Tag Archives: infections resistant to antibiotics

GPs dishing out MORE antibiotics just to treat colds: Number given treatment by doctors rose by 40 per cent between 1999 and 2011

The proportion of patients given antibiotics by GPs for coughs and colds rose by 40 per cent between 1999 and 2011, a study has found.

Antibiotics do not work against viruses, which are often the cause of colds and sore throats.

But researchers from Public Health England and University College London discovered that the proportion of patients prescribed antibiotics by their GP for coughs and colds reached a new high of 51 per cent in 2011 – up from 36 per cent in 1999.

And despite dire warnings about the dangers of antibiotic resistance caused by overuse, they suggested that GPs tend to prescribe them when they are put under pressure by worried patients.

According to the study, which was published in the Journal of Antimicrobial Chemotherapy, the 10 per cent of GP practices with the highest prescribing rates gave antibiotics to two-thirds of patients with the minor illnesses.

Researchers monitoring prescriptions in 537 GP practices across the UK found some gave antibiotics to four out of five patients with sore throats. One in ten GP practices prescribed antibiotics to at least 97 per cent of patients suffering from ear infections.

And use of the recommended antibiotic trimethoprim in women for cystitis increased from 8 per cent in 1995 to 50 per cent in 2011.
 
Last year 41.6million prescriptions were dispensed for antibiotics in England, according to figures from the Health and Social Care Information Centre, which do not show how many were handed out for coughs and colds.

The Government’s chief medical officer Dame Sally Davies said last month that pushy patients have been partly to blame for the rise of deadly superbugs which are immune to the drugs.

And the Prime Minister has warned that Britain faces returning to the ‘dark ages of medicine’ where antibiotics no longer work.

Lead researcher Professor Jeremy Hawker, a consultant epidemiologist from Public Health England, said: ‘Although it would be inappropriate to say that all cases of coughs and colds or sore throats did not need antibiotics, our study strongly suggests that there is a need to make improvements in antibiotic prescribing.

Gets rid of them: it was suggested some doctors prescribe useless antibiotics to stop patients returning

Gets rid of them: It was suggested some doctors prescribe useless antibiotics to stop patients returning

‘Previous research has shown that only 10 per cent of sore throats and 20 per cent of acute sinusitis benefit from antibiotic treatment, but the prescription rates we found were much higher than this.’

He added: ‘The worry is that patients who receive antibiotics when they are not needed run the risk of carrying antibiotic-resistant bacteria in their gut.

‘If these bacteria go on to cause an infection, antibiotics will then not work when the patient really does need them.’

Professor Hawker went on to say that ‘defensive medicine’ could be partly responsible for some GPs prescribing them more often for coughs and colds to save them ‘being caught out’ by complications if the condition got worse.

And he suggested that GPs keen to cut down on their workload may give patients a prescription to stop them coming back to the surgery.

Dr Maureen Baker, chairman of the Royal College of General Practitioners, said: ‘Antibiotics are very effective drugs, as long as they are used appropriately. But we’ve developed a worrying reliance on them.

‘GPs face enormous pressure to prescribe them, even for minor symptoms which will get better on their own or can be treated effectively with other forms of medication.’

She added: ‘Our patients and the public need to be aware of the risks associated with inappropriate use of antibiotics – and know how to use them responsibly.

‘This study reinforces the message that we issued recently for frontline health professionals to resist pressure from patients for unnecessary prescriptions and explore alternatives to them.’

 
Source Mail Online
 

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

Antibiotic resistance: Cameron warns of medical ‘dark ages’

The world could soon be “cast back into the dark ages of medicine” unless action is taken to tackle the growing threat of resistance to antibiotics, Prime Minister David Cameron has said.

He has announced a review into why so few anti-microbial drugs have been introduced in recent years.

Economist Jim O’Neill will lead a panel including experts from science, finance, industry, and global health.

It will set out plans for encouraging the development of new antibiotics.
‘Taking the lead’

The prime minister said: “If we fail to act, we are looking at an almost unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine where treatable infections and injuries will kill once again.”

Mr Cameron said he discussed the issue at a G7 leaders meeting in Brussels earlier this month and got specific support from US President Barack Obama and German Chancellor Angela Merkel.

It is hoped that the review panel’s proposals will be discussed at next year’s G7 summit, which will be hosted by Germany.

“Penicillin was a great British invention by Alexander Fleming back in 1928,” Mr Cameron told the BBC. “It’s good that Britain is taking the lead on this issue to solve what could otherwise be a really serious global health problem.”

He said the panel would analyse three key issues: the increase in drug-resistant strains of bacteria, the “market failure” which has seen no new classes of antibiotics for more than 25 years, and the over-use of antibiotics globally.

‘Time bomb’

It is estimated that drug-resistant strains of bacteria are responsible for 5,000 deaths a year in the UK and 25,000 deaths a year in Europe.

bacteria

bacteria A resistant strain of bacteria

Chief Medical Officer for England Prof Dame Sally Davies has been a key figure helping to get the issue on the government and global agenda.

Last year she described the threat of antimicrobial resistance as a “ticking time bomb” and said the dangers it posed should be ranked along with terrorism.

She spoke at a meeting of scientists at the Royal Society last month which warned that a response was needed akin to efforts to combat climate change.

Dame Sally said: “I am delighted to see the prime minister taking a global lead by commissioning this review.

“New antibiotics made by the biotech and pharmaceutical industry will be central to resolving this crisis which will impact on all areas of modern medicine.”
Antibiotics dates of discovery timeline

Medical research charity the Wellcome Trust is providing £500,000 of funding for Mr O’Neill and his team, which will be based at their headquarters in central London.

Antimicrobial resistance has been a key issue for Jeremy Farrar, since he became director of the Wellcome Trust last year.

“Drug-resistant bacteria, viruses and parasites are driving a global health crisis,” he said.

“It threatens not only our ability to treat deadly infections, but almost every aspect of modern medicine: from cancer treatment to Caesarean sections, therapies that save thousands of lives every day rely on antibiotics that could soon be lost.”

‘Market failure’

Antibiotics have been an incredible success story, but bacteria eventually develop resistance through mutation.

One example is MRSA, which has been a major threat for years in hospitals. It is resistant to all but the most powerful of antibiotics, and the main weapon against it is improved hygiene, which cuts the opportunity for infection to spread.

Without antibiotics a whole raft of surgical procedures would be imperilled, from hip replacements to cancer chemotherapy and organ transplants.

Before antibiotics, many women died after childbirth after developing a simple bacterial infection.

Mr O’Neill is a high-profile economist who is best-known for coining the terms Bric and Mint – acronyms to describe countries which are emerging and potential powerhouses of the world economy.

He is not, though an expert on antibiotics or microbes. But Mr Cameron told the BBC it was important to have an economist heading the review:

“There is a market failure; the pharmaceutical industry hasn’t been developing new classes of antibiotics, so we need to create incentives.”

Jeremy Farrar said: “This is not just a scientific and medical challenge, but an economic and social one too which would require analysis of regulatory systems and behavioural changes to solve them.”

Mr O’Neill will begin work in September and is expected to deliver his recommendations next spring.

Last month antibiotic resistance was selected as the focus for the £10m Longitude Prize, set up to tackle a major challenge of our time. 

Source BBC News

Scientists say weakness in ‘superbug’ bacteria could herald new treatments

A weakness in the defences of “superbug” bacteria has been uncovered by British scientists, raising the prospect of new treatments to tackle infections that are resistant to antibiotics.

The researchers have identified a weakness affecting the membrane barrier that surrounds some of the most drug-resistant bacterial cells.

The discovery, reported in the journal Nature, may pave the way to a new generation of drugs that work by bringing down the defensive wall.

At the heart of their findings is the way “gram negative” bacterial cells transport the barrier’s molecular “bricks”.

Professor Changjiang Dong, from the University of East Anglia’s (UEA) Norwich Medical School, said: “We have identified the path and gate used by the bacteria to transport the barrier building blocks to the outer surface. Importantly we have demonstrated that the bacteria would die if the gate is locked.

“This is really important because drug-resistant bacteria is a global health problem. Many current antibiotics are becoming useless, causing hundreds of thousands of deaths each year.

“The number of superbugs are increasing at an unexpected rate. This research provides the platform for urgently needed new-generation drugs.”

Experts have warned that the rise of resistant bacteria around the world poses a global threat greater than that of climate change.

Bugs such as MRSA (methicillin resistant Staphylococcus aureus) are becoming increasingly immune even to antibiotics that are the last resort in treatment, adding risk to operations and procedures that should be routine.

In a report this year England’s chief medical officer, Dame Sally Davies, warned that antibiotic resistant bacteria capable of causing untreatable infections posed a “catastrophic threat”.

She called for urgent action worldwide to address the problem.

“Gram-negative” bacteria, which include Escherichia coli (E coli) and the bugs that cause gonorrhea, cholera and Legionnaire’s disease, are especially resistant to antibiotics.

They can evolve a number of mechanisms to make them immune to drugs, including reducing the permeability of their outer membrane.

But if the membrane barrier falls the bacteria die.

Haohao Dong, another member of the UAE team, said: “The really exciting thing about this research is that new drugs will specifically target the protective barrier around the bacteria, rather than the bacteria itself. Because new drugs will not need to enter the bacteria itself, we hope that the bacteria will not be able to develop drug resistance in future.”

Source The Guardian