Tag Archives: Antibiotics

Rule that patients must finish antibiotics course is wrong, study says

Experts suggest patients should stop taking the drugs when they feel better rather than completing their prescription

Telling patients to stop taking antibiotics when they feel better may be preferable to instructing them to finish the course, according to a group of experts who argue that the rule long embedded in the minds of doctors and the public is wrong and should be overturned.

Patients have traditionally been told that they must complete courses of antibiotics, the theory being that taking too few tablets will allow the bacteria causing their disease to mutate and become resistant to the drug.

But Martin Llewelyn, a professor in infectious diseases at Brighton and Sussex medical school, and colleagues claim that this is not the case. In an analysis in the British Medical Journal, the experts say the idea that stopping antibiotic treatment early encourages antibiotic resistance is not supported by evidence, while taking antibiotics for longer than necessary increases the risk of resistance.

There are some diseases where the bug can become resistant if the drugs are not taken for long enough. The most obvious example is tuberculosis, they say. But most of the bacteria that cause people to become ill are found on everybodys hands in the community, causing no harm, such as E coli and Staphylococcus aureus. People fall ill only when the bug gets into the bloodstream or the gut. The longer such bacteria are exposed to antibiotics, the more likely it is that resistance will develop.

The experts say there has been too little research into the ideal length of a course of antibiotics, which also varies from one individual to the next, depending in part on what antibiotics they have taken in the past.

In hospital, patients can be tested to work out when to stop the drugs. Outside hospital, where repeated testing may not be feasible, patients might be best advised to stop treatment when they feel better, they say. That, they add, is in direct contravention of World Health Organisation advice.

Other experts in infectious diseases backed the group. I have always thought it to be illogical to say that stopping antibiotic treatment early promotes the emergence of drug-resistant organisms, said Peter Openshaw, president of the British Society for Immunology.

This brief but authoritative review supports the idea that antibiotics may be used more sparingly, pointing out that the evidence for a long duration of therapy is, at best, tenuous. Far from being irresponsible, shortening the duration of a course of antibiotics might make antibiotic resistance less likely.

Alison Holmes, a professor of infectious diseases at Imperial College London, said a great British authority, Prof Harold Lambert, had made the same point in a Lancet article entitled Dont keep taking the tablets as early as 1999. It remains astonishing that apart from some specific infections and conditions, we still do not know more about the optimum duration of courses or indeed doses in many conditions, yet this dogma has been pervasive and persistent.

Jodi Lindsay, a professor of microbial pathogenesis at St Georges, University of London, said it was sensible advice. The evidence for completing the course is poor, and the length of the course of antibiotics has been estimated based on a fear of under-treating rather than any studies, she said. The evidence for shorter courses of antibiotics being equal to longer courses, in terms of cure or outcome, is generally good, although more studies would help and there are a few exceptions when longer courses are better for example, TB.

But the Royal College of GPs expressed concerns. Recommended courses of antibiotics are not random, said its chair, Prof Helen Stokes-Lampard. They are tailored to individual conditions and in many cases, courses are quite short for urinary tract infections, for example, three days is often enough to cure the infection.

We are concerned about the concept of patients stopping taking their medication midway through a course once they feel better, because improvement in symptoms does not necessarily mean the infection has been completely eradicated. Its important that patients have clear messages and the mantra to always take the full course of antibiotics is well known. Changing this will simply confuse people.

The UKs chief medical officer, Prof Dame Sally Davies, said: The message to the public remains the same: people should always follow the advice of healthcare professionals. To update policies, we need further research to inform them.

[The National Institute for Health and Care Excellence] is currently developing guidance for managing common infections, which will look at all available evidence on appropriate prescribing of antibiotics.

The Department of Health will continue to review the evidence on prescribing and drug-resistant infections, as we aim to continue the great progress we have made at home and abroad on this issue.

Read more: https://www.theguardian.com/society/2017/jul/26/rule-patients-must-finish-antibiotics-course-wrong-study-says

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From Viagra to Valium, the drugs that were discovered by accident

From Alexander Fleming onwards, the lives of millions have been transformed and saved by treatments that scientists were not even looking for

When scientists in New Zealand discovered that a meningitis vaccine fortuitously protects against gonorrhoea, they were benefiting from an unpredictable force responsible for some of historys most striking medical breakthroughs: serendipity.

So many things have been discovered by chance. The German writer, scientist and all-round polymath Johann Wolfgang Goethe, a discoverer himself, wrote: Discovery needs luck, invention, intellect none can do without the other.

Viagra

In pharmaceutical giant Pfizers laboratories in Kent, a failed treatment for angina accidentally became a billion-dollar erectile dysfunction blockbuster, and the worlds most famous blue pill.

During early clinical trials of sildenafil, now better known by its trade name Viagra, male volunteers taking the pills consistently reported unprovoked, long-lasting erections. After further investigation, it turned out that Viagra, designed to relax blood vessels around the heart to improve blood flow, was having the same effect on arteries within the penis. Since its commercial release in 1998, it has been used to improve the sex lives of millions of men worldwide.

Incidentally, the 2007 Ig Nobel Prize, awarded annually for that years most useless research, was awarded to three Argentinian scientists who discovered that Viagra helped hamsters recover faster from jet-lag.

Penicillin

Returning to work after a month-long Scottish vacation in 1928, pathologist Alexander Fleming made a discovery in a discarded culture dish, which he had unintentionally left open to the elements on a window sill in his laboratory at St Marys Hospital in London.

In Flemings absence, the dish, growing the dangerous bacteria staphylococcus aureus, had become contaminated with an air-borne mould a type of fungus. Fleming noticed that, near the blue-green strands of fungus, growth of the bacteria had been stopped in its tracks.

Fleming had inadvertently stumbled across the first antibiotic, which he called penicillin.

For his accidental discovery, he shared the Nobel prize for medicine in 1945 with Florey and Chain, Oxford chemists who perfected the process of penicillin mass production in time to treat infected battlefield injuries sustained in the second world war.

When I woke up just after dawn on 28 September, 1928, I certainly didnt plan to revolutionise all medicine by discovering the worlds first antibiotic, or bacteria killer, Fleming later recalled. But I suppose that was exactly what I did.

Heart pacemaker

New York engineer Wilson Greatbatch invented the worlds first implantable heart pacemaker but he didnt mean to.

While trying to build a device to record heartbeats in 1956, he accidentally installed the wrong type of resistor into his prototype which promptly began to emit regular electrical pulses.

Realising these pulses were recapitulating the electrical activity of a normal heartbeat, Greatbatch immediately saw the potential of his device. After two years of refinements, his design for a pacemaker that could be implanted into the heart was patented in 1960 and soon went into production. Life-saving descendants of this first device now improve the lives of over half a million patients with slow heartbeats every year.

Stomach ulcers

In the 1980s, two Australian doctors were ridiculed for suggesting that stomach ulcers were caused not by business lunches and stress, but by infection with a common bacteria. Barry Marshall, a gastroenterologist and his pathologist colleague in Perth, Robin Warren, noticed that stomach biopsies taken from their ulcer patients all contained the same spiral-shaped bacteria, called helicobacter pylori.

To prove their hunch, Marshall deliberately downed a pint of foaming helicobacter broth that hed grown in his lab after isolating it from the stomach of one of his patients. Within a week, he had rampant stomach inflammation which was then completely reversed by taking antibiotics.

Their discovery has also meant the virtual eradication of a type of stomach cancer caused by helicobacter infection.

For their work (and presumably Marshalls bravery), Marshall and Warren were awarded the 2005 Nobel prize for medicine.

Antidepressants

Several classes of antidepressants owe their discovery to chance, from iproniazid, which was initially used to treat tuberculosis in the 1950s, to the tricyclics of the 1960s, which stemmed from an experimental treatment for schizophrenia and the more recent breakthrough involving the use of ketamine.

Valium

The entry-level benzodiazapine was developed in the 1950s by a Polish immigrant in the US, Leo Sternbach, from discarded chemical compounds he had synthesised 20 years earlier in Poland when he was working on experiments to create new dyes.

The dyes were a failure. The benzodiazapines quickly became the most popular prescription drugs in the US.

Read more: https://www.theguardian.com/lifeandstyle/2017/jul/11/from-viagra-to-valium-the-drugs-that-were-discovered-by-accident

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Untreatable gonorrhoea ‘superbug’ spreading around world, WHO warns

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World Health Organization tells of very serious situation after confirming three known cases where all antibiotics were ineffective


The World Health Organization has warned of the spread of totally untreatable strains of gonorrhoea after discovering at least three people with the superbug.

Giving details of studies showing a very serious situation with regard to highly drug-resistant forms of the sexually transmitted disease (STD), WHO experts said on Friday it was only a matter of time before last-resort gonorrhoea antibiotics would be of no use.

Gonorrhoea is a very smart bug, said Teodora Wi, a human reproduction specialist at the Geneva-based UN health agency. Every time you introduce a new type of antibiotic to treat it, this bug develops resistance to it.

The WHO estimates 78 million people a year get gonorrhoea, an STD that can infect the genitals, rectum and throat.

The infection, which in many cases has no symptoms on its own, can lead to pelvic inflammatory disease, ectopic pregnancy and infertility, as well as increasing the risk of getting HIV.

Wi, who gave details in a telephone briefing of two studies on gonorrhoea published in the journal PLOS Medicine, said one had documented three specific cases one each in Japan, France and Spain of patients with strains of gonorrhoea against which no known antibiotic is effective.

These are cases that can infect others. It can be transmitted, she told reporters. And these cases may just be the tip of the iceberg, since systems to diagnose and report untreatable infections are lacking in lower-income countries where gonorrhoea is actually more common.

The WHOs programme for monitoring trends in drug-resistant gonorrhoea found in a study that from 2009 to 2014 there was widespread resistance to the first-line medicine ciprofloxacin, increasing resistance to another antibiotic drugs called azithromycin, and the emergence of resistance to last-resort treatments known as extended-spectrum cephalosporins (ESCs).

In most countries, it said, ESCs are now the only single antibiotics that remain effective for treating gonorrhoea. Yet resistance to them has already been reported in 50 countries.

Manica Balasegaram, director of the Global Antibiotic Research and Development Partnership, said the situation was grim and there was a pressing need for new medicines.

The pipeline, however, is very thin, with only three potential new gonorrhoea drugs in development and no guarantee any will prove effective in final-stage trials, he said.

We urgently need to seize the opportunities we have with existing drugs and candidates in the pipeline, he said. Any new treatment developed should be accessible to everyone who needs it, while ensuring it is used appropriately, so that drug resistance is slowed as much as possible.

Read more: https://www.theguardian.com/society/2017/jul/07/untreatable-gonorrhoea-superbug-spreading-around-world-who-warns

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Health report links antibiotics to risk of miscarriage

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Canadian study finds taking the drugs raises chances of having a miscarriage by between 60% and 100%

Many common antibiotics may double the risk of miscarriage in early pregnancy, research has shown.

A Canadian study has found that taking the drugs raised the chances of having a miscarriage by between 60% and 100%.

The link was seen with several classes of antibiotic including macrolides, quinolones, tetracyclines, sulphonamides and metronidazole. However, nitrofurantoin, often used to treat urinary tract infections in pregnant women, had no effect on miscarriage risk. Nor did the widely used antibiotic erythromycin.

The researchers looked at data from almost 9,000 cases of miscarriage at an average time of 14 weeks into pregnancy, involving girls and women aged between 15 and 45.

The study leader, Dr Anick Brard, from the University of Montreal in Quebec, said: Infections are prevalent during pregnancy. Although antibiotic use to treat infections has been linked to a decreased risk of prematurity and low birth weight in other studies, our investigation shows that certain types of antibiotics are increasing the risk of spontaneous abortion, with a 60% to two-fold increased risk.

Women who miscarried were more likely to be older, living alone, and to have multiple health issues and infections. But all these factors were accounted for in the analysis, whose findings are published in the Canadian Medical Association Journal.

Dr Brard added: The increased risk was not seen for all antibiotics, which is reassuring for users, prescribers and policymakers.

The researchers identified a total of 182,369 pregnancies from the Quebec pregnancy cohort, a large population group from the province providing data for ongoing studies. Of these, 8,702 (4.7%) ended with an early miscarriage.

Writing in the journal, the team concluded that there was a link between some antibiotics and an increased risk of miscarriage, but added: However, residual confounding by severity of infection cannot be ruled out.

Read more: https://www.theguardian.com/society/2017/may/02/health-report-links-antibiotics-to-risk-of-miscarriage

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