strep and penicillinÿÿÿÿÿ

HANS BUSK hans.busk at dkb.dk
Thu Jan 12 15:02:00 EST 1995


 ********** Original       To: BOB MORRELL
 * CARBON *      was       By: HANS BUSK
 *  COPY  *   posted:      On: DKBBBS
 **********              Conf: 2000 - internet.email
-----------------------------------------------------------------------

BM> but in the case of MDR TB, everything I have seen indicates
BM> incomplete treatment. And my own institution's experience (or lack
BM> of experience) with Vanco resistance run against the overuse therapy
BM> (since we have

My statement was of course oversimplified, but I think there is a lot of
evidence supporting it. I agree of course that WHEN you know the bug you
should treat it appropriately i.e. usually with eradication as the goal.
Your example with TB is of course obvious.
Regarding the vanco-resistance, we are seeing now problems occurring.
Probably the use of an antibiotic has to rise above a certain threshold
in a population before resistance develops. Even if you use a lot of
vancomycin in a ward, you can be lucky to avoid problems for a
long time because the necessary mutation has to develop de novo. As the
use become more widespread the probability of such a mutation increases.
When you have a certain risk of getting resistent strains by accident,
because they are spread in society, the selectionpressure i.e. your use
of the drug in a ward will be a very important factor for your level of
resistance. Other major factors of course are avoidance of
crossinfections (Staff hygiene), and the type of patients in the ward.

BM> a ten step lead does not mean the end of an era. Smarter use
BM> (actually reading the lab MIC's would be a start!) will, combined
BM> with increased development, keep us ahead in most infections. (a
BM> humble and optimistic opinion)

I hope you are right, but an important prerequisite is that man try to
use his brains! My comment was a little effort in that direction.

Use only antibiotics wisely. It is the only kind of drugs, where the
treatment of one patient severely can affect the outlook for another
patient.

I think we fundamentally agree, I am just a bit more pessimistic than
you are! :-)

Yours
Hans Erik Busk
Denmark

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