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Posts tagged ‘Antibiotics’

Faecal transplants for severe digestive infection sufferers

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Faecal transplants could now be a better alternative than antibiotics for patients who suffer from a severe digestive infection, known as Clostridium difficile (C diff).

 

SINGAPORE: Faecal transplants could now be a better alternative than antibiotics for patients who suffer from a severe digestive infection, known as Clostridium difficile (C diff).

The infection causes severe diarrhoea, inflammation of the colon, blood in stools and can even lead to death in extreme cases.

The National University Hospital (NUH) conducted the first Faecal Microbiota Transplant for two such patients since the start of this year.

NUH has been seeing more patients with C diff infection in the past three years.

About 30 patients are treated each month.

More than two-thirds of the patients respond to the current treatment using antibiotics.

But one-third of them may be resistant to antibiotics.

Dr Nicholas Chew, consultant and clinical director at NUH, said: “If you were to treat C diff infection and diarrhoea with antibiotic, essentially you are using the same root cause of the condition in the first place to try and treat it.

“There is also increasing incidence of resistance to standard antibiotics that we would use to treat C diff diarrhoea, so in essence, these antibiotics may not work anymore, and that occurs in about 20 to 30 per cent of patients with C diff diarrhoea.”

While it can affect patients of any age group, it tends to be more severe in the elderly and the very ill.

Studies have shown that the success rate of a faecal transplant is about 90 per cent.

The transplant involves repopulating the gastrointestinal tract with good micro-organisms to restore the normal gut ecosystem.

After collecting a healthy donor’s faeces, the sample is processed to sieve out the good micro-organisms.

The micro-organisms are then transplanted through an endoscope or a colonoscope into the patient where they will multiply in the patient’s colon.

Donors have to undergo a stringent screening process just like any other organ transplants.

Blood and faecal tests are done to ensure that the sample from donors are free from infections and safe for transplant.

But doctors said getting patients to agree to the new treatment method can be challenging.

“It’s a treatment modality with a high yuck factor, but then we do process the samples very thoroughly and we administer the samples through endoscopic means.

“So at no point is the patient able to smell or taste the sample, and the sample has been processed,” said Dr David Ong, consultant and clinical director at NUH.

Patients can opt for either a colonoscopy which costs S$300 or a gastroscopy at S$150 after subsidy.

via Faecal transplants for severe digestive infection sufferers – Channel NewsAsia.

AFP: A world without antibiotics? The risk is real: experts

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Humans face the very real risk of a future without antibiotics, a world of plummeting life expectancy where people die from diseases easily treatable today, scientists say (AFP/File, Saul Loeb)

 

Paris — Humans face the very real risk of a future without antibiotics, a world of plummeting life expectancy where people die from diseases easily treatable today, scientists say.

Experts tracking the rise of drug resistance say years of health gains could be rolled back by mutating microbes that make illnesses more difficult and expensive to cure and carry a higher risk of death.

Some say the threat to wellbeing is on the scale of global warming or terrorism — yet resistance is being allowed to spread through an entirely preventable means — improper use of antibiotics.

“It is a major public health problem,” Patrice Courvalin, who heads the Antibacterial Agents Unit of France’s Pasteur Institute, told AFP.

“It is about more than not being able to treat a disease. It will erase much progress made in the last 20-30 years.”

Without antibiotics to tackle opportunistic bacteria that pose a particular risk for people who are very ill, major surgery, organ transplants or cancer and leukaemia treatment may become impossible, he explained.

“In some parts of the world, already we have run out of antibiotics,” said Timothy Walsh, a professor of medical microbiology at Cardiff University.

“In places in India, Pakistan, Bangladesh, possibly Russia, Southeast Asia, central South America, we are at the end game. There’s nothing left. And unfortunately there is nothing in the pipeline either.”

Resistance to drugs emerges through changes in the bacterium’s genetic code — altering the target on its surface to which antibiotics would normally bind, making the germ impenetrable or allowing it to destroy or “spit out” the antibiotic.

These super-germs triumph through Darwinian pressure, helped by humans.

The wrong antibiotics, taken for too short a period, in too low a dose or stopped to early, will fail to kill the altered microbes.

Instead, the drugs will indiscriminately damage other bacteria and give the resistant strain a competitive advantage — allowing it to dominate and spread.

At the base of the problem is doctors prescribing antibiotics wrongly or unnecessarily, and the ease with which medicines can be obtained without a script in some parts of the world, including Asia and Africa.

As much as 70 percent of antibiotics are given for viral infections, against which they are wholly ineffective, the experts say.

Then there is the problem of farmers in countries like the United States adding antibiotics to animal feed to help herds grow faster.

Compounding all of this is the rise in global travel — a boon for bacterial spread, and a sharp drop in antibiotics development blamed on a lack of financial incentives for the pharmaceutical industry.

A return to the pre-antibiotic era?

The World Health Organisation (WHO) says drug resistance “threatens a return to the pre-antibiotic era”.

“Many infectious diseases risk becoming untreatable or uncontrollable,” it states in a factsheet on antimicrobial resistance.

A case in point: some 450 000 people developed multi-drug resistant (MDR) TB in 2012 and 170,000 died from it. MDR TB does not respond to the most potent TB drugs — isoniazid and rifampin.

Nearly 10 percent of MDR cases are thought to be of the even deadlier XDR (extensively drug resistant) variety which does not respond to a yet wider range of drugs.

Like other drug-resistant microbes, MDR and XDR TB can be transferred directly between people — you can get it even if you have never taken antibiotics in your life.

“Antibiotic resistance is an emerging disease and a societal problem. The use you can make of an antibiotic depends on the use made by others,” said Courvalin.

Another worry for health planners today is the spread of a multi-drug resistant strain of the bacterium Klebsiella pneumoniae — a common cause of infections of the urinary tract, respiratory tract and bloodstream, and a frequent source of hospital outbreaks.

In some parts of the world, only the carbapenem antibiotics class remains effective, but now signs are emerging of resistance even to this last line of defence.

Antibiotics are thought to have saved hundreds of millions of lives since Alexander Fleming first discovered penicillin in 1928.

But even Fleming’s own warnings of impending drug resistance went unheeded, and now scientists say people may start dying from infections like meningitis and septicaemia that are eminently curable today.

“If we keep going like this, the vast majority of human bacterial pathogens will be multi-resistant to antibiotics,” said Courvalin.

The answer? Prudent drug use — better and faster diagnosis to determine whether an infection is viral or bacterial and whether it is even susceptible to treatment.

Farmers must stop feeding antibiotics to their livestock, and hospital and individuals improve their hygiene to prevent bacterial spread.

Yet few experts believe the damage can be undone.

“The bugs have become very sophisticated, they’ve become very complex,” said Walsh.

“You can decrease resistance or reduce it, but never completely reverse it.”

via AFP: A world without antibiotics? The risk is real: experts.

Can you mix antibiotics and alcohol?

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Studies show booze won’t stop most treatments from working properly or cause unpleasant side-effects. However, the story isn’t quite that simple.

 

Women who are in the early stages of pregnancy, and who are not ready to share the happy news, know that turning down an alcoholic drink at a social occasion can be a dead giveaway. Telling friends and colleagues they are on antibiotics is the perfect excuse because they are so commonly used. Even the nosiest of acquaintances is unlikely to ask what they are being taken for.

But is it really true that you need to abstain from alcohol when on a course of antibiotics?

Some people assume that alcohol will stop antibiotics from working properly, while others believe that it will cause side-effects. When staff in a London genitourinary clinic surveyed more than 300 patients they found that 81% believed the former assumption, with 71% believing the latter.

For most antibiotics neither of these assumptions is true. The fear for doctors is that these erroneous beliefs might make patients skip their medication over a glass of wine. Anything that encourages people to miss doses of antibiotics adds to the serious problem of antibiotic resistance.

In fact, the majority of the most commonly prescribed antibiotics are not affected by alcohol. There are some exceptions. The antibiotics cephalosporin cefotetan and cephalosporin ceftriaxone slow alcohol breakdown, leading to a rise in levels of a substance called acetaldehyde. This can cause a host of unpleasant symptoms including nausea, vomiting, facial flushing, headache, breathlessness and chest pain. Similar symptoms are caused by a drug called disulfiram, sometimes used in the treatment for alcohol dependency. The idea is that the moment a patient has a drink, they experience these unpleasant symptoms, and this dissuades them from drinking more. The symptoms are unpleasant, so it is important that people abstain from alcohol while they’re taking these particular antibiotics, and for a few days afterwards.

Another type of antibiotic that comes with a specific warning not to take alongside alcohol is metronidazole. Used to treat dental infections, infected leg ulcers and pressure sores, it’s thought to cause the same list of symptoms as the previously mentioned cephalosporins. This link has been disputed since a 2003 review of studies found a lack of evidence to support it, and a very small controlled study in which Finnish men given metronidazole for five days suffered no side effects when they consumed alcohol. The authors concede that this doesn’t rule out the possibility that a few individuals are affected, and the current advice is still to avoid alcohol when taking it.

There are a few other antibiotics for which there are good reasons to avoid drinking alcohol while taking them, including tinidazole, linezolid and erythromycin, but these interactions are so well-known that doctors give patients specific warnings.

Recycled tale

This leaves a long list of other antibiotics that can be mixed with alcohol. Of course getting drunk is not going to help your recovery when you’re ill. It can make you tired and dehydrated, but it’s not because of any interaction with your medication.

It’s possible that the isolated cases led to the myth that all antibiotics don’t mix with alcoholic drinks, but there are two more intriguing theories. One is that because antibiotics are used to treat some of the most common sexually transmitted diseases, doctors in the past were somehow punishing the patients for becoming infected by depriving them of their favourite tipple.

Or there’s the explanation given to one of the authors of the London genitourinary clinic survey. James Bingham met the late Brigadier Sir Ian Fraser, who introduced the use of penicillin for injured soldiers in North Africa during World War II. At the time penicillin was in such short supply that after a patient had taken it, the drug was retrieved from his urine and recycled. Recuperating soldiers were allowed to drink beer, but unfortunately this increased the volume of their urine, making it harder obtain the penicillin and, according to the Brigadier, led commanding officers to ban beer.

It’s a good story, irrespective of whether or not it is the true source of the popular misconception. Dispelling the myth is something of a double-edged sword. Encouraging those on the antibiotics who cannot resist a glass or two to complete their courses of treatment could help counter the spread of antibiotic resistance. However greater public understanding of the true picture may mean that women wanting to keep their early pregnancies to themselves in social situations may have to be a little more inventive in future.

via BBC – Future – Health – Can you mix antibiotics and alcohol?.

Antibiotics ‘ineffective for coughs’

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Overprescribing of antibiotics can lead to bacterial resistance

Antibiotics are ineffective in treating patients with persistent coughs caused by mild chest infections, the Lancet journal reports.

About 2,000 patients across 12 European countries filled in an ‘illness’ diary.

The study found that the severity and duration of symptoms in patients treated with antibiotics were no different to those given a placebo.

But experts caution that if pneumonia is suspected, antibiotics should still be used due to the disease’s severity.

Paul Little from the University of Southampton, who led the research, said: “Using the antibiotic amoxicillin to treat respiratory infections in patients not suspected of having pneumonia is not likely to help and could be harmful.

 

Most mild chest infections will settle by themselves with no need for antibiotics – as mainly caused by viruses”

Dr Nick Hopkinson British Lung Foundatio

“Overuse of antibiotics, dominated by primary care prescribing, particularly when they are ineffective, can lead to the development of resistance and have side effects like diarrhoea, rash and vomiting.

“Our results show that people get better on their own. But given that a small number of patients will benefit from antibiotics the challenge remains to identify these individuals.”

Previous research into whether or not antibiotics are beneficial in the treatment of chest infections, where symptoms include shortness of breath, weakness, high fever, coughing and fatigue, have produced conflicting results- particularly in older people where chest infections can lead to further complications.

This study randomly divided patients into two groups – one received the antibiotic and the other was given a placebo, an inert treatment in the form of a sugar pill, three times a day for seven days.

The study found little difference in the severity and duration of symptoms reported between groups. This was also true for older patients – those aged 60 years or over – who made up nearly a third of the study.

And those taking antibiotics were reported to have more side effects including nausea, rash and diarrhoea than those given the placebo.

Drug resistance

Chest infections are one of the most common problems patients go to their GP about.

Dr Nick Hopkinson, a member of the British Lung Foundation, thought the study was helpful back-up when patients ask them for antibiotics.

He said: “Some patients with mild chest infections will ask for a prescription – this study can help GPs suggest it may not be the best thing for them.

“Most mild chest infections will settle by themselves with no need for antibiotics – as they are mainly caused by viruses. Those with mild infections are told to come back if symptoms don’t get better.

“This study is encouraging and supports what GPs are already doing.”

Overprescribing of antibiotics can lead to bacterial infection resistance.

Dr Michael Moore, from the Royal College of General Practitioners, who also co-authored the study, said: “It is important that GPs are clear when they should and should not prescribe antibiotics to patients to reduce the emergence of bacterial resistance in the community.

“This study backs the approach taken in the National Institute for Health and Clinical Excellence (NICE) guidelines that patients who present with acute lower respiratory tract infection where pneumonia is not suspected can be reassured by their GP that they will recover without antibiotics and that the illness is likely to last about three weeks in total whether or not they have a prescription.”

The European study, which included Belgium, England, France and Germany, took place between November 2007 and April 2010.

It looked at 2,061 patients who had a persistent cough lasting more than 28 days and where a chest infection, like bronchitis, was suspected.

Those thought to have pneumonia were excluded from the study due to the severity of the disease if not treated promptly.

Participants completed a daily diary for the duration of their illness and rated the the severity of their symptoms including cough, shortness of breath, chest pain, and blocked or runny nose.

BBC

Liow: No trace of banned antibiotics in poultry products

THE Health Ministry has found no evidence of banned antibiotics in Ayamas poultry products after testing several samples.

“We found all the Ayamas poultry products to be free from chloramphenicol antibiotics,” said Minister Datuk Seri Liow Tiong Lai in his winding-up speech on the Supply Bill 2013 at the committee stage for his ministry.

He was responding to concerns over traces of chloramphenicol in Ayamas products, which led states like Sabah and Sarawak to impose a temporary ban.

Chloramphenicol is an antibiotic used to treat bacterial infection. Although rare, the drug is known to cause fatal blood disorders such as aplastic and hypoplastic anaemia.

It was reported that a circular dated Nov 1 from the Sarawak Veterinary Authority on the import suspension of products from Ayamas Food Corporation into the state went viral in social media networks.

Liow said the ministry would continue to monitor food samples, including at the retail and production end, to ensure that they were free from dangerous health risks.

He also denied allegations that there were conflicting results on the findings between the Health Ministry and the Veterinary Department.

Meanwhile, Deputy Higher Education Minister Datuk Dr Hou Kok Chung told the House that some 13,192 students who borrowed from the National Higher Education Fund Corporation (PTPTN) have had their study loans converted into scholarships.

“The policy was introduced in 2003 as an incentive for students to excel in their studies. They would be exempted from repaying their loans once they obtained first class honours in their Bachelor’s Degree.

“As of Sept 30 this year, 13,192 graduates have benefited from the policy involving an exemption of loans worth RM375mil,” Dr Hou told Datuk Mohamad Aziz (BN-Sri Gading) during Question Time.

The Star

Antibiotics overuse can kill

Bitter pill: Juriana Jonait (left) and Syeerin Erni looking at a poster at the Health Ministry in Putrajaya.

Bitter pill: Juriana Jonait (left) and Syeerin Erni looking at a poster at the Health Ministry in Putrajaya.
PUTRAJAYA: The tendency of Malaysians to pop antibiotics as a quick fix to a range of ailments can lead to antimicrobial resistance that can kill.

Health Minister Datuk Seri Liow Tiong Lai said the use of antibiotics among Malaysians was rising and the number of cases of antimicrobial resistance or AMR has increased steadily.

He warned that injudicious prescription of antibiotics can cause AMR, meaning that the drug may no longer provide remedial effect against the microorganism which caused the sickness concerned.

This meant that patients would face greater health costs, possibly even risk death, when their bodies failed to respond to the standard treatment of antibiotics when it was truly needed, he said after opening the Annual Scientific Meeting on Antimicrobial Resistance 2012 here yesterday.

“A study in 2008 involving 82 public clinics and 17 private clinics showed that the antibiotic prescription rate for upper respiratory tract infection was 46.7% among private primary care clinics and 27.8% in public primary care clinics,” Liow said.

“In our country, we are experiencing an increase in certain AMR cases, namely the extended-spectrum beta lactamase and the acinetobacter (bacteria types).

“My advice to patients is to not demand for antibiotics unless the doctors have diagnosed the need.”

Liow said disciplinary action could be taken against pharmacists who sold antibiotics without a doctor’s prescription.

Malaysian Pharmaceutical Soci-ety president Datuk Nancy Ho said the profession had seen cases of patients trying to “self-medicate” by requesting for antibiotics based on what they have read on the Internet.

The Star

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