Antimicrobial Usage & Spread of Resistance -Reply

[Gary Lum]

Steven Projan wrote:
> 
> I've seen it written and said many times that the using antibiotics
> for treating what may be a viral infection represents a missue of
> antibiotics and is a major cause of antibiotic resistant bacteria.
> 
> Indeed this could be true but before we accept this oft repeated
> theory as fact, how about someone shows us some data?
> 
> 1)  We can be fairly certain that the use of low doses of antibiotics
> in animal feed can select for the emergence and dissemination of
> resistant bacteria.  There is good data on this subject.
> 
> 2)  We also can be pretty sure that certain patterns of hospital use
> of antibiotics can select for mutliply resistant bacteria (like
> vancomycin resistant enterococci).  Again lots of data on this issue
> have been published.
> 
> But 3)  For the most part antibiotic resistance genes are usually not
> found to arise in the U.S. but are "imported" with the initial
> emergence of pathogenic, resistant strains arising elsewhere (like
> methicllin resistant staphylococci and penicillin resistant
> pneumococci).  This may be caused by even worse abuses abroad or
> environmental factors abroad - like antibiotic use coupled with poor
> sanitation and poor personal hygiene.
> 
> In fact community acquired infections from resistant bacteria,
> although on the rise, are far rarer than hospital infections from
> resistant bacteria - therefore one might well hypothesize that
> resitance is spread into the community from hospitals and/or nursing
> homes.  So what real impact is there from ex-hospital use in terms of
> the emergence and spread of resistance?
> 
> And do we actually know how often antibiotics are prescribed for
> viral infections?  And how many people with viral infections then go
> on to contract a secondary bacterial infection (which an antibiotic
> may therefore prevent)? And what if only 20% of such infections are
> really bacterial - do we let those 20% suffering from bacterial
> infections get sicker until we get the culture results?  Is that
> smart practice?  Since when does the Hipocratic oath say "Do no
> good"?
> 
> Sorry but before I can accept the premise that bad family doctors
> writing antibiotic prescriptions for what may be a viral infection
> cause antibiotic resistance all I can say is:
> 
> SHOW ME THE DATA!!!  And I don't mean The New York Times or that
> semi-informed, hyperbolizing, plague of a tabloid journalist Laurie
> Garrett, I mean good, solid peer reviewed, New England Journal of
> Medicine-type data.
> 
> Steve Projan
> Wyeth-Ayerst Research
> (a big bad pharmaceutical company)



Come to Australia and experience our community acquired MRSA and
resistant _Streptococcus pneumoniae_.

Gary

--
******************************************************** 
Dr Gary Lum
Director of Microbiology
Royal Darwin Hospital

Microbiologists do it with culture and sensitivity 
Meet me at http://www.ozemail.com.au/~glum/index.html
E-mail me at glum at ozemail.com.au or gary.lum at nt.gov.au