Antimicrobial Usage & Spread of Resistance -Reply

Karl Roberts kr1 at PGSTUMAIL.PG.CC.MD.US
Wed Jan 22 07:57:25 EST 1997

Dear Steven,
	OK, I agree, there is not enough solid evidence for the idea that 
antibiotic resistance is being fostered by bad care. However, I think 
that enough evidence is available to warrant further investigation. "Big, 
Bad drug companies" such as yours are certainly scientifically and 
financially capable of helping to find out if such resistance is 
spreading...after all, R&D is (hopefully) a major part of your budget. 
Thanks for your thoughtful reply,
Karl J. Roberts

On 21 Jan 1997, 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)

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