operations. Farm waste runoff can enter rivers, lakes, and ground water, and these wastes are sometimes spread on agricultural fields as fertilizer as well.
What should be done?
A recent study from Denmark, where the use of antibiotics in healthy farm animals was banned, demonstrates that ending this practice dramatically reduces the levels of resistant bacteria present in those animals. To keep antibiotics working for people who need them, we must stop the overuse of antibiotics in healthy pigs, poultry, and cattle, especially antibiotics that are also used in human medicine. Four steps must be taken:
Congress or the U.S. Food and Drug Administration (FDA) should phase out the use of medically important antibiotics in healthy livestock and poultry.
Companies involved in the production and marketing of meat and poultry (meat producers, supermarkets, restaurants, factory farms, etc.) should voluntarily agree to stop buying or selling meat produced with antibiotics for purposes other than treating sick animals. (A 1999 National Academy of Sciences report estimated that the elimination of all such uses of antibiotics in poultry, cattle, and swine production would cost consumers only $5 to $10 per person annually).
Congress or FDA should require the collection of accurate data on the production and use of antibiotics in both human medicine and animal agriculture, and make that information available to the public.
Talk with your doctor to make sure that antibiotics, which work against bacterial infections, are not prescribed for viral infections such as the cold or flu. Also, take the full course of any antibiotic, as prescribed.
The September, 2001 issue of the Journal of Pediatrics reports that giving infants the antibiotic erythromycin, especially within the first two weeks of life, can increase their chances of developing an intestinal disorder that likely will require surgery.
The disorder, called infantile hypertrophic pyloric stenosis (IHPS), occurs when the tube leading from the stomach to the small intestine (the pyloris) becomes enlarged, blocking the stomach's outlet. This results in projectile vomiting, dehydration and weight loss. IHPS is the most common cause of abdominal surgery in infancy. The researchers also found that there may be a link between IHPS and a mother using the antibiotic during the last 10 weeks of pregnancy as well. The study also saw some evidence that two related antibiotics, azithromycin and clarithromycin may also be linked to IHPS.
Women Who Take Antibiotics Are at Increased Risk, But Researchers Aren't Sure Why
By Salynn Boyles
WebMD Medical News Reviewed By Charlotte Grayson, MD
Feb. 17, 2004 - New research links the use of antibiotics to an increase in breast cancer risk, but it is not yet clear if taking the drugs actually causes the disease.
In the study, women who had more than 25 antibiotic prescriptions filled over roughly 17 years had twice the risk of breast cancer as women who never took antibiotics. The risk was smaller, but still elevated, for women who took fewer antibiotics, and the increase in risk was seen for all classes of antibiotics tested.
"We are saying that there is an association between antibiotic use and breast cancer, but we are not saying that antibiotics cause breast cancer," study co-author Stephen H. Taplin, MD, MPH, tells WebMD. "We definitely need to look more closely at this association to try and find the cause."
The National Cancer Institute-supported study is in this week's issue of the Journal of the American Medical Association.
Inflammation Might Explain Link
Taplin says antibiotic use may directly influence breast cancer risk, or the increased risk may be linked to the diseases women are using antibiotics to treat. In an editorial accompanying the study, University of Pittsburgh epidemiologist Roberta Ness, MD, noted that there is compelling evidence linking the inflammation which can result from chronic infection to breast cancer. Such infections are routinely treated with antibiotics.
In an interview with WebMD, Ness said the study should not scare women away from taking antibiotics when they are needed. But she added that there is an urgent need for everyone to take fewer antibiotics when they are not needed.
The over-reliance on antibiotics to treat conditions for which they are not effective, such as colds and other viral infections, has contributed to the worldwide problem of drug-resistant bugs. The U.S. Centers for Disease Control and Prevention (CDC) reports that virtually all significant bacterial infections are becoming resistant to the antibiotic treatment of choice.
"Antibiotics save lives, but the overuse of antibiotics is the thing that scares me most in public health," Ness says. "If the effect of this study is to make a woman think twice about asking her doctor for an antibiotic when she may not need one, that would be a positive thing."
Other Ways to Reduce Risk
In the study, medical records were reviewed for 2,266 breast cancer patients and 7,953 women without cancer enrolled in a Washington State health plan. Lead author Christine M. Velicer, PhD, and colleagues reviewed the total number of antibiotic prescriptions filled and the total number of days on antibiotics.
The researchers found that the more antibiotics the women took over the observation period of roughly two decades, the higher their risk of breast cancer. The study is only the second to examine the impact of antibiotic use on breast cancer. A study from Finland, also involving roughly 10,000 women, also found a link between the two.
American Cancer Society breast cancer spokesperson Debbie Saslow, PhD, agrees that it is far too soon to say that antibiotics cause breast cancer.
"It is important for women who need to be on antibiotics for medically valid reasons to not be afraid to take them," she tells WebMD. "There are many other proven ways to lower breast cancer risk, such as exercising, maintaining body weight, and if you drink alcohol, drink less or stop. And most women have gotten the message about hormone replacement therapy. Limiting the use of HRT [hormone replacement therapy] can also reduce risk."
SOURCES: Velicer et al., Journal of the American Medical Association, Feb. 19, 2004; Vol. 291: pp. 827-836 Christine M. Velicer, PhD, Group Health Cooperative Center for Health Studies, Seattle, WA. Roberta Ness, MD, MPH, chair, department of epidemiology, University of Pittsburgh. Stephen H. Taplin, MD, MPH, senior scientist, Division of Cancer Control and Population Sciences, National Cancer Institute. Debbie Saslow, PhD, director of breast and gynecologic cancers, American Cancer Society.
More Allergy, Asthma When Antibiotics Given Before 6 Months Old
By Salynn Boyles
WebMD Medical News Reviewed By Michael Smith, MD
on Tuesday, September 30, 2003
Sept. 30, 2003 - Evidence continues to build for the so-called "hygiene hypothesis" as the latest study shows that babies treated with antibiotics during the first six months of life may be at increased risk for developing allergies and asthma during childhood.
Investigators from Detroit's Henry Ford Hospital report three times as much asthma in high-risk children given antibiotics before the age of 6 months. These children were also almost twice as likely to develop allergies to pets, ragweed, grass, and dust mites by age 7.
Consistent with previous research, living in households with at least two cats and/or dogs during the first year of life appeared to protect the children against allergies and against asthma caused by allergies. But being breastfed for four months or more was found to increase their risk.
Lead researcher Christine Cole Johnson, PhD, presented the findings at the European Respiratory Society's annual conference in Vienna, Austria.
"I'm not suggesting children shouldn't receive antibiotics, but I believe we need to be more prudent in prescribing them for children at such an early age," Johnson noted in a news release. She added that antibiotics are too often prescribed to treat illness for which they have no effect, such as colds and the flu.
Roughly half of the 445 children enrolled in the study had been treated with antibiotics before the age of 6 months. Antibiotic use was recorded from birth, and at age 6 or 7 years the children underwent a battery of tests for allergies and asthma.
Risk was slightly increased for all children treated with antibiotics before 6 months of age, but it was most elevated for those who were found to be at high risk for allergies and for asthma caused by allergies. Clinical epidemiologist and study co-researcher Keoki Williams, MD, MPH, says high-risk children included those who lived in a household with fewer than two cats and/or dogs, had a family history of allergies, or were breastfed for four months or more.
Although breastfeeding has been linked to an increase in allergies and asthma, it's important to note that breastfeeding is associated with a wide array of health benefits and is still the preferred method of feeding young infants.
It is now widely believed that early childhood exposure to bacteria and other infection-causing agents helps protect against allergies and asthma. This hygiene hypothesis suggests that increasingly sterile environments are to blame for the dramatic rise in allergic diseases during the past few decades.
Overuse of antibiotics has been implicated because the drugs kill bacteria in the gut, which may, in turn, weaken the immune system.
"For asthma, especially, exposure to antibiotics that eradicate a wide variety of bacteria seemed to really increase risk," Williams tells WebMD. "[Like antibiotics], breastfeeding is believed to be protective against infections, and if that is so it may be a risk factor for allergies and asthma."
Pediatric pulmonologist Stanley Goldstein, MD, tells WebMD that studies like this one lend credibility to the hygiene hypothesis and give rise to the hope of developing effective interventions to prevent allergies and asthma.
"There are studies going on now looking at whether exposing children to these agents [bacteria and other infections] very early in life is protective against allergic diseases," he says. "Based on the scientific evidence that we have seen in the past few years, there is a lot of optimism that this approach will work."
SOURCES: European Respiratory Society 13th Annual Congress, Vienna, Austria, Sept. 27-Oct. 1, 2003. Keoki Williams, MD, MPH, clinical epidemiologist, Henry Ford Hospital, Detroit. Stanley Goldstein, MD, pediatric pulmonologist, Long Island, New York; board of directors, American Academy of Allergy, Asthma, and Immunology. News release, Henry Ford Health System.
By Alison Palkhivala
WebMD Medical News Archive Reviewed By Charlotte Grayson, MD
March 19, 2001 -- Getting those telltale signs of a runny nose, fever, cough, sore throat, or sneezing? You probably have a cold. Go to the doctor if you feel you need to, but don't expect to be prescribed an antibiotic, and for the sake of your own health, don't ask for one.
More and more evidence is emerging that the vast majority of these upper respiratory tract infections do not require antibiotic treatment and that doctors, often bowing to pressure from their patients, are prescribing antibiotics anyway. Not only does this open patients up to side effects of antibiotics that they probably don't need anyway, but it contributes to the development of bacteria that are resistant to antibiotics, making it more difficult to treat potentially serious infections when they arise.
"Probably 80-90% of the time upper respiratory tract infections or sore throats are caused by viruses, not by bacteria that need to be treated with antibiotics," W. Lee Fanning, MD, tells WebMD. "People often don't understand the difference between a bacteria and a virus. Viruses do not respond to antibiotics, [but bacteria do,] and when you use antibiotics on the majority of people who have a viral infection, you're selecting out bacteria in their system [that are resistant to the antibiotic] that then can be transmitted to other people." Fanning is chief of infectious disease at Geisinger Health System in Danville, Pa.
In an attempt to put a halt to the inappropriate prescribing of antibiotics for upper respiratory tract infections in otherwise healthy adults, the CDC has teamed up with the American College of Physicians-American Society of Internal Medicine to produce a set of guidelines, published in the March 20 issue of the medical journal Annals of Internal Medicine, outlining appropriate treatment of such conditions.
"The new developments regarding antibiotic treatment of upper respiratory tract infections is showing that there is no need to use antibiotics in the great majority of these infections," Vincenza Snow, MD, one of the authors of the guidelines, tells WebMD. "More and more evidence is showing that overuse of antibiotics ... has been driving the precipitous rise in antibiotic resistance. " Snow is a senior medical associate in scientific policy at the American College of Physicians.
"There's a lot of patient pressure [on doctors] to give an antibiotic, because we have trained patients to expect antibiotics," says Snow. "[People with an upper respiratory tract infection need to] know that they are not going to get better in two to three days; these things tend to last up to two weeks."
Antibiotics can also be pricey and cause side effects such as intestinal discomfort and allergic reactions.
Fanning says his patients often tell him they want an antibiotic because the last time they had similar symptoms they took one and got better within seven to 10 days. What they don't know, he says, is that these patients would have gotten better in that amount of time even without the antibiotic.
"Don't ask for an antibiotic," says Richard E Besser, MD, another author of the guidelines. "Ask for the best treatment available. Talk with your clinician about what to expect with your illness and question whether you need an antibiotic. ... There are studies that show that a clinician is more likely to prescribe an antibiotic if he or she thinks the patient wants one, regardless of the diagnosis and regardless of whether the patient truly wants one. That shows that if patients and doctors can talk to each other and truly express their wishes, that in itself will decrease the over-reliance on antibiotics." Besser is director of the CDC campaign to promote appropriate antibiotic use for respiratory infections
The highlights of the guidelines, which the experts emphasize are only appropriate for otherwise healthy adults without any chronic diseases are summarized below:
General upper respiratory tract infections: Standard colds, flu, coughs, and runny noses are almost always caused by a virus, so antibiotics will have absolutely no effect and should not be prescribed.
Acute sinusitis: Neither antibiotics nor sinus X-rays are necessary for typical cases of sinusitis. This condition is most often caused by a virus, but it will usually go away on its own even if it is bacterial. Antibiotics should only be used if the symptoms are really severe and your doctor is convinced the cause is bacterial.
Acute bronchitis: Once your doctor rules out pneumonia, which does require antibiotic treatment, there is no need to treat acute bronchitis with antibiotics. The condition is almost always caused by a virus and will go away on its own. It may take weeks for the cough to disappear, but antibiotics will not speed up recovery. Take over-the-counter painkillers, fever reducers, inhalers, cough suppressants, and vaporizers to help you feel better.
Acute sore throat: Sore throats will go away on their own, and antibiotics will only speed the process up if you have strep throat (which occurs in about 10% of sore throats). Your doctor will look for signs like high fever, swollen glands, pus on your tonsils, and lack of cough to determine whether you have strep throat and might use a simple in-office test to confirm any suspicions. Tell your doctor if you spend a lot of time with small children, as this might affect the decision to prescribe antibiotics.
The American College of Physicians-American Society of Internal Medicine has developed a patient education brochure that can be obtained by calling 1-800-523-1546, ext. 2600.
By Laurie Barclay
WebMD Medical News Archive Reviewed By Dr. Tonja Wynn Hampton
Feb. 16, 2001 -- Homeopathy is a popular form of alternative medicine based on the concept of "similars" -- the idea that the same substance that could make a person ill in large amounts could actually relieve symptoms of that illness in very small amounts. In other words, that which doesn't kill you makes you stronger.
The applications of homeopathy are widespread -- everything from treating the common cold to clearing up childhood ear infections. It's this latest use that caught the attention of a group of West Coast researchers, who set out to evaluate in a scientific way the many reports of homeopathic success.
"We set this up as a pilot study, not really expecting to see any positive effect from homeopathy," says researcher Jennifer Jacobs, MD, MPH, clinical assistant professor of epidemiology at the University of Washington School of Public Health and Community Medicine in Seattle. "We were surprised that homeopathy decreased symptoms [of middle ear infections] in the first 24 hours of treatment."
The implications are important. Not only did the researchers determine that individualized homeopathic treatments can give early relief to the ear pain, fever, and fussiness associated with ear infections, they also say such treatment could potentially help reduce antibiotic use in children, something which has been associated with increasing rates of antibiotic resistance.
The study, which appears in the February issue of the Pediatric Infectious Disease Journal, was funded by the Standard Homeopathic Company and took place in a private pediatric practice in Seattle. Children with middle ear infection received either a homeopathic remedy geared to their specific symptoms, or a placebo. They took the pills three times daily for five days, or until their ear pain and fever got better, whichever came first.
The children, aged 18 months to 6 years, were divided into two groups, with 36 receiving homeopathic treatment and 39 getting placebo. Neither the researchers nor the parents knew which treatment each child got until the study was over.
Eight different homeopathic remedies were given in combinations that were individualized for each child, depending on his or her mood, type of pain, amount of thirst, and length of time with symptoms. The most commonly used remedies were Pulsatilla (windflower), Chamomilla (German chamomile), Sulfur (elemental sulfur), and Calcarea carbonica (calcium carbonate).
At the beginning of treatment, all the children had fluid in the middle ear and had suffered ear pain and/or fever -- but for less than 36 hours. The doctors examined them for objective measures of ear infection, specifically fluid in the middle ear. They also looked at subjective measures by asking parents and children to report in a diary whether they felt less pain and had less fever during the course of treatment.
To assess the treatment, doctors checked the children after five days, two weeks, and six weeks, and found that over this range of time, 10-20% of the homeopathy group showed more signs of improvement than the kids taking placebo. The researchers admit the study was too small to know for sure if this difference could be explained by chance alone, or to tell if the homeopathic treatment reduced the need for antibiotics.
But when the researchers looked at the symptom diaries, they found that at 24 and 64 hours after treatment, the children who got the homeopathic treatment reported significantly less ear pain and fever than those who received placebo.
"This finding may actually be more important ... since early symptom relief may help prevent overuse of antibiotics," Jacobs says.
In light of increasing fears concerning antibiotic resistance, many pediatricians are adopting a "watch and wait" approach to ear infections, reserving antibiotic use for those children who do not improve within a couple of days.
As there are essentially no side effects from homeopathic medications, parents can safely give them to their children at the first sign of ear infection. "Homeopathic medications are good to decrease symptoms while we're waiting for the body to do its work and fight off the infection," Jacobs says. "And kids like taking them because of their sweet taste."
If high fever and ear pain persist after 24 hours, Jacobs recommends that parents consult their pediatrician, who may then elect to start appropriate antibiotics.
"On its own, ... this study is not sufficient to warrant a conclusion that homeopathy is effective for [ear infections]," says Andrew Vickers, PhD, an independent research consultant to the Royal London Homoeopathic Hospital in the U.K., who was asked to review the study for WebMD. Nevertheless, Vickers finds the study "provocative" and suggests it be replicated with a larger number of patients.
Ralph Ballard, MD agrees that more research is needed and recommends that future studies compare homeopathy to both placebo and to antibiotic treatment. Ballard is a professor of family medicine at Monash University in Victoria, Australia.
And although she agrees that homeopathy deserves more rigorous evaluation, Australian doctor Marie Pirotta predicts there may be difficulties in doing so. Because homeopathic treatments are created individually for each patient, it may be impossible to design a traditional scientific study to compare them.
"This is always going to be a problem with trials of this type," says Pirotta, who teaches at the University of Melbourne in Carlton, Australia.
by Suzanne Laurie
originally published March 2004
What does perplex many of us is how safe, effective and abundant natural alternatives have been disregarded and rejected for so long.
In this article, Suzanne Laurie describes the result of the over use of antibiotics and suggests alternative natural remedies to be used, especially for minor complaints. Antibiotic medication produced great excitement when it was introduced in the 1930s. Many thought it would be the cure for all infectious diseases. What was not taken into account was the adaptability of bacteria and their increased resistance and we are now in a situation where antibiotics are fast becoming obsolete through overuse.
Because of the initial success of antibiotics, research into alternatives such as vitamins and bacteriophages was halted until quite recently. Moreover, pharmaceutical companies are continuing their search for stronger and stronger antibiotics rather than looking for a more sustainable alternative. This is because they are still making huge profits from their patented synthetic drugs.
Laurie acknowledges that antibiotics have an important use in medicine, especially when the bacteria has infected blood stream, bone, spinal cord or other vital organs. She feels, however, that there are many remedies for more common ailments which have been vastly neglected. These include herbs such as echinacea and garlic. The former stimulates the immune system and is a mild antibiotic, and the latter is an excellent antibacterial, antiviral and antifungal agent. Propolis, made by bees to ensure an infection-free environment for egg laying, can be used as a strong antiseptic, antibiotic, antifungal and antiviral agent. Antioxidants can also be used, not to attack pathogens directly, but to ensure optimal immune function. The body manufactures its own antioxidants from minerals such as copper, manganese, selenium, zinc and the Vitamin B complex. It also uses ready-made antioxidants from vitamins A, C and E, carotenoids and zinc. The best foods where antioxidants are to be found are dark green vegetables, dark coloured berries, carrots and other yellow, red or orange vegetables and fruit. Many essential oils also have excellent antiviral and antibacterial effect, most notably oregano, clove, tea tree and thyme.
Laurie concludes with two case studies, one of a 17 year old girl with recurrent throat infection and one of a 26 year student with a skin rash caused by bacterial infection.
In the first case an improved diet with more fruit and vegetables, a multivitamin and mineral supplement and the use of echinacea when she felt ill, produced a good result with only one infection shortly after the initial consultation and only one other mild sore throat. In the second case a high dose of multivitamin and mineral plus extra antioxidants was prescribed, together with daily intake of garlic and the application tea tree oil to the rash. After two months only scarring remained.
Contrary to what most mainstream doctors will tell you, there are effective alternatives to pharmaceutical antibiotics. These agents have not been adequately studied, but have many years of anecdotal evidence behind them.
Echinacea, for example, was recently shown to be one of the best natural antibiotics in a study at the University of Munich. Dr Alfred Vogel promoted Echinacea for more than 40 years and this report proves that there are natural ways to support and boost the defenses of the human body. This North American plant was originally used by Indians for the healing of wounds, snake bites, and infections. It inhibits the ability of the bacteria to penetrate cells and it particularly stimulates a certain type of white blood cells called macrophages that consume the bacteria present in our body. It is beneficial as a single remedy but can profitably be taken together with Goldenseal, Hydrastis canadensis. Liquid Cone flower extracts are usually preferable as they have the most rapid effect.
1:2 liquid extract: 10 - 20 ml. a day in acute infections.
Goldenseal (Hydrastis canadensis) A North American plant - just like Cone flower - used as a medicinal herb by the Indians. The active substances of this plant include various alkaloids, e.g. berberine. It has cleansing, disinfectant, and bacteriostatic effects.
Dried root (10% alkaloid): 250 mg. 3 times a day.
St. John's wort (Hypericum perforatum) From ancient times, this herb has been used as an ingredient in wound ointments. In addition to its mood-lifting effect, St. John's wort is known for its anti-inflammatory and antibacterial effects that can kill off resistant staphylococci. Among other things, St. John's wort contains the substance hyperforin which has antibiotic effects. The plant can also be used externally. It can profitably be used together with Cone flower. St. John's wort is non-toxic in the recommended dosages and detoxifies the body to such a degree that conventional medicine taken together with St. John's wort might lose its effect. You should therefore consult your doctor if you consider taking St. John's wort whilst taking conventional medicine. If you are using St. John's wort, you should avoid strong sunlight as the herb can make you hypersensitive to light.
1:2 liquid extract: 5 ml. a day in case of acute infection.
Dried root: 4 g. 3 times a day in case of acute infection.
Garlic (Allium sativum) Garlic has a long tradition of being a natural antibiotic. Hippokrates, the founder of the art of healing, recommended this herb among other things as a disinfectant. Today, we known that when garlic is crushed, its ingredients come into contact with each other and make antibacterial connections, e.g. the sulphur compound allicin. Garlic juice has been proved to either inhibit or kill more than 20 bacterial species. However, garlic has the best effect on intestinal or respiratory infections.
Fresh garlic: A minimum of 3 large cloves of garlic a day. Acutally, there is no upper limit in case of acute infections.
Dried powder: 300 mg. 3 times a day before meals in case of acute infections.
Probiotics: "For therapeutic use, acidophilus products should be measured in billions of CFU (colony-formingunits)". Aim for 3 to 5 varieties. Use human strains. Fortunately, the digestive tract acts as a fertile ground in which we can plant new, healthy organisms, and those organisms are called probiotics. Taking these valuable mixtures of Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacteria longum, and other organisms can restore proper digestive function. Saccharomyces boulardii is a special organism that seems to have some use in treating Clostridium dificile, a dangerous digestive infection that results from overuse of antibiotics. Probiotics provide innumerous benefits to your health and body. Listed are some of the ways they can help: As an immune system booster, In the fight against cancer, For digestive health,To fight infections (viral, bacterial, fungal), As an intestinal cleanser, In the battle against environmental toxins (in the air we breathe, the water we drink, etc.)
Colostrum: In the July 2000 issue of the American Journal of Clinical Nutrition, British researchers combed the research on the use of bovine colostrum for a variety of gastrointestinal conditions, including inflammatory bowel disease, and also gastrointestinal injury caused by either anti-inflammatory drugs (like ibuprofen) or chemotherapy. The authors conclude that "early results are encouraging and we envisage the standard use of these products in the clinical management of gastrointestinal diseases within the next decade." Colostrum is rich in immune stimulating substances like immunoglobulins.
Selasih: The botanical name for this plant is ocimum sanctum. It is called tulasi by Indians. The English name is Holy basil. It is held is very high esteem in Ayurveda, the Indian science of traditional healing. In fact, next to the lotus, it is the second most sacred herb of the vedas (the ancient holy books). It is known as the "herb with many cures". As it has a very high place in Ayurveda, it is a very well researched herb. Among its many documented effects are as immunostimulant, expectorant, anti-emetic, anti-inflammatory, anthelmintic, antiseptic, analgesic, hepatoprotective, stress adaptogen, anti-cattarhal and mild blood purifier.
Liver herbs: The bitter herb, hempedu bumi (andographis paniculata) is an excellent antibiotic.
Vitamin C: Robert Cathcart, M.D. - probably the most experienced therapist currently using very high doses of ascorbic acid - has been treating with the nutrient for decades to get AIDS patients back on their feet. In a published report he describes the use of oral vitamin C in bacterial infections with doses as high as 200 grams or higher. He includes over 30 references of others who have used very high doses in disease treatment. A fantastic remedy against all bacterial infections. The only reason why some individuals have not had good results from taking vitamin C must be that they have taken too little. The white blood cells designed to remove bacteria from any undesirable place in the entire body are dependent on vitamin C and the level of activity of the blood cells increases with increased amounts of this vitamin.
In acute bacterial infections, you (adults) should normally take 2 - 3 g. vitamin C as a shock dose. After this, take 1½ - 2 g. every hour - in severe cases even more. In very serious cases it might be necessary to take vitamin C in larger intravenous injections - a doctor will administer this.
The sooner the treatment is initiated, the sooner you will overcome the infection. In order to increase the absorption of vitamin C, it might be a good idea to supplement with some bioflavonoids; e.g. fresh fruit- or vegetable juice. Once your body has reached its saturation point for vitamin C, your stools will get thin. Then slowly step down the dose to normal dose.
Olive Leaf Extract: This flavonoid and antioxidant has been tested as an antimicrobial agent, with sufficient power to achieve a published status in peer-review journals.Olive leaf extract has been used against infections for thousands of years and its effect has been confirmed by recent scientific studies. The fruit, bark, and roots - and particularly the leaves - of the olive trea contain the bitter substance oleuropein which both stimulates the white blood cells and prevents the propagation of microorganisms, including bacteria, by disturbing their production of amino acids.
The dosage in acute bacterial infections is 1 capsule (500 mg., at least 15% oleuropein) to be taken for 1 week 3 times a day between meals. In severe infections, the dose can be doubled.
Wild oregano extract (Origanum vulgare) Oregano is probably mostly known as a pizza spice. However, wild oregano is an old medicinal herb. It contains terpenes such as thymol and carvacrol which inhibit coli bacteria, salmonella bacteria, and staphylococci. Moreover, researchers have discovered that wild oregano has stronger antioxidant effects than other herbs.
Dosage of capsules with wild oregano: 2 capsules 1 - 3 times a day according to the severity of the infection.
Do not take an oregano cure during pregnancy.
Grapefruit Seed Extract: "Citricidal," a natural antibiotic made from an extract of grapefruit seed, was developed from the observation that something in grapefruit (though not in other citrus fruits) keeps bacteria at bay for extended periods of time.
Colloidal Silver: By far the most controversial agent in the armamentarium of 'natural' antibacterial agents. Jonathan V. Wright, M.D.'s research has found that bacteria have an enzyme system that is disrupted by the presence of silver ions, causing the organism to die. In fact, it was commonly used as the only hope against severe infections prior to the advent of antibiotics in the 1940's. Dr. Wright suggests adult doses of "One tablespoon of colloidal silver at a 40 ppm (parts per million) concentration at the first signs of any infection and 1-2 teaspoons three to four times daily until the infection is gone. Then stop!" Silver has been known for centuries for its bacteriostatic effect and the use of silver preparations in therapy was widespread up until the introduction of antibiotics.
Colloidal silver is the designation of microscopic silver particles, partly in the form of silver ions suspended in demineralised water. The strength of the preparation is measured in PPM (Parts Per Million). Colloidal silver is believed to work by disturbing the bacterial enzymatic system. If CS comes into contact with intestinal bacteria, it will weaken or kill these bacteria just as conventional antibiotics. For this reason, it is advisable to combine CS with a supplement of lactic acid bacteria. However, the majority of the consumed CS is supposed to be absorbed by the oral mucosa and therefore only a limited amount of CS reaches the intestines.
Acute adult dosage: 1 tbsp. (40 PPM) at the first signs of infection. Then, take 1 - 2 tsp. 3 - 4 times a day between meals until the infection has disappeared and the treatment is finished. The dosage can vary somewhat from one preparation to the next.
Other natural antibiotics covered include garlic, marigold, Tea Tree oil, Wild Indigo, honey, grapefruit seed extract, and wormwood. Chapters cover topics such as childhood infections, herbal, homoeopathic and nutritional medicine, nutritional supplements and the role of stress all supported by research references.
An Indiana University School of Medicine study has confirmed a linkage between erythromycin, one of the most commonly prescribed antibiotics, and the subsequent development of pyloric stenosis, a condition that affects one in 500 newborns. The study appears in the current issue of the Journal of Pediatrics.
Pyloric stenosis, which usually occurs in the first or second month of life, is a blockage of the outlet of the stomach that causes projectile vomiting, leading to weight loss and dehydration. It is the most common indication for abdominal surgery in infancy.
"The link between erythromycin and pyloric stenosis is an important finding which will make a difference to the health of babies," said the study's principal investigator, Barbara E. Mahon, M.D., M.P.H., a clinical assistant professor of pediatrics at the IU School of Medicine.
Using clinical data extracted from the Regenstrief Medical Record System -- a comprehensive electronic medical records system that gathers and stores data including diagnoses, radiology and operative reports, pharmacy records, and physician observations -- the researchers studied 14, 876 babies born between June 1993 and December 1999. They found that if given erthromycin during the first two weeks of life, babies were 10.5 times more likely to develop pyloric stenosis than babies who were not given the antibiotic.
"This large scale study could only have been undertaken with the vast amount of data available in the Regenstrief system," said Dr. Mahon. Co-authors of the study are Marc Rosenman, M.D. a health services research fellow at the Regenstrief Institute for Healthcare ,and Martin Kleiman, M.D., Ryan White Professor of Pediatrics at the IU School of Medicine.
The newborns were given erthromycin by mouth in a 10-to-14 day course, usually because of maternal chlamydia at the time of delivery. Erythromycin has had a long history as a useful, safe, and generally well-tolerated drug, the researchers reported. However, as a result of their study they say that the antibiotic should be used only with prudence in the first two weeks of life.
The IU School of Medicine study also showed that babies who received an erythromycin eye ointment, a common treatment for conjunctivitis, did not have a higher risk of pyloric stenosis.
Journal of Pediatrics 2001; 139:380384