Jun 12, 2012

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Two of my childrens favorite activities just happened in early June. First, the Intermountain Sport Fishing Enhancement group had their kids fishing day at Uncle Bobs Trout pond south east of Dauphin. Then, the Winnipegosis Ducks Unlimited group had their kids fishing day at Quarry House just north of Winnipegosis. Both events are designed with kids in mind. Sure both teach the kids a little about fishing and conservation, but more importantly there is lots of fun, food and prizes to keep the kids entertained. Many thanks to all the volunteers at both events. These events show a little education can go a long way. That statement applies to antibiotic resistance as well.


Antibiotic resistance has been in the news again lately and the headlines are a little scary. In China 1 in 10 cases of Tuberculosis are drug-resistant. World Health Organization warns that gonorrhea is becoming increasingly drug-resistant. What are these diseases, what is antibiotic resistance and, and how does this all affect you?


What is tuberculosis? Tuberculosis (TB) is a lung infection that has probably been around as long as there have been people. We have anthropological evidence of TB as least as far back as 7000 years ago. TB is spread in tiny water droplets containing the TB bacteria. These droplets are sprayed around every time an infected person coughs, sneezes or speaks. Before the discovery of antibiotics, many people died of TB. Now with antibiotics, TB can usually be cured in 6-9 months using about 4 different antibiotics. However, we are seeing more cases of TB in which the antibiotics dont work.


Gonorrhea is a sexually transmitted disease that is commonly known as the clap. It is the second most common sexually transmitted disease after chlamydia. Gonorrhea can cause infertility, pregnancy complications or even death of a pregnant woman. Babies born to mothers with gonorrhea have a 50% chance of getting an eye infection that can lead to blindness. The good news is that gonorrhea is very easy to treat with common antibiotics. However, recently gonorrhea that is resistant to the cephalosporin class of antibiotics has turned up in Japan, Britain, Hong Kong and Norway. Since these are countries with first class health care systems, there is a good chance there is undetected antibiotic resistant gonorrhea circulating in Canada and the United States.


Now a little back ground on antibiotics. Sir Alexander Fleming discovered penicillin in 1928. He was doing research on bacteria and was already known as a good researcher, but a messy lab technician. Coming back to his lab after a few days off, he found some cultures of his bacteria that hed forgotten had been spoiled by mold. Instead of just throwing out all the culture plates, he noticed a zone around some of the mold was completely free of bacteria. The mold (later named Penicillium notatum) produced a substance (now called penicillin) that killed the bacteria. Penicillin was eventually isolated and made in large quantities. When it was given to people, certain infections were cured!


Penicillin was a miraculous discovery. Bacterial infections can kill people. Before antibiotics, strept throat, sexually transmitted diseases and infected wounds often killed people. As miraculous as antibiotics are, they arent perfect. Several decades after penicillin was discovered, doctors started noticing antibiotic resistance. Antibiotic resistance is when bacteria arent killed by a certain antibiotic anymore.


How do bacteria become resistant to an antibiotic? There are different ways but it often happens when the bacteria are exposed to a small dose of the antibiotic. This dose is either too small to kill them or given for too short a time to kill them. For example, lets say you go to the doctor and insist that she give you an antibiotic for your cough. Then, you only take 2 or 3 days worth of the antibiotics and save the rest for next time. This will kill off the most of the bacteria, but it will leave some alive. The ones that are left will have a natural immunity to the antibiotic. Those bacteria will reproduce and all their offspring will have a resistance to that antibiotic. Now that original antibiotic wont work anymore. You now have an antibiotic resistant infection!


It turns out antibiotic resistance isnt a new phenomenon. Antibiotic resistance has been around longer than we humans have been using antibiotics. Gerald Wright from McMaster University and his colleagues published a paper in August 2011 in Nature that showed us how old antibiotic resistance might be. The researchers looked at Actinobacteria, which lives in soil and doesnt cause disease. They found some Actinobacteria was resistant to many antibiotics. Then the researchers looked at some frozen soil from the Yukon from 30,000 years ago. It had Actinobacteria that was resistant to penicillins, tetracyclines and vancomycin. Why are ancient bacteria resistant to modern antibiotics? Well we dont really know, but one theory goes like this. Bacteria in the soil are always competing with each other and other microbes like fungi. Fungi, like the mold that produced penicillin, create antibiotics to kill off the surrounding bacteria. The soil bacteria must evolve a way to protect themselves from the chemical weapon, so they evolve antibiotic resistance. It is kind of like a microscopic arms race. This goes to show bacteria are very capable of developing antibiotic resistance given the right conditions.


What should we do so our antibiotics will work when we need them? Start with non-drug measures. Gonorrheas spread can be mostly eliminated by using condoms. Coughing and sneezing into the crook of your elbow and washing your hands often reduces the spread of airborn diseases including TB. Listen to your doctor when she says you dont need an antibiotic for your cough. Treating a viral infection with an antibiotic wont make you better and can promote antibiotic resistance. And if your doctor gives you an antibiotic, finish your antibiotics! Do not stop taking an antibiotic part way through the course of treatment without first discussing it with your doctor. Even if you feel better, use the entire prescription as directed to make sure that all of the bacteria are destroyed. Dead bacteria dont cause resistance.


A little bit of education now will turn our kids into passionate and responsible fisher people later. And a little bit of education can help you prevent antibiotic resistance.


The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.


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