A frequent criticism leveled against the use of long term antibiotics for Lyme disease is that it contributes to the rise of super-bugs. Is this true?
LLMDS treating chronic Lyme disease typically use older generation antibiotics such as Amoxicillin or Minocycline. The dreaded MRSA- Methicillin resistant Staphylococcus aureus is resistant to Methicillin. Methicillin is an advanced generation penicillin. It inactivates penicillinase, an enzyme elaborated by evolved, resistant strains of Staph. All Staph aureus have been resistant to Amoxicillin for decades! The use of first generation antibiotics play no role in the development of sophisticated- antibiotic resistant bacteria. This argument holds no water. This overstated theory is not supported by decades of clinical practice or published scientific research. Super-bugs grow in an environment oozing with the latest- "super-antibiotics." Where does this occur?
It has been long established that super-bugs have emerged from the hospital environment. Hospitals have been on the cutting edge of using the latest and greatest antibiotics. In general, the newest, hi-tech antibiotics have been prescribed by infectious disease specialists, who have brandished these new drugs like a kid showing off a new shiny toy. To be fair, in recent years, ID specialists have become increasingly aware of this problem and made efforts to reign in the use of such super-antibiotics. MRSA emerged in hospitals and then spread to nursing homes and long term care facilities. It is only after its genesis in these venues that MRSA egressed into the general population. It has long been known that "nosocomial" infections- hospital acquired infections, are different and much more dangerous and antibiotic resistant than infections acquired in the "community."
Are hospitals the main problem then? No.
70% of antibiotics used in the US are used in agriculture. Farmers have access to latest hi-tech antibiotics and use them with impunity, without any oversight by the IDSA of physicians who are rightfully concerned with the advent of highly resistant germs. For the most part this information has remained outside the purview of public awareness and kept on the back pages of print media. The inappropriate use of antibiotics in agriculture is the invisible 800 pound gorilla sitting in the room when it comes to the issue of emerging super-bugs.
When you get down to brass tacks, the use of long term antibiotics in Lyme patients is criticized because the critics believe that a non-existent disease is being treated. If the disease does not exist off course no drugs, let alone antibiotics should be prescribed.
The problem is that Lyme disease is real. It is a multi-system, frequently life threatening disease. Do Lyme drugs cause Superbugs? NO. It is phony issue.
If the IDSA has issue with the existence of chronic Lyme, then lets have a debate about the real issue and the real science.
4 comments:
Hey Doc...
In the late 80's or early 90's I remember there was a lot on the news about antibiotics.
What they said was to make sure you took all of your antibiotics because if you quit after you felt better, the bacteria would regrow if not killed and next time be resistent to the antibiotic you just took and stopped to soon.
I remember this clearly, as I was a child photographer at the time and picked up impentago. A doc not worth her salt thought I had an allergic reaction to something and gave me hydrocortison cream.
needless to say it spread all over my body and even internally by the time I got to a dermatologist who knew what it was immediately. I do not remember what I took for 10 days, but am allergic to ceftins and pennicillian so it wasn't one of those.
Anyway...I remember her saying clearly that it was a staph infection and that I had to finish my antibiotics OR ELSE.
So, technically, if this is true...wouldn't a few 10 day courses of antibiotics, for someone like me who had lyme for a very very long time....wouldn't that create an antibiotic resistent bug in my body? I mean, I know I remember that before it wasn't overuse of antibiotics they were blaming, it was too little.
And of course there are antibiotics in food we eat. In cities it ends up in the water supply.
So, couldn't this mini-exposure be devastating as well to those of us undertreated or undiagnosed? Wouldn't THAT be what created a superbug in us as opposed to killing it all at once that FIRST time?
Its rhetorical to a point, and I may not be making sense here but hopefully you get what I am saying. Thanks!!
If antibiotics are stopped before all the targeted germs are killed the infection may relapse. Some germs develop antibiotic resistance easily, whereas others do not. For example, Staph was quick to develop resistance to Penicillin. On the other hand, GABS- the strep throat germ has never developed resistance to antibiotics and appears to lack the ability to become resistant. "Strep pneumo," a pneumonia and meningitis germ, only recently developed resistance to Penicillin after decades of exposure.
Germs vary in their ability to become resistant. Lyme? we can not culture it. We don't know if it becomes resistant or not. Our clinical experience would suggest that it does not develop resistance. Syphilis is not known to develop resistance. I do not know if this is relevant.
Bacteria become resistant because of natural selection. Bacteria replicate- reproduce quickly, typically every 20 minutes. With each replication there is a chance of a random genetic mutation. Some mutations may be beneficial to the germ and enhance its survival in the face of antibiotics. If antibiotic therapy kills 99% of a particular colony of bacteria there is a chance that remaining germs may have acquired restance. Incidentally, spirochetes, like Bb replicate very slowly, perhaps every 24 hours, this may have implications regarding its relative likelihood of acquiring resistance to antibiotics.
What is the affect of long term antibiotics on the development of germ resistance? It is not clear. One theory would should suggest that the "hit and run" approach of brief courses of hi tech antibiotics, frequently used in agriculture, may promote antibiotic resistance. By the same token, long term antibiotics may have the opposite effect. It is known that high enough concentrations of a particular antibiotic can sometimes overcome the natural resistance to the drug present in the microbe. It could also be postulated that continued pressure on the population of germs which keeps the number of pathogens to a low or negligible level, decreases the likelihood of mutations which might lead to drug resistance. The development of resistance is a numbers game. Drug resistance is more likely to occur when a large population of germs is replicating. Random, individual genetic mutations are very unlikely to lead to antibiotic resistance. When a bacteria develops resistance through this process it is the equivalent of hitting the lottery. Superbugs form in a nursery which allows large numbers of germ to replicate in an antibiotic rich environment which places evolutionary or natural selection pressures on the population to develop drug resistance. This specific environment is found in hospitals and in the animal husbandry environments.
Based on this line of reasoning, the use of long term antibiotics in humans creates an environment which specifically discourages the development of superbugs.
Not only pigs and cows, but flies in poultry
houses and poultry litter.
http://www.jhsph.edu/publichealthnews/press_releases/2009/graham_flies.html
March 16, 2009
"Flies May Spread Drug-Resistant Bacteria from Poultry Operations"
(Johns Hopkins School of Public Health)
Sorry. The url is incomplete as shown
above. Need to add at the end:
(following "press releases"):
/2009/graham_flies.html
Daphne
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