Tag Archives: antibiotics

Drug-resistant bacteria: Sewage-treatment plants described as giant ‘mixing vessels’ after scientists discover mutated microbes in British river

Superbugs resistant to some of the most powerful antibiotics in the medical arsenal have been found for the first time in a British river – with scientists pinpointing a local sewage-treatment plant as the most likely source.

Scientists discovered the drug-resistant bacteria in sediment samples taken downstream of the sewerage plant on the River Sowe near Coventry. The microbes contained mutated genes that confer resistance to the latest generation of antibiotics.

The researchers believe the discovery shows how antibiotic resistance has become widespread in the environment, with sewage-treatment plants now acting as giant “mixing vessels” where antibiotic resistance can spread between different microbes.

A study found that a wide range of microbes living in the river had acquired a genetic mutation that is known to provide resistance to third-generation cephalosporins, a class of antibiotics used widely to treat meningitis, blood infections and other hospital-acquired infections.

Within the river sediment, the scientists also found human gut bacteria that had developed resistance to another kind of antibiotic, called imipenem, which is administered by intravenous injections for severe infections not normally treatable with other antibiotics.

“These are frontline antibiotics and we were not expecting to see these kinds of levels of resistance to them in the environment. It is quite staggering,” said Professor Elizabeth Wellington of  the University of Warwick, who led the study. “This is a worrying development and we need to be concerned about it. We’ve completely underestimated the role waste-treatment processes can play in antibiotic resistance,” she told The Independent.

Antimicrobial resistance occurs when bacteria evolve genetically so that they cannot be killed by antibiotic drugs

Antimicrobial resistance occurs when bacteria evolve genetically so that they cannot be killed by antibiotic drugs

Tests have shown that the level of antibiotic resistance is many times higher downstream of the Coventry sewage-treatment facility than it is upstream.

“The way sewerage plants mix up different types of waste means they’re hotspots, helping bacteria share genes that mean they can deactivate or disarm antibiotics that would normally kill them,” Professor Wellington said.

“This is a big deal, because this is the most common bacterial resistance gene causing failures in treatment of infections, and it’s the first time anyone has seen this gene in UK rivers,” she added.

“The problem is we use river water to irrigate crops, people swim or canoe in rivers, and both wildlife and food animals come into contact with river water. These bacteria also spread during flooding, and with more flooding and heavy rain this could get worse.”

Stricter regulations and higher levels of sewage treatment, with an emphasis on preventing untreated sewage being discharged during a storm, are needed to halt the rise of antibiotic resistance in the environment, Professor Wellington said.

“We’re on the brink of Armageddon and this is contributing to it. Antibiotics could just stop working,” she added.

Earlier this month, David Cameron warned that the world could be “cast back into the dark ages of medicine” where people die of relatively trivial and treatable infections caused by drug-resistant bacteria.

Source The Independent

How to fix a broken market in antibiotics

The drugs don’t work – and neither does the market, when it comes to antibiotics.

When sophisticated bugs that medicines used to kill within days start to fight back and win, all of healthcare, and the people it keeps alive, is in trouble.

Take gonorrhoea, a sexually transmitted disease contracted by more than 100 million people a year: it used to be easily treatable but has now developed superbug strains that are drug-resistant and are spreading around the planet.

Tuberculosis is a similar tale. Totally resistant forms of the lung infection emerged in India just a few years ago and have now been detected worldwide. Hospital patients in Africa with untreatable TB are often simply sent home to die.

It’s a glimpse of what Britain’s chief medical officer Sally Davies calls the “apocalyptic scenario” of a post-antibiotic era, which the World Health Organisation says will be upon us this century unless something drastic is done.

Waking up to the threat, governments and health officials are getting serious about trying to neutralize it. It may seem like a question of science, microbes and drugs – but in truth it is a global issue of economics and national security.

Fixing the problem is daunting but past successes in rolling out drugs for HIV, vaccinating millions of children in the developing world and recalibrating rewards for medicines to treat rare genetic diseases suggest it is doable.

The debate moved to center stage last week when British Prime Minister David Cameron launched a global review of the crisis, securing specific support from U.S. President Barack Obama and German Chancellor Angela Merkel.

That builds on a resolution passed at the World Health Assembly in Geneva in May recognizing the pressing need for the world to act in the fight to combat increasing resistance.

“We cannot contemplate failure,” Davies told Reuters in an interview in her office in London’s Whitehall. “We have to find something that works for the world.”

What this demands, according to academic and industry experts, is a new business model that rewards drug firms for developing new antibiotics even if they are rarely used.

It is no accident that Cameron chose a big-hitting economic brain – former Goldman Sachs chief economist Jim O’Neill – to head the review.

“This is…not a science issue. This is an issue of markets and economics,” said Davies. “A scientist would just get bogged down and not get it.”

TALE OF TWO DRUGS

In recent decades, drugmakers have slashed investment in antibiotics because of poor returns from a class of low-priced medicines that are only used for short periods, even as overuse of existing drugs has spurred the spread of resistance.

As a result, the world’s biggest investor in the field today is a little-known U.S. firm, Cubist Pharmaceuticals, with an annual research budget for antibiotics of $400 million.

The industry complains its bug-killing medicines are severely undervalued – and they have a point.

Just over a year ago, Johnson & Johnson won approval for the first drug in 40 years that provides a new way to treat TB, yet sales of Sirturo are forecast by analysts to total just $75 million this year.

Compare that to Gilead Sciences’ new hepatitis C drug Sovaldi – carrying an eye-watering U.S. price tag of $1,000 per pill – which is tipped to sell more than $8 billion in 2014.

The key challenge is how to reward companies for finding drugs like Sirturo that must be used as sparingly as possible to avoid resistance developing – in effect, breaking the traditional link between payment and prescription volume.

Since it typically takes 15 years to develop a new drug, smart companies are starting to think ahead now, even though any market revamp is at least two years off – perhaps requiring a special United Nations session sometime in 2016.

GlaxoSmithKline, for example, one of the few large drug companies still working in the field, already has teams working through the implications of such a shift.

A belief that the tide may turn has also encouraged Roche back into antibiotics. The Swiss firm last launched an antibiotic in 1982.

And self-interest comes into play as well: A post-antibiotic world would undermine sales of important drugs to fight cancer or prevent rejection after organ transplants, since these medicines cannot be given without the safety net of effective antibiotics for treating potentially deadly infections.

Patrick Vallance, a former academic who now heads up GSK’s pharmaceuticals research, believes a system of advanced market commitments could be the answer, under which governments would agree to buy up new antibiotics for, say, a 10-year period.

A similar scheme for vaccines, known as GAVI, funded largely by donor governments and philanthropists, already works well and has helped buy shots to immunize hundreds of millions of children in poor countries against killer diseases.

But while GAVI guarantees firms big orders in exchange for low vaccine prices, an antibiotic purchase arrangement would need to turn that concept on its head by minimising the volume used – a challenge for manufacturers and governments alike.

PRIZE WINNING?

Others see a role for prizes, along the lines of the 2004 Ansari X Prize for space flight. Indeed, a $17 million British Longitude prize – modelled on the original search 300 years ago for an accurate way to measure longitude – was offered last month for a simple bacterial infection test that could lead to smarter antibiotic use.

However, prizes work best for single breakthroughs, whereas the world needs a sustainable flow of new antibiotics to keep modern medicine ahead in the evolutionary race with bacteria.

Extending patents for antibiotics is another approach, since antibiotics typically reach peak sales after 13 years on the market, compared to just six for other drugs, by which time the initial patent has run out.

A variation on the concept is transferable patent extensions for other medicines – expanding the time during which a drug company can reap profits from an expensive patented product in another area, such as cancer or heart disease.

Offering additional market exclusivity has worked for so-called orphan drugs for rare diseases, but the trade-off has been sky-high prices that have sparked their own controversy.

State support for new drug research may be another way to help plug the gap, as exemplified by Europe’s Innovative Medicines Initiative, which is funded jointly by industry and the EU.

It is clear, however, there is no simple solution – and some experts fear veering too far from free market forces will create perverse incentives that could result in taxpayers’ money ending up in shareholders’ pockets with meagre benefit to society.

Steve Gilman, chief scientific officer at Cubist, is skeptical about decoupling financial rewards from sales.

“De-linkage is an interesting concept but I’m not sure it is a practical concept,” he said in an interview. “Who’s going to come up with the money just to put drugs on the shelf?”

Like many in the United States, he is more focused on simply raising prices as the key lever to improving rewards – a view that resonates with many investors, according to Akiva Felt, an industry analyst at investment firm Oppenheimer, who worries that complex new purchase deals would be hard to value.

For companies like Cubist the current situation is not all doom and gloom. The exit of bigger players has reduced competition, while recent steps to ease the regulatory path to market have helped and the U.S. Generating Antibiotics Incentives Now (GAIN) Act now ensures some extra patent life.

Indeed, the U.S. Food and Drug Administration has approved two new drugs from Cubist and Durata Therapeutics for acute bacterial skin infections in the last two months. That’s encouraging but a more fundamental fix is still needed.

Jeremy Farrar, head of the Wellcome Trust medical charity which has made antibiotic resistance a top priority area for research funding, sees an analogy with the defence industry.

“This is a national security issue because of what it would do to the whole of medicine and health – and governments are just going to have to step in,” he told Reuters.

“The government doesn’t design a tank, but it does promise to buy one if you build it to certain standards and specifications. There are lessons to be learned in the antimicrobial world and the pharma sector from other industries which governments just have to have, and have to fund.” 

Source Reuters

Babies given antibiotics before they’re one ‘are more prone to eczema’: Drugs increase risk by 40%

Babies given antibiotics before they are a year old are more likely to develop eczema, say British researchers.

After years of debate about a possible link, a huge study shows taking the drugs in the first year of life increases the chances of developing the skin disorder by 40 per cent.

Each additional course of antibiotics further raises the risk of eczema – which affects one in five children in the UK – by 7 per cent.
Babies given antibiotics before they are a year old are more likely to develop eczema, say British researchers

Babies given antibiotics before they are a year old are more likely to develop eczema, say British researchers

About 2.4million of the UK’s 12million children have been diagnosed with the disease, caused by an over-active immune system and resulting in dry and itchy skin.

Researchers from Guy’s and St Thomas’ NHS Foundation Trust, King’s College London, the University of Nottingham and the Aberdeen Royal Infirmary reviewed data from 20 studies involving almost 293,000 babies and children.

Senior researcher Dr Carsten Flohr, of King’s College and Guy’s, said some previous studies had implied a link, but this was the first systematic large-scale review.

He said: ‘We found antibiotic exposure in early life may increase the risk of subsequent eczema by up to 40 per cent, with broad-spectrum antibiotics having a more pronounced effect. It’s a real effect.
About 2.4million of the UK’s 12million children have been diagnosed with the disease, caused by an over-active immune system and resulting in dry and itchy skin

About 2.4million of the UK’s 12million children have been diagnosed with the disease, caused by an over-active immune system and resulting in dry and itchy skin

‘Having antibiotics in the second year of life is less likely to be important, but we don’t have the studies to examine it.’

Dr Flohr recommended that antibiotics should be prescribed ‘with caution’, especially to infants with a family history of eczema or allergic disease.

But he stressed: ‘Doctors usually have good reason to prescribe antibiotics to infants.

‘The importance of this finding is to get a better understanding of the complex relationship between antibiotic use and allergic disease.

‘We need further research as determination of a true link between antibiotic use and eczema would have far-reaching clinical and public health implications.’

The latest research analysed 16 studies looking at a potential link between eczema and use of antibiotics in under ones and three more examining a possible link with exposure in the womb. One study looked at both, says a report in the British Journal of Dermatology.

Researchers found a ‘trend’ with prenatal exposure but insufficient evidence to make a link.

Eczema has no cure, but medical moisturisers called emollients can be used to keep the skin lubricated, backed up by steroid creams.

The proportions of children with eczema has risen from 3 per cent in the 1950s to 20 per cent today.
Rising allergy levels have several suspected triggers such as too-clean lifestyles, Caesarean births – which may affect immune systems – diet and the early use of antibiotics.

Nina Goad, of the British Association of Dermatologists, said: ‘Eczema is our most common skin disease.

‘The evidence is not conclusive and the researchers are not suggesting that parents should withhold antibiotics from children when doctors feel such treatment is necessary.

‘But studies like this give an insight into possible avoidable causes and may help to guide medical practice.’

Source MailOnline

Antibiotics are being painted onto the hulls of ships leading to more superbugs

Antibiotics are being painted onto the hulls of ships to them clear of barnacles in a practice that is helping to drive the appearance of drug resistant bacteria, ministers from the world’s richest nations have been warned. The use of antibiotics by the shipping industry emerged at a high level meeting of science ministers from the G8, who have prioritised tackling the problem of antibiotic resistance.

Dame Sally Davis, the British Chief Medical Officer, told the ministers that the common antibiotic Tetracycline, which is used to treat common infections in patients, was being added to paint for use on the hulls of ships to prevent the build up of algae and barnacles, known as fouling.

However, bacteria in the water can develop resistance to the antibiotic and it can be passed onto other organisms such as Escherichia coli and Salmonella.

There were almost 43,000 patients who caught so called “superbugs” in NHS hospitals last year.

David Willetts, the British science minister who led the meeting this week, said the soaring levels of antibiotic resistant infections was now one of the greatest threats facing the world.

He said: “I think some of us were shocked to hear for the first time that antibiotics are being put into paint to keep barnacles off ships.

“We need to share information to get a measure of what is happening and the scale of the threat, we need to promote research and development.

“We also need to look at domestic prescribing practices and try to promote a more responsible approach to prescribing.”

The use of antibiotics to keep ships clear of barnacles is the latest case of antibiotics being overused that is causing alarm among the medical community.

Scientists have raised concerns that the widespread use of antibiotics the vetinary industry has helped to drive the evolution of resistant strains of bacteria.

Doctors have also been criticised for over prescribing antibiotics, particularly to treat viral infections where they will have no effect.

Patients who do not finish courses of treatment are also helping to drive the emergence of new antibiotic resistant strains.

Mark Walport, the UK government’s chief scientific adviser, added: “The control of barnacles is an important issue but it needs to be looked at.

“The use of antibiotics has been fragmented and they are now used without a broader view of the affect that can have.”

Mr Willetts was speaking at the end of a three day meeting in London between the G8 science ministers.

They agreed to prioritise tackling antibiotic resistance and neurodegenerative diseases.

Gary Goodyear, minister of state for science and technology in Canada, said: “The fact we are seeing more and more antibiotics becoming less and less effective is of enormous concern for all of our societies.

“We feel very strongly that we can work together and collaborate to a solution faster.”

Genevieve Fioraso, minister for higher education and research in France, added: “We have to face societal challenges that are deep and we won’t succeed alone.”

Professor Mark Fielder, general secretary of the Society for Applied Microbiology said “Better prescribing policies and improved hygiene would help us to reduce the unnecessary use of antibiotics and to keep them for when there is a defined need for human or animal health.

“However, there is no panacea for the range of problems associated with antibiotic resistance and applied microbiologists are looking into alternative ways to treat infectious diseases as well as a variety of sources for new antibiotics.”

Source The Telegraph

Antibiotics could cure 40% of chronic back pain patients

Scientists hail medical breakthrough by which half a million UK sufferers could avoid major surgery and take antibiotics instead.

Up to 40% of patients with chronic back pain could be cured with a course of antibiotics rather than surgery, in a medical breakthrough that one spinal surgeon says is worthy of a Nobel prize.

Surgeons in the UK and elsewhere are reviewing how they treat patients with chronic back pain after scientists discovered that many of the worst cases were due to bacterial infections.

The shock finding means that scores of patients with unrelenting lower back pain will no longer face major operations but can instead be cured with courses of antibiotics costing around £114.

One of the UK’s most eminent spinal surgeons said the discovery was the greatest he had witnessed in his professional life, and that its impact on medicine was worthy of a Nobel prize.

“This is vast. We are talking about probably half of all spinal surgery for back pain being replaced by taking antibiotics,” said Peter Hamlyn, a consultant neurological and spinal surgeon at University College London hospital.

Hamlyn recently operated on rugby player Tom Croft, who was called up for the British and Irish Lions summer tour last month after missing most of the season with a broken neck.

Specialists who deal with back pain have long known that infections are sometimes to blame, but these cases were thought to be exceptional. That thinking has been overturned by scientists at the University of Southern Denmark who found that 20% to 40% of chronic lower back pain was caused by bacterial infections.

In Britain today, around 4 million people can expect to suffer from chronic lower back pain at some point in their lives. The latest work suggests that more than half a million of them would benefit from antibiotics.

“This will not help people with normal back pain, those with acute, or sub-acute pain – only those with chronic lower back pain,” Dr Hanne Albert, of the Danish research team, told the Guardian. “These are people who live a life on the edge because they are so handicapped with pain. We are returning them to a form of normality they would never have expected.”

Claus Manniche, a senior researcher in the group, said the discovery was the culmination of 10 years of hard work. “It’s been tough. There have been ups and downs. This is one those questions that a lot of our colleagues did not understand at the beginning. To find bacteria really confronts all we have thought up to this date as back pain researchers,” he said.

The Danish team describe their work in two papers published in the European Spine Journal. In the first report, they explain how bacterial infections inside slipped discs can cause painful inflammation and tiny fractures in the surrounding vertebrae.

Working with doctors in Birmingham, the Danish team examined tissue removed from patients for signs of infection. Nearly half tested positive, and of these, more than 80% carried bugs called Propionibacterium acnes.

The microbes are better known for causing acne. They lurk around hair roots and in the crevices in our teeth, but can get into the bloodstream during tooth brushing. Normally they cause no harm, but the situation may change when a person suffers a slipped disc. To heal the damage, the body grows small blood vessels into the disc. Rather than helping, though, they ferry bacteria inside, where they grow and cause serious inflammation and damage to neighbouring vertebrae that shows up on an MRI scan.

In the second paper, the scientists proved they could cure chronic back pain with a 100-day course of antibiotics. In a randomised trial, the drugs reduced pain in 80% of patients who had suffered for more than six months and had signs of damaged vertebra under MRI scans.

Albert stressed that antibiotics would not work for all back pain. Over-use of the drugs could lead to more antibiotic-resistant bacteria, which are already a major problem in hospitals. But she also warned that many patients will be having ineffective surgery instead of antibiotics that could alleviate their pain.

“We have to spread the word to the public, and to educate the clinicians, so the right people get the right treatment, and in five years’ time are not having unnecessary surgery,” she said.

Hamlyn said future research should aim to increase the number of patients that respond to antibiotics, and speed up the time it takes them to feel an improvement, perhaps by using more targeted drugs.

The NHS spends £480m on spinal surgery each year, the majority of which is for back pain. A minor operation can fix a slipped disc, which happens when one of the soft cushions of tissue between the bones in the spine pops out and presses on nearby nerves. The surgeons simply cut off the protruding part of the disc. But patients who suffer pain all day and night can be offered major operations to fuse damaged vertebrae or have artificial discs implanted.

“It may be that we can save £250m from the NHS budget by doing away with unnecessary operations. The price of the antibiotic treatment is only £114. It is spectacularly different to surgery. I genuinely believe they deserve a Nobel prize,” said Hamlyn. Other spinal surgeons have met Albert and are reviewing the procedures they offer for patients.

Source The Guardian