E-DRUG: Use of ceftriaxone in poor countries (15)
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Dear e-druggers,
The correspondence about the use of ceftriaxone made me make few comments:
Antibiotics are naturally occurring substances (or closely related derivatives) that have coexisted with bacteria for years. Resistance genes have been a part of the genetic make up of bacteria long before the introduction of antibiotic usage in medicine.
From the correspondence it is obvious that ceftriaxone is overused in some of the 'poor' countries. But the emphasis is not on money. As a general 'rule of thumb', the more frequently an antibiotic is used, the higher the rate of bacterial resistance.
Although ceftriaxone is not the 'worst guy', the propensity of the third generation of cephalosporins for inducing bacterial resistance is well documented.
Cephalosporins have bad reputation not only for selecting extended spectrum betalactamase (ESBL) producing Enterobacteriaceae and stably derepressed mutants of inducible Enterobacteriaceae, but also enterococci, methicillin-resistant S. aureus (MRSA), Clotrdium difficile and yeasts 1.
The presence of ESBL on plasmids provides the potential for rapid spread of resistance among bacteria. The ESBL mediated resistance have been reported from countries all over the world, including Europe, USA, South America, the Middle East, the Far East, Africa and Australia 2.
The moderator has noted that 'discussants are not differentiating between substituting oral narrow-spectrum antibiotics for minor infections with ceftriaxone and serious infections needing admittance to hospital'. But I wonder whether it is just like that. A reflection of the reality, with no differentiation, when prescribing... (I have witnessed it in my country, also) [Ivana, the moderator admits to have addressed the topic insufficiently. Of course it is not just that! I have not had time to go into all aspects and have just made brief comments to a couple of postings.]
There is no country in the world, rich enough, to pay for resistant bacteria.
Dictionary: Antibiotic= agent that destroys bacteria.
It may be tempting to look for the origin of the word:
'Bios' means LIFE in Greek.
Best regards,
Ivana Ilickovic, MSc in clinical pharmacy
Montenegro
ivanapav@yahoo.com
1) Gould IM A review of the role of antibiotic policies in the control of antibiotic resistance. Journal of Antimicrobial Chemotherapy (1999) 43, 459-465
2) Rahal JJ Extended-spectrum beta-lactamases: how big the problem is? Clinical microbiology and infection 2000: 6 (Suppl 2): 2-6