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Local super bugs are growing more resistant to antibiotics



Experts say continuing the reduction of unnecessary prescriptions helpful in the battle against super bugs

The first case of antibiotic resistance to a bacteria at the root of some of the most common ailments in man is giving new importance to the push by medical experts to limit the use of antibiotics.

"The real public health message here is that when your physician says you don’t need an antibiotic you don’t need one," said Dr. Paul Martiquet, Whistler’s medical health officer.

"We have cases where physicians say, ‘I told the patient they probably don’t need an antibiotic, but the patient insisted so what was I supposed to do?’

"So there has to be knowledge amongst the general public of when to use antibiotics and when not to."

Things are looking up on the prescription front. According to data released by IMS Health between 1990 and 1995 the number of prescriptions for antibiotics increased steadily to reach 27.3 million annually.

But by the end of 1999 the number had decreased by close to 2 million, to 25.5 million.

Medical experts have long dreaded the day when the antibiotic vancomycin, often described as the weapon of last resort, met a staphylococcus aureus bug it couldn’t match.

That happened last month in Michigan. Luckily the patient responded to two new drugs but both cost over $150 a day, compared to the $10 a day for vancomycin.

Now some medical professionals are facing the bleak prospect of being unable to fight some of the most common staphylococcus infections with antibiotics in the future.

This was the case before the discovery of penicillin when surgical procedures, now performed routinely, would have been too dangerous to carry out because of the risk of infection.

Staphylococcus aureus causes infections like septicemia, pneumonia, bone infections, skin infections and is the most common infection picked up in hospitals.

Three out of 10 healthy people carry SA on their skin or in their nose and they will not normally cause harm.

The most important way to prevent any bacterial infection is to wash your hands before eating, drinking or applying personal care products and after using the toilet.

Martiquet, while concerned about this latest development, cautions against an alarmist reaction.

"The concern for Whistler and B.C. really isn’t the exotic stuff," said Martiquet.

"It is the bread and butter stuff we are seeing, for example the drug resistant tuberculosis in the Whistler area. We are seeing streptococcus that has had some resistance to different antibiotics that we don’t normally see resistance to and that is a concern."

Tuberculosis is endemic in many First Nations groups including those in the corridor, said Martiquet. Those who suffer from the disease, now have to take a cocktail of drugs, which are not only expensive, they are long-term therapies.

There are currently several effective antibiotics to fight strep. But resistance is growing. If you have strep throat you should get antibiotics. But only a swab can confirm the diagnosis.

Nearly all colds, flues and ear infections are caused by viruses and treating them with antibiotics is useless.

Many parents feel that as soon as their child gets an ear infection they must get a prescription, but since most of the infections are viral, said Martiquet, an antibiotic is of no use.

Most ear infections will clear up on their own, as will most other viral infections.

"If things don’t improve then use your common sense and see your family doctor," said Martiquet.

Medical experts are still one step ahead of the superbugs thanks to research and development of new antibiotics.

But over prescription continues to play a role in the growing resistance exhibited by certain bacteria.

Bacteria in the wild do not usually have resistance to antibiotics. In order for a bacterium to become resistant to a given antibiotic there must be either a natural mutation in a gene within the bacterial chromosome or the system that leads to resistance must be acquired.

Acquisition of antibiotic resistance occurs when genetic material is taken up by the bacterial cell and either incorporated into the chromosome, or, it is able to exist in a stable form independent of the chromosome.

Antibiotic-resistant super bugs aren’t just a threat to the health of Canadians they are a major drain on the already overtaxed health-care system.

The most common form of antibiotic resistance, methicillin-resistant staphylococcus aureus (MRSA) is costing Canadian hospitals between $50 million and $60 million a year according to Toronto research published recently in the International Journal of Infection Control and Hospital Epidemiology.

According to the most recent data available, 1999, there were 4.12 cases of MRSA per 1,000 hospital admissions in the country. That is nearly a five-fold increase from the rate in 1995 when Canada began to track the problem.

Said Martiquet: "We should be very conservative in our use of common antibiotics for common ailments."