Colloidal Silver

[Badly Shaved Monkey]

No BSM, I do not promote colloidial silver. I know the problems it can cause and anyone who thinks about taking it could easily find the side-effects and risks by doing a simple google search.

Good.

Now, back to the derail. I know we are all supposed to get in a sweat about 'over-prescription' of antibiotics. But if the figure is taht about 1/3 of prescriptions are inappropriate, I'm not sure that should lead us to conclude that over-prescription has much responsibility for antibiotic resistance. That still means that 2/3 of prescriptions are appropriate. Given the near-universal nature of the ability of bacteria to develop resistance I'd bet a fair sum of money that even if the 1/3 were instantly abolished we'd see resistance developing at pretty much the same rate.

In other words, I doubt that "overprescription" is to blame. I suspect that widespread prescription per se of antibiotics is to blame.

This is not my speciality, so I'd be interested in Rolfe's views, but it just seems obvious to me that placing bugs under selective pressure even in correctly chosen patients is still going to select for resistance simply because bacterial disease treatable by antibiotics is so prevalent.

Blaiming overperscription is an easy way to divert the blame to foolish doctors instead of accepting that the problem is locked into biology however well doctors behave. Sadly, this means the problem is more not less intractable.

 

[Rob Lister]

Good.

Now, back to the derail. I know we are all supposed to get in a sweat about 'over-prescription' of antibiotics. But if the figure is taht about 1/3 of prescriptions are inappropriate, I'm not sure that should lead us to conclude that over-prescription has much responsibility for antibiotic resistance. That still means that 2/3 of prescriptions are appropriate. Given the near-universal nature of the ability of bacteria to develop resistance I'd bet a fair sum of money that even if the 1/3 were instantly abolished we'd see resistance developing at pretty much the same rate.

In other words, I doubt that "overprescription" is to blame. I suspect that widespread prescription per se of antibiotics is to blame.

This is not my speciality, so I'd be interested in Rolfe's views, but it just seems obvious to me that placing bugs under selective pressure even in correctly chosen patients is still going to select for resistance simply because bacterial disease treatable by antibiotics is so prevalent.

Blaiming overperscription is an easy way to divert the blame to foolish doctors instead of accepting that the problem is locked into biology however well doctors behave. Sadly, this means the problem is more not less intractable.

Some very fair reasoning, that.

Is it also fair to wonder that what the CDC might consider as an unnecessary antibiotic prescription might differ from what an in-the-weeds family doctor's thinks is unnecessary?

Case in point: Doctors that prescribe antibiotics for a common cold. No, it won't help the cold but it won't hurt it and and it might ward off opportunistic infections, especially in the very young and very old. Even though the infection risk is small, the 'added resistance' this prescription causes is even smaller and his malpractice insurance premiums are already very high indeed.

 

[Badly Shaved Monkey]

Some very fair reasoning, that.

Is it also fair to wonder that what the CDC might consider as an unnecessary antibiotic prescription might differ from what an in-the-weeds family doctor's thinks is unnecessary?

We have a big problem with Pseudomonas infections in dog ears. We treat it with antibiotics and no one can reasonably say this is not a bacterial disease but it's a bugger to shift and in a high percentage of cases we can't cure it and in the process that population acquires resistance to what we are using.

No one has come up with a mode of treatment that doesn't involve antibiotics and I do too many TECA/LBO procedures, but that's the only way to remiove the problem in end-stage cases. I hadn't done as many as we used to and was rather smugly thinking our medical management had got a lot better, but like buses they all seem to arrive at once and I've done multiple procedures in the last few weeks, though several have been second opinions cases not just our own cases. Which just goes to show that we can't win 'em all but we'd win even fewer without antibiotics.

 

[Anders]

We have a big problem with Pseudomonas infections in dog ears. We treat it with antibiotics and no one can reasonably say this is not a bacterial disease but it's a bugger to shift and in a high percentage of cases we can't cure it and in the process that population acquires resistance to what we are using.

<snip>

Isn't pseudomonas a bacteria family? Or is that just the name of the disease?

 

[Badly Shaved Monkey]

Isn't pseudomonas a bacteria family? Or is that just the name of the disease?

Pseudomonas aeruginosa. Inhabitant of dirty drains and smelly dog ears.

 

[Art Vandelay]

Now, back to the derail. I know we are all supposed to get in a sweat about 'over-prescription' of antibiotics. But if the figure is taht about 1/3 of prescriptions are inappropriate, I'm not sure that should lead us to conclude that over-prescription has much responsibility for antibiotic resistance. That still means that 2/3 of prescriptions are appropriate. Given the near-universal nature of the ability of bacteria to develop resistance I'd bet a fair sum of money that even if the 1/3 were instantly abolished we'd see resistance developing at pretty much the same rate.

Well, it seems reasonable to assume that it would drop by at least 33%. Furthermore, responsible antibiotics use probably leads to much less resistance than irresponsible use. If a patient is put on a strict antibiotics regime, the bacteria has to instantly develop resistance. In the case of haphazard antibiotics use, however, some of the bacteria survives, regardless of resistence. The more resistent ones, however, will survive at greater rates, and this allows for a gradual evolution of resistence over thousands of generations. In addition, proper antibiotics supervision will probably be accompanied by proper vector supervision, which means that steps will taken to ensure that the bacteria is not transmitted to another person, and that those that already have it (including the person that infected the current patient) will be treated.

Anders

Isn't pseudomonas a bacteria family?

I think that you missed the double negative: "no one can reasonably say this is not a bacterial disease".

 

[JSFolk]

Just to clarify a little about the doctors giving antibiotics to expedition members or folks going on vacation: These are probably not meant to be used prophylactically. I've done a lot of reading about long-distance sailing/cruising, and one of the things that you do before going out is to get your doctor to give prescriptions for a few good multi-spectrum antibiotics, along with instructions for their use. That way, when you get some sort of weird tropical disease while anchored off of an atoll in the South Pacific, you can do something about it. Antibiotics can also be used to control, say, appendicitis until you can get to a doctor.

I'm against over-use of antibiotics too, but let's not fly off the handle.

 

[Rob Lister]

Well, it seems reasonable to assume that it would drop by at least 33%. Furthermore, responsible antibiotics use probably leads to much less resistance than irresponsible use. If a patient is put on a strict antibiotics regime, the bacteria has to instantly develop resistance. In the case of haphazard antibiotics use, however, some of the bacteria survives, regardless of resistence. The more resistent ones, however, will survive at greater rates, and this allows for a gradual evolution of resistence over thousands of generations. In addition, proper antibiotics supervision will probably be accompanied by proper vector supervision, which means that steps will taken to ensure that the bacteria is not transmitted to another person, and that those that already have it (including the person that infected the current patient) will be treated.

I'm a novice here so don't dis' me unless you're in a really bad mood. I don't claim to know what I'm talking about. Still, to this novice, some of your post does not make logical sense.

You suggest that it is reasonable to assume that resistance problems would drop by 33% (the amount of presumed over-prescription). If so, what pathogens are becoming resistant?

Either the patient has a nasty pathogen or does not.

If the patient does not then the nasty pathogen is not exposed to the antibiotic and therefore cannot become resistant.

If the patient does have the nasty pathogen then the antibiotic is, at least in part, indicated.

Are you suggesting that pathogens should be left to their own devices and only treated medically if the normal immune system can't handle it by itself? If so, I'd think (probably incorrectly) that you're trading a bad resistance problem for a worse one -- one in which an antibiotic can't handle a pathogen as opposed to one in which a human can't handle (assumes pathogens can become resistant to natural immune measures as well).

 

[Darat]

ah phoo. posting info from the WHO and CDC is hardly "jumping in with both fists swinging". Overuse of antibiotics is a real pet peeve of mine and to see Darat comment that he knows MANY doctors who will give antibiotics for someone just going on vacation and to recommend this practice for this poor fellow who obviously doesn't make good choices (making his own silver) warranted comment IMHO. If it is "derailing" a thread then just ignore it.

You misunderstood my comment Barbrae.

What I was referring to was a prescription for the drugs so that they can take some with them on expedition or holiday. I was not saying I knew Doctors who just told people to take them for no reasons. The reason these Doctors will do this is that in many remote parts of the world it just is not possible to get any antibiotics. Therefore you get a scratch in the middle of say a jungle trek, an infection develops and without antibiotics your chances are not too great. Therefore it is sensible to take a broad spectrum antibiotic with you.

You also misunderstood my comment about the politician.

What I was commenting on was the fact hat he had a stupid belief that for some reason antibiotics would be in short supply after the year 2000 and embarked on a stupid (and known to be dangerous) self administered, dosage unbeknown, purity unknown course of “colloidal silver”. A more sensible way to plan for a possible shortage of antibiotics would have been to obtain supplies of antibiotics prior to 31st December 2001.

 

[Badly Shaved Monkey]

Well, it seems reasonable to assume that it would drop by at least 33%.

No. Once it has arisen in any population of a bacterial species it has the potential to propagate through the population.

If a patient is put on a strict antibiotics regime, the bacteria has to instantly develop resistance. In the case of haphazard antibiotics use, however, some of the bacteria survives, regardless of resistence. .

1. Not just the bacteria causing the current infection are exposed, your whole body's bacterial population is exposed and can establish a reservoir of resistance on mobile genetic elements.

2. Successful treatment does not necessarily equate with creation of elimination of all the causal microbes either in the infected site or in the body as a whole.

 

[Art Vandelay]

If the patient does not then the nasty pathogen is not exposed to the antibiotic and therefore cannot become resistant.

But not-so-nasty pathogens can become resistant.

If the patient does have the nasty pathogen then the antibiotic is, at least in part, indicated.

Isuppose that depends on how one defines "pathogen". Furthermore, if a bacteria just happens to be present, there's no reason to think that the amount of antibiotics would be in the right amount.

Are you suggesting that pathogens should be left to their own devices and only treated medically if the normal immune system can't handle it by itself?

Well, "pathogen" and "bacteria" are hardly synonyms. Not all pathogens are bacteria, and not all bacteria are pathogens. But I don't think that antibiotics should be prescribed unless there is a clear reason.

QUOTE]Originally posted by Darat
I was not saying I knew Doctors who just told people to take them for no reasons. The reason these Doctors will do this is that in many remote parts of the world it just is not possible to get any antibiotics. Therefore you get a scratch in the middle of say a jungle trek, an infection develops and without antibiotics your chances are not too great. Therefore it is sensible to take a broad spectrum antibiotic with you.[/quote]But that would still invite abuse. The whole point of having prescriptions is that doctors decide when they are warranted, rather than leaving it up to the patient. I'm not disputing that there are cases where this is appropriate, only that there is nothing to worry about.

A more sensible way to plan for a possible shortage of antibiotics would have been to obtain supplies of antibiotics prior to 31st December 2001.

Or secure a supply of colloidal silver, to be administered after there was actually some evidence of the collapse of civilization.

No. Once it has arisen in any population of a bacterial species it has the potential to propagate through the population.

Huh?

1. Not just the bacteria causing the current infection are exposed, your whole body's bacterial population is exposed and can establish a reservoir of resistance on mobile genetic elements.-

Yes, but that happens in improperly admistered cases as well.

2. Successful treatment does not necessarily equate with creation of elimination of all the causal microbes either in the infected site or in the body as a whole.

But it is much more likely than in improperly adminstered cases.

 

[Badly Shaved Monkey]

Originally posted by Art Vandelay

Huh?


Once a bacterial species has acquired resistance anywhere in its range then that resistant strain may spread and the reisstance may be passed among species, so there are too many factors at play to assume a simple linear relation between the prevalence of resistance and the prevalence of over-prescription.


Yes, but that happens in improperly admistered cases as well.

All I'm saying is that there is not a simple proportionality between over-prescrption and resistance, but that if anything resistane is likely to be greater than would be expected not because of relative overprescription, but simply because antibiotics are used a lot in absolute terms.


But it is much more likely than in improperly adminstered cases.

Which pushes the bias back towards an effect for bad prescribing habits, but neither of us knows the size of that effect.

Your points would be valid counters if I had said that overprescription had no effect, but what I said was that the effect of overprescription is less than we might suppose and it is the absolute level of use that is more important in the spread of antibiotic resistance. What neither of us has is hard data to support or refute my contention, but I still think my qualitative arguments are valid.

 

[Dredred]

That's his color from now on.

Some more people who've explored the joy of silver-drinking:

 

[Badly Shaved Monkey]

Some more people who've explored the joy of silver-drinking:

Yikes!

 

[Rolfe]

Pseudomonas aeruginosa. Inhabitant of dirty drains and smelly dog ears.

Have you tried cefoperazone? (Calling cascade on an intramammary preparation and using it as a topical.) Rosemary Reid tipped me the wink and Prester John supplied more information. I'm finding that at least 50% of Ps. aeruginosa isolates from canine ears are sensitive.

Bacterial resistance fascinates me, the way they always seem to come up with the goods on demand. And nobody has been able to tell me whether or not maintaining a resistance gene in the absence of the selection pressure produced by antibiotic use will be a cost to the organism. But I haven't got any nice neat answers. Except I agree with you, most resistance is caused by legitimate use of the antibiotics. That is, using them on the organisms you actually want to kill.

Rolfe.

 

[Badly Shaved Monkey]

Have you tried cefoperazone?

No, and I'd forgotten about it's previous mentions here. What's the tradename?

 

[CaveDave]

No, and I'd forgotten about it's previous mentions here. What's the tradename?

See http://www.drugs.com/cons/Cefoperazone.html
For a nasty post-op infection they gave me Keflex for 10 days I-V.

Dave

 

[Rolfe]

No, and I'd forgotten about it's previous mentions here. What's the tradename?

Pathocef Intramammary Suspension. (Keflex is cephalexin as far as I know, which is something else.)

Huh, first thing I got landed with this morning was an ear Ps. aeruginosa resistant to everything but Polymixin B. Evil organism!

Rolfe.

 

[Mojo]

But not-so-nasty pathogens can become resistant.

Isuppose that depends on how one defines "pathogen".

Since "pathogen" is generally defined as "disease-causing organism", pathogens are pretty much "nasty" by definition.

 

[Badly Shaved Monkey]

Huh, first thing I got landed with this morning was an ear Ps. aeruginosa resistant to everything but Polymixin B. Evil organism!

Rolfe.

Can they get resistant to that as well? It punches holes in cell membranes doesn't it? So, the effect is almost physical rather than biochemical.