Development of antibiotic resistant bacteria is a growing problem. We may still have some time before we’re faced with examples of total bacterial resistance, but there have been reports of isolated cases where bacteria have shown resistance of most, if not all antibiotics. In the Jan. 13, 2017, issue of Morbidity and Mortality Weekly Report (MMWR) there was a report: “Notes from the Field: Pan-Resistant New Delhi Metallo-Beta-Lactamase-Producing Klebsiella pneumoniae — Washoe County, Nevada, 2016.” A 70-year-old woman died from an infection that was resistant to every antibiotic available in the United States.
A number of programs are being implemented, albeit slowly, to reduce the development of bacterial resistance. One of the major concerns has been the use of antibiotics in animal feed, not for treatment of infections, but to encourage rapid weight gain.
A program to assure judicious use of antibiotics may be less effective than had been hoped, according to an October 2016 issue brief from the Pew Charitable Trust, which reported, “Judicious Animal Antibiotic Use Requires Drug Label Refinements … Analysis shows more than 1 in 3 labels will not fully meet judicious use standards after implementation of FDA policy.” In 2002, the Proceedings of the National Academy of Sciences published a report “Antibiotics in agriculture: When is it time to close the barn door?” The answer seems to be: soon, soon.
The reduced use of antibiotics in animal feed is one of the major steps towards controlling antibiotic resistance, but there are other steps that should be taken to reduce resistance, and these can be tied, not so much to greed, as to politics and rectitude. The Republican Party has an ongoing crusade to shut down all Planned Parenthood clinics. The party has done this state by state, wherever it can cut off funding for clinical services and President Trump has set the goal of shutting the clinics on a national level.
We’ve already seen what happens to public health in poor towns when the Planned Parenthood Clinic is forced to close. The Chicago Tribune wrote “Conservative political forces in Indiana were driven by religious fervor to gut all public funding from Planned Parenthood. They led the nation in demonizing the organization because 3 percent of its services involved reproductive services — abortion.”
While the state Legislature was busy defunding Planned Parenthood, there was a epidemic of opioid addiction and HIV infection. “The number of opioid-related deaths in Indiana spiraled from 200 in 2002 to 700 in 2012, according to the Indiana State Department of Health. … The public’s HIV treatment bill for Austin (Indiana) will run $200 million once the epidemic peaks — at least $1 million to save each uninsured patient, say health experts.”
Louisiana had similar problems, where cut-backs in funding to Planned Parenthood led to increases in HIV and other sexually transmitted diseases. The politicians apparently thought it would be easy – take the money from one group and give it to another. It doesn’t work. In part it’s because most of the money involved is for services provided, and if the patients can’t, or won’t go to the new clinic, there’s really no way to transfer the money. The other is that clinicians are not interchangeable, and the quality of service is not always equal, even if it’s for something as simple as reading a drug package insert and following instructions.
The April 27 issue of MMWR had an important report: “Adherence to CDC Recommendations for the Treatment of Uncomplicated Gonorrhea — STD Surveillance Network, United States, 2016.” Gonorrhea, the sexually transmitted disease (STD) caused by Neisseria gonorrhoeae, is the second most common notifiable disease in the US after chlamydia; 468,514 cases were reported to state and local health departments in 2016, an increase of 18.5% from 2015. N. gonorrhoeae has progressively developed resistance to most antimicrobials used to treat the infection. As a result, CDC recommends two antimicrobials (250 mg of ceftriaxone plus 1 g of azithromycin for treating uncomplicated gonorrhea to improve treatment efficacy and, hopefully, to slow the emergence and spread of antimicrobial resistance.
When the CDC monitored provider compliance with treatment standards they found that there were no differences based on patient age or race, but the patients treated in family planning/reproductive health centers received the recommended treatment 94% of the time, while other providers followed the treatment guidelines only 80%. The results documented that the family planning and STD centers were offering the highest quality of care, and local and state authorities should be monitoring the quality of treatment to protect us from the resistant bugs that will just laugh at our attempts at treatment.
The bugs can develop resistance to our treatments a lot faster than we’ve been able to find new antibiotics. These are things that we really should be concerned about.
Sam Uretsky is a writer and pharmacist living in New York. Email sdu01@outlook.com.
From The Progressive Populist, June 1, 2018
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