The content of the article from Ben Hirschler (Mon Mar 18, 2013) should be shouted from the rooftops.
I get the sense that people think that antibiotic resistance is a new problem. It is not. Ben Hirschler contrasts antibiotic resistance with the appearance of AIDS in the early 1980s. Antibiotic resistance is even older than AIDS. A few facts can place the antibiotic resistance problem in its historical perspective:
1928 Alexander Fleming observed a fungus that appeared to destroy bacteria. About 10 years later, he made available this fungus to the research group led by Howard Florey and Ernest Chain, which isolated the active compound penicillin.
1941 Florey and Chain found that penicillin was very effective in saving lives that would have been lost to bacterial infection.
1943 Florey's group observed the first case of resistance to penicillin
1955 The mechanism of antibiotic resistance was hypothesised, as a consequence of the discovery of the structures of nucleic acids, and their role in transmitting genetic or inherited information
1958 The first observed case of multiple antibiotic resistance was observed
1960s Widespread use of antibiotics in livestock commenced
1973-4 The first calls by the Pharmacy profession for the use of antibiotics to be limited only to those cases where they were effective. It was recognised that many antibiotic prescriptions were being written for patients with self-limiting viral infections. These calls were ignored.
During my years as an undergraduate student in the early 1970s, the problem of antibiotic resistance was recognised, but it was not until many years later that a serious effort to reduce inappropriate antibiotic usage was undertaken.
I am completely in agreement with the proposal for much greater public funding into antibiotic research, both for new antibiotics and for improved use of older still effective antibiotics.
Rgds
Richard Prankerd
Senior Lecturer
Faculty of Pharmacy and Pharmaceutical Sciences
Drug Delivery Disposition and Dynamics
Monash Institute of Pharmaceutical Sciences
Monash University (Parkville Campus)
381 Royal Parade, Parkville
Victoria 3052, Australia
Tel: Int + 61 3 9903 9003
Fax: Int + 61 3 9903 9583
E-mail: richard.prankerd@monash.edu
www.pharm.monash.edu.au
I have repeatedly stressed on this forum that trying to discover new
antibiotics is not the first answer - When looking at new drugs
available on the market for the last five-ten years it is obviously a
failure - but what is far more important is education; improving hygiene
standards, maintaining a strict antibiotics regime, setting limiting
standards for surgical prophylaxis (especially orthopedic surgeons and
gynecologists), and so do everything possible to avoid resistance and
making old antibiotics effective again. This might be more expensive
than the introduction of newer drugs, but in the long run more
cost-effective. I could make this lecture much longer, but there are a
host of publications proving my point.
Good luck and best wishes,
Leo Offerhaus (retired internist and clinical pharmacologist, Bussum,
the Netherlands).
offerhausl@euronet.nl
Leo Offerhaus is focusing on education and treatment standars for
antibiotics. There should also be some focus on cultural habits and national health regulation.
In many (most) countries the treatment tradition and guidelines have focus
on the individual, rather than the society. My impression is that in US the hospital or physician can be sued if they don't prescribe the 'best'
infection treatment for the patient. And 'best' is defined with focus on the individual patient, and the time frame includes only the ongoing suspected infection.
But what is best for the patient today may not be the best in a wider time
perspective. And like in economics. Something that is profitable for the
individual may be non-profitable, and even damaging to society.
So in addition to treatment guidelines, we need laws and health regulation
to protect society from rich egoists.
I feel very flattered by your supportive comments, and I always hope
that more people will think about it and introduce some changes in
hospital management, prescribing behaviour and professional hygiene. I
would like to add one particular nuisance, i.e., the unlimited sale to
the public of powerful antibiotics without prescription as is the case
in most circummeditarranean countries, most of Africa, and Asia:
Well-known sources of multiresistant microorganisms, and, finally the
rampant misuse of powerful drugs in veterinary medicine - which often is
not medicine at all, but a means of increasing the production of meat
and eggs, even in "civilized" countries like the Netherlands or
Scandinavia. I realize that like the anti-tobacco war it is a hopeless
fight, but keeping quiet and hoping that the storm blows over is not
helpful.
As to the request to write a review in a peer-reviewed journal: I feel
quite honoured, but I no longer have easy access to a medical library
which makes it quite difficult and time-consuming to write such an
article, so I hope somebody else will do that. Nevertheless, thank you.