Puppies Are Making People Sick — And it’s People’s Fault
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The Never-Ending Debate Over Finishing Your Antibiotics
Maybe You Shouldn't Take All of Your Antibiotics, After All
Sponsored
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FM","link":"/"}},"futureofyou_444606":{"type":"posts","id":"futureofyou_444606","meta":{"index":"posts_1591205157","site":"futureofyou","id":"444606","score":null,"sort":[1537808634000]},"guestAuthors":[],"slug":"puppies-are-making-people-sick-and-its-peoples-fault","title":"Puppies Are Making People Sick — And it’s People’s Fault","publishDate":1537808634,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>Antibiotic-resistant bacteria that have infected more than 100 people and that have been linked to pet store puppies appear to have spread at least in part because healthy dogs were given \u003ca href=\"https://www.statnews.com/2018/09/14/gottlieb-idea-antibiotic-resistance/\" target=\"_blank\" rel=\"noopener\">antibiotics \u003c/a>— a decision that all but surely fostered \u003ca href=\"https://www.statnews.com/2017/01/12/nevada-woman-superbug-resistant/\" target=\"_blank\" rel=\"noopener\">antibiotic resistance\u003c/a>.[contextly_sidebar id=\"HDE34Sd5YWLlXCnShh6EZNM8CydbBxW9\"]\u003c/p>\n\u003cp>“This is shocking,” said Lance Price, head of George Washington University’s Antibiotic Resistance Action Center. “This is an important study that’s shining a light on something that we need to spend more time on.”\u003c/p>\n\u003cp>More than half of the puppies in a sample of roughly 150 dogs studied as part of the outbreak investigation were given antibiotics not because they were sick, but to keep them from becoming so, according to a new \u003ca href=\"https://www.cdc.gov/mmwr/volumes/67/wr/mm6737a3.htm?s_cid=mm6737a3_w\" target=\"_blank\" rel=\"noopener\">study \u003c/a>published Thursday. The technique, called prophylaxis, has been widely used in food animal production and is blamed for fueling antibiotic resistance.\u003c/p>\n\u003cp>“We just have to change how we’re thinking about antibiotics,” warned \u003ca href=\"https://www.statnews.com/2018/03/19/antibiotics-food-animals-superbugs/\" target=\"_blank\" rel=\"noopener\">Matthew Wellington\u003c/a>, antibiotics program director for U.S. PIRG, the Public Interest Research Group.\u003c/p>\n\u003cp>The outbreak of the bacteria, Campylobacter jejuni, which causes diarrheal disease, started in early 2016 and continued until February of this year. People from 18 states fell ill, including 29 pet store employees. The investigation, which began in August of 2017, discovered that puppies were the source of the problem.\u003c/p>\n\u003cp>Thursday’s study was published in Morbidity and Mortality Weekly Report, a journal produced by the Centers for Disease Control and Prevention. It revealed how many antibiotics the dogs had been given as well as the results of testing done on bacterial samples — known as isolates — from 10 of the sick people and eight of the puppies to see which drugs might kill the bacteria.[contextly_sidebar id=\"q4wh1QIIYj2SgExEJSBT0dpA9hyykGIx\"]\u003c/p>\n\u003cp>“Outbreak isolates were resistant by antibiotic susceptibility testing to all antibiotics commonly used to treat Campylobacter infections,” the authors reported.\u003c/p>\n\u003cp>“This outbreak demonstrates that puppies can be a source of multidrug-resistant Campylobacter infections in humans, warranting a closer look at antimicrobial use in the commercial dog industry.”\u003c/p>\n\u003cp>The outbreak involved six pet store chains, but the problem likely is a broader one, the study showed. Officials in four states visited 20 pet stores and collected antibiotic administration records for about 150 puppies. Of those, 95 percent had received at least one course of drugs —\u003cbr>\nand many received more than one — before reaching the store or while at the store. Sixteen different types of antibiotics were used. And about half the treated dogs were not sick — they were given the drugs to prevent illness.\u003c/p>\n\u003cp>Senior author Mark Laughlin, a veterinarian with CDC’s division of foodborne, waterborne and environmental diseases, said investigators were taken aback by the scale of antibiotic use in the industry.\u003c/p>\n\u003cp>“We were surprised to see the large number of different types of drugs and the large number of courses that the dogs were exposed to. These are pretty young animals on the whole,” he told STAT.\u003c/p>\n\u003cp>Initially the CDC thought it might be able to trace the infections to a single source — one breeder or commercial breeding facility where the bacterium had spread. But as the investigators learned more about the byzantine world of the breeding and distribution of dogs sold in pet stores, it became clear there wasn’t a single source.\u003c/p>\n\u003cp>In effect, the system was creating the problem. “These dogs were coming from a large variety of sources,” Laughlin said.[contextly_sidebar id=\"y0nEJMe3DFJWuNjaVc0QYWLkG8UyuJYo\"]\u003c/p>\n\u003cp>Price wasn’t impressed. “If your system requires a constant or regular dose of antibiotics to keep the animals healthy, your system’s broken. You’ve designed a system that makes sick animals,” he said.\u003c/p>\n\u003cp>Wellington agreed. “Antibiotics should only be used to treat illness, not to compensate for poor practices — whether it’s trucking dogs long distances and having poor hygiene in the process along the way,” he said. “These are lifesaving medicines that should only be used to treat sick animals or sick people.”\u003c/p>\n\u003cp>Campylobacter jejuni is a common infection; the CDC estimates that about 1.3 million cases occur every year in the U.S. Fortunately most people recover without needing medical care.\u003c/p>\n\u003cp>Both Wellington and Price have been vocal critics of misuse of antibiotics in food animal production. But use of the drugs in the commercial dog industry wasn’t on their radar.\u003c/p>\n\u003cp>Price was startled by the report. “For me, this is an indication that they need to be raising these animals differently. They’re creating this terrible distribution system for multidrug-resistant bacteria,” he said.\u003c/p>\n\u003cp>The reality is that, although the outbreak appears to have ended, there could well be ongoing cases because the practices that led to puppies becoming infected with multidrug resistant drugs are still being used.\u003c/p>\n\u003cp>Laughlin said the CDC is working with veterinarian associations and the commercial dog industry, which he said was concerned and keen to make changes.\u003c/p>\n\u003cp>They must, Wellington insisted.\u003c/p>\n\u003cp>“This is one of the clearest examples I’ve seen where resistant bacteria are originating in animals from antibiotic overuse, and they’re passing directly to people and spreading rapidly,” he said. “So I think this is one of those situations where it’s incredibly clear that this is a problem we need to solve.”\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This \u003c/span>\u003c/i>\u003ca href=\"https://www.statnews.com/2018/09/20/antibiotics-resistant-bacteria-puppies-people/\" target=\"_blank\" rel=\"noopener\">\u003ci>\u003cspan style=\"font-weight: 400\">story\u003c/span>\u003c/i>\u003c/a>\u003ci>\u003cspan style=\"font-weight: 400\"> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n","blocks":[],"excerpt":"More than half of the puppies in a sample of roughly 150 dogs studied as part of the outbreak investigation were given antibiotics to keep them from becoming sick.","status":"publish","parent":0,"modified":1537761866,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":25,"wordCount":942},"headData":{"title":"Puppies Are Making People Sick — And it’s People’s Fault | KQED","description":"More than half of the puppies in a sample of roughly 150 dogs studied as part of the outbreak investigation were given antibiotics to keep them from becoming sick.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Puppies Are Making People Sick — And it’s People’s Fault","datePublished":"2018-09-24T17:03:54.000Z","dateModified":"2018-09-24T04:04:26.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"444606 https://ww2.kqed.org/futureofyou/?p=444606","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/09/24/puppies-are-making-people-sick-and-its-peoples-fault/","disqusTitle":"Puppies Are Making People Sick — And it’s People’s Fault","source":"Health","nprByline":"Helen Branswell\u003cbr />STAT","path":"/futureofyou/444606/puppies-are-making-people-sick-and-its-peoples-fault","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Antibiotic-resistant bacteria that have infected more than 100 people and that have been linked to pet store puppies appear to have spread at least in part because healthy dogs were given \u003ca href=\"https://www.statnews.com/2018/09/14/gottlieb-idea-antibiotic-resistance/\" target=\"_blank\" rel=\"noopener\">antibiotics \u003c/a>— a decision that all but surely fostered \u003ca href=\"https://www.statnews.com/2017/01/12/nevada-woman-superbug-resistant/\" target=\"_blank\" rel=\"noopener\">antibiotic resistance\u003c/a>.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“This is shocking,” said Lance Price, head of George Washington University’s Antibiotic Resistance Action Center. “This is an important study that’s shining a light on something that we need to spend more time on.”\u003c/p>\n\u003cp>More than half of the puppies in a sample of roughly 150 dogs studied as part of the outbreak investigation were given antibiotics not because they were sick, but to keep them from becoming so, according to a new \u003ca href=\"https://www.cdc.gov/mmwr/volumes/67/wr/mm6737a3.htm?s_cid=mm6737a3_w\" target=\"_blank\" rel=\"noopener\">study \u003c/a>published Thursday. The technique, called prophylaxis, has been widely used in food animal production and is blamed for fueling antibiotic resistance.\u003c/p>\n\u003cp>“We just have to change how we’re thinking about antibiotics,” warned \u003ca href=\"https://www.statnews.com/2018/03/19/antibiotics-food-animals-superbugs/\" target=\"_blank\" rel=\"noopener\">Matthew Wellington\u003c/a>, antibiotics program director for U.S. PIRG, the Public Interest Research Group.\u003c/p>\n\u003cp>The outbreak of the bacteria, Campylobacter jejuni, which causes diarrheal disease, started in early 2016 and continued until February of this year. People from 18 states fell ill, including 29 pet store employees. The investigation, which began in August of 2017, discovered that puppies were the source of the problem.\u003c/p>\n\u003cp>Thursday’s study was published in Morbidity and Mortality Weekly Report, a journal produced by the Centers for Disease Control and Prevention. It revealed how many antibiotics the dogs had been given as well as the results of testing done on bacterial samples — known as isolates — from 10 of the sick people and eight of the puppies to see which drugs might kill the bacteria.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“Outbreak isolates were resistant by antibiotic susceptibility testing to all antibiotics commonly used to treat Campylobacter infections,” the authors reported.\u003c/p>\n\u003cp>“This outbreak demonstrates that puppies can be a source of multidrug-resistant Campylobacter infections in humans, warranting a closer look at antimicrobial use in the commercial dog industry.”\u003c/p>\n\u003cp>The outbreak involved six pet store chains, but the problem likely is a broader one, the study showed. Officials in four states visited 20 pet stores and collected antibiotic administration records for about 150 puppies. Of those, 95 percent had received at least one course of drugs —\u003cbr>\nand many received more than one — before reaching the store or while at the store. Sixteen different types of antibiotics were used. And about half the treated dogs were not sick — they were given the drugs to prevent illness.\u003c/p>\n\u003cp>Senior author Mark Laughlin, a veterinarian with CDC’s division of foodborne, waterborne and environmental diseases, said investigators were taken aback by the scale of antibiotic use in the industry.\u003c/p>\n\u003cp>“We were surprised to see the large number of different types of drugs and the large number of courses that the dogs were exposed to. These are pretty young animals on the whole,” he told STAT.\u003c/p>\n\u003cp>Initially the CDC thought it might be able to trace the infections to a single source — one breeder or commercial breeding facility where the bacterium had spread. But as the investigators learned more about the byzantine world of the breeding and distribution of dogs sold in pet stores, it became clear there wasn’t a single source.\u003c/p>\n\u003cp>In effect, the system was creating the problem. “These dogs were coming from a large variety of sources,” Laughlin said.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Price wasn’t impressed. “If your system requires a constant or regular dose of antibiotics to keep the animals healthy, your system’s broken. You’ve designed a system that makes sick animals,” he said.\u003c/p>\n\u003cp>Wellington agreed. “Antibiotics should only be used to treat illness, not to compensate for poor practices — whether it’s trucking dogs long distances and having poor hygiene in the process along the way,” he said. “These are lifesaving medicines that should only be used to treat sick animals or sick people.”\u003c/p>\n\u003cp>Campylobacter jejuni is a common infection; the CDC estimates that about 1.3 million cases occur every year in the U.S. Fortunately most people recover without needing medical care.\u003c/p>\n\u003cp>Both Wellington and Price have been vocal critics of misuse of antibiotics in food animal production. But use of the drugs in the commercial dog industry wasn’t on their radar.\u003c/p>\n\u003cp>Price was startled by the report. “For me, this is an indication that they need to be raising these animals differently. They’re creating this terrible distribution system for multidrug-resistant bacteria,” he said.\u003c/p>\n\u003cp>The reality is that, although the outbreak appears to have ended, there could well be ongoing cases because the practices that led to puppies becoming infected with multidrug resistant drugs are still being used.\u003c/p>\n\u003cp>Laughlin said the CDC is working with veterinarian associations and the commercial dog industry, which he said was concerned and keen to make changes.\u003c/p>\n\u003cp>They must, Wellington insisted.\u003c/p>\n\u003cp>“This is one of the clearest examples I’ve seen where resistant bacteria are originating in animals from antibiotic overuse, and they’re passing directly to people and spreading rapidly,” he said. “So I think this is one of those situations where it’s incredibly clear that this is a problem we need to solve.”\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This \u003c/span>\u003c/i>\u003ca href=\"https://www.statnews.com/2018/09/20/antibiotics-resistant-bacteria-puppies-people/\" target=\"_blank\" rel=\"noopener\">\u003ci>\u003cspan style=\"font-weight: 400\">story\u003c/span>\u003c/i>\u003c/a>\u003ci>\u003cspan style=\"font-weight: 400\"> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/444606/puppies-are-making-people-sick-and-its-peoples-fault","authors":["byline_futureofyou_444606"],"categories":["futureofyou_1060","futureofyou_73"],"tags":["futureofyou_1184","futureofyou_1614","futureofyou_61"],"featImg":"futureofyou_444608","label":"source_futureofyou_444606"},"futureofyou_441174":{"type":"posts","id":"futureofyou_441174","meta":{"index":"posts_1591205157","site":"futureofyou","id":"441174","score":null,"sort":[1525201206000]},"guestAuthors":[],"slug":"drug-sanctuaries-offer-hope-for-a-post-antibiotic-world","title":"‘Drug Sanctuaries’ Offer Hope for a Post-Antibiotic World","publishDate":1525201206,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>We are at risk of entering a post-antibiotic era.\u003c/p>\n\u003cp>Each year since 2013, a major global institution — including the \u003ca href=\"http://reports.weforum.org/global-risks-2013/risk-case-1/the-dangers-of-hubris-on-human-health/\" target=\"_blank\" rel=\"noopener\">World Economic Forum\u003c/a>, the \u003ca href=\"http://www.who.int/antimicrobial-resistance/global-action-plan/en/\" target=\"_blank\" rel=\"noopener\">World Health Organization\u003c/a> and the \u003ca href=\"http://www.un.org/ga/search/view_doc.asp?symbol=A/71/L.2&referer=/english/&Lang=E\" target=\"_blank\" rel=\"noopener\">United Nations General Assembly\u003c/a> — has issued this grave warning to the world.[contextly_sidebar id=\"XV9iH3usDUjTEoRS7VEResmysvKM5CrO\"]\u003c/p>\n\u003cp>A \u003ca href=\"https://theconversation.com/canada-could-lead-the-fight-for-life-in-a-post-antibiotic-world-80864\" target=\"_blank\" rel=\"noopener\">post-antibiotic future is daunting\u003c/a>. When the drugs don’t work, we get sicker more often. We stay sicker longer. This hurts the economy because sick people don’t work.\u003c/p>\n\u003cp>In response, we really only have two options.\u003c/p>\n\u003cp>One is to gather more arrows in our quiver — by discovering new antibiotics to which microbes like bacteria are not currently resistant.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The second is to manage our current arsenal of drugs better so that they remain effective for as long as possible. The key to doing this is to reduce the global burden of antibiotic resistance by decreasing the quantity of drugs we use.\u003c/p>\n\u003cp>\u003cstrong>Delivering drugs differently\u003cbr>\n\u003c/strong>The first strategy of response to antibiotic resistance is not as easy as it sounds. While there are many potential new therapies that could be effective, there are few incentives for industry to invest in their development.\u003c/p>\n\u003cp>If an antibiotic works well, it is used for a short time — a few days to a couple of weeks at the most. The \u003ca href=\"https://www.pharmaceutical-journal.com/news-and-analysis/features/why-are-there-so-few-antibiotics-in-the-research-and-development-pipeline/11130209.article\" target=\"_blank\" rel=\"noopener\">commercial return on a drug designed to treat longer lasting non-communicable illnesses, like cancer, for instance, can be much higher\u003c/a> because the drugs are used for longer.\u003c/p>\n\u003cp>The logic of the second strategy is straightforward. The widespread use of antibiotics in medicine and agriculture means that a drug-resistant variant of a bacterium will enjoy a strong selective advantage and can quickly spread. So by reducing the use of drugs, we reduce the selection pressure on resistance and slow the rate at which resistance evolves and spreads. Simple.[contextly_sidebar id=\"VbydMq0RqS7R9WIF0Ye7B1EZAyZoMl2y\"]\u003c/p>\n\u003cp>Except it’s not. How, precisely, should we reduce the volume of drugs we use?\u003c/p>\n\u003cp>We can’t just introduce a blanket ban on prescriptions and stop using drugs altogether. If my loved one is sick and there is a drug that can make them better, I want that drug.\u003c/p>\n\u003cp>But maybe we could deliver our drugs in ways that would make it harder for resistance to evolve and spread? And so prolong the amount of time a drug remains effective?\u003c/p>\n\u003cp>\u003cstrong>Creating drug sanctuaries\u003cbr>\n\u003c/strong>One suggestion that\u003ca href=\"http://kassenlab.weebly.com/\" target=\"_blank\" rel=\"noopener\"> my research group\u003c/a> has been exploring is to make use of \u003ca href=\"https://onlinelibrary.wiley.com/doi/abs/10.1002/evl3.43\" target=\"_blank\" rel=\"noopener\">drug sanctuaries, or drug-free environments\u003c/a> — to effectively reduce the strength of selection for resistance.\u003c/p>\n\u003cp>If drug-sensitive variants of microbes have a growth advantage over resistant ones when no drug is around, then sensitive variants would predominate in drug-free refuges and help keep resistant ones from taking over the population.\u003c/p>\n\u003cp>Drug sanctuaries could be used in hospitals. For example, different wards could restrict the use of certain drugs (generating a form of spatial sanctuary) or could alternate the use of a drug on the same ward over time (a form of temporal sanctuary).\u003c/p>\n\u003cp>Evolutionary models can help guide us here. Variation in time is like paying taxes: You can’t avoid it. A variant that evolves in a temporally varying environment is the one that does best across all conditions experienced.\u003c/p>\n\u003cp>Variation in space, on the other hand, provides more options because the different locations can act as refuges for the specialized variants of bacteria. Because those locations are always available, then specialists can coexist indefinitely. At least in theory.\u003c/p>\n\u003cp>\u003cstrong>Buying us time\u003cbr>\n\u003c/strong>This seems to be what happened when we did an experiment to test the theory.\u003c/p>\n\u003cp>Resistance to the commonly used antibiotic ciprofloxacin took longer to spread in laboratory populations of the opportunistic pathogen Pseudomonas aeruginosa — a bacterium that causes acute infections in hospitals, especially intensive- care units, and chronic infections in the lungs of cystic fibrosis patients — when drug sanctuaries were experienced in space rather than time.\u003c/p>\n\u003cp>Resistant and sensitive genetic variants actually coexisted in spatial sanctuaries because of a trade-off between resistance and growth rate.\u003c/p>\n\u003cp>Resistant variants could withstand the drug, but grew far more slowly than sensitive ones in the sanctuary. The result was that neither could be eliminated by natural selection.[contextly_sidebar id=\"MjDUXQparIcTA4fgoyev9hL5QsR382iY\"]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>What surprised us, though, was that over time, this trade-off broke down.\u003c/p>\n\u003cdiv class=\"post__col \">\n\u003cdiv class=\"post__col-right\">\n\u003carticle>\n\u003cdiv class=\"body-text\">\n\u003cp>The resistant strains actually gained mutations that improved their ability to grow in the absence of the drug. By the end of the experiment, most populations in the spatial sanctuary were dominated by antibiotic-resistant strains.\u003c/p>\n\u003cp>Evidently drug sanctuaries in space could allow us to keep using drugs for longer, but not indefinitely. Eventually we will need new arrows in our quiver.\u003c/p>\n\u003cp>\u003cstrong>A challenge for evolutionary biology\u003cbr>\n\u003c/strong>Our experiments are highly contrived and restricted to one strain of one pathogen evolving in response to one drug in the defined and controlled conditions of a laboratory.\u003c/p>\n\u003cp>Whether our conclusions hold for other bugs and other drugs, or more complicated networks of transmission characteristic of hospitals and the communities they are embedded in, remains to be seen.\u003c/p>\n\u003cp>What our work allows us to do is get directly at the ecological and genetic mechanisms responsible for the emergence, coexistence and eventual demise of diversity.\u003c/p>\n\u003cp>Using these evolutionary principles in more complex, real-world situations to manage our arsenal of drugs for as long as possible will be a major challenge for evolutionary biology in the years to come.\u003c/p>\n\u003c/div>\n\u003c/article>\n\u003c/div>\n\u003c/div>\n\n","blocks":[],"excerpt":"One key to reducing the global burden of antibiotic resistance is by decreasing the quantity of drugs we use. But we can’t just introduce a blanket ban on prescriptions and stop using drugs altogether. ","status":"publish","parent":0,"modified":1525173275,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":30,"wordCount":919},"headData":{"title":"‘Drug Sanctuaries’ Offer Hope for a Post-Antibiotic World | KQED","description":"One key to reducing the global burden of antibiotic resistance is by decreasing the quantity of drugs we use. But we can’t just introduce a blanket ban on prescriptions and stop using drugs altogether. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"‘Drug Sanctuaries’ Offer Hope for a Post-Antibiotic World","datePublished":"2018-05-01T19:00:06.000Z","dateModified":"2018-05-01T11:14:35.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"441174 https://ww2.kqed.org/futureofyou/?p=441174","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/05/01/drug-sanctuaries-offer-hope-for-a-post-antibiotic-world/","disqusTitle":"‘Drug Sanctuaries’ Offer Hope for a Post-Antibiotic World","source":"Health","nprByline":"Rees Kassen\u003cbr />The Conversation","path":"/futureofyou/441174/drug-sanctuaries-offer-hope-for-a-post-antibiotic-world","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>We are at risk of entering a post-antibiotic era.\u003c/p>\n\u003cp>Each year since 2013, a major global institution — including the \u003ca href=\"http://reports.weforum.org/global-risks-2013/risk-case-1/the-dangers-of-hubris-on-human-health/\" target=\"_blank\" rel=\"noopener\">World Economic Forum\u003c/a>, the \u003ca href=\"http://www.who.int/antimicrobial-resistance/global-action-plan/en/\" target=\"_blank\" rel=\"noopener\">World Health Organization\u003c/a> and the \u003ca href=\"http://www.un.org/ga/search/view_doc.asp?symbol=A/71/L.2&referer=/english/&Lang=E\" target=\"_blank\" rel=\"noopener\">United Nations General Assembly\u003c/a> — has issued this grave warning to the world.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>A \u003ca href=\"https://theconversation.com/canada-could-lead-the-fight-for-life-in-a-post-antibiotic-world-80864\" target=\"_blank\" rel=\"noopener\">post-antibiotic future is daunting\u003c/a>. When the drugs don’t work, we get sicker more often. We stay sicker longer. This hurts the economy because sick people don’t work.\u003c/p>\n\u003cp>In response, we really only have two options.\u003c/p>\n\u003cp>One is to gather more arrows in our quiver — by discovering new antibiotics to which microbes like bacteria are not currently resistant.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The second is to manage our current arsenal of drugs better so that they remain effective for as long as possible. The key to doing this is to reduce the global burden of antibiotic resistance by decreasing the quantity of drugs we use.\u003c/p>\n\u003cp>\u003cstrong>Delivering drugs differently\u003cbr>\n\u003c/strong>The first strategy of response to antibiotic resistance is not as easy as it sounds. While there are many potential new therapies that could be effective, there are few incentives for industry to invest in their development.\u003c/p>\n\u003cp>If an antibiotic works well, it is used for a short time — a few days to a couple of weeks at the most. The \u003ca href=\"https://www.pharmaceutical-journal.com/news-and-analysis/features/why-are-there-so-few-antibiotics-in-the-research-and-development-pipeline/11130209.article\" target=\"_blank\" rel=\"noopener\">commercial return on a drug designed to treat longer lasting non-communicable illnesses, like cancer, for instance, can be much higher\u003c/a> because the drugs are used for longer.\u003c/p>\n\u003cp>The logic of the second strategy is straightforward. The widespread use of antibiotics in medicine and agriculture means that a drug-resistant variant of a bacterium will enjoy a strong selective advantage and can quickly spread. So by reducing the use of drugs, we reduce the selection pressure on resistance and slow the rate at which resistance evolves and spreads. Simple.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Except it’s not. How, precisely, should we reduce the volume of drugs we use?\u003c/p>\n\u003cp>We can’t just introduce a blanket ban on prescriptions and stop using drugs altogether. If my loved one is sick and there is a drug that can make them better, I want that drug.\u003c/p>\n\u003cp>But maybe we could deliver our drugs in ways that would make it harder for resistance to evolve and spread? And so prolong the amount of time a drug remains effective?\u003c/p>\n\u003cp>\u003cstrong>Creating drug sanctuaries\u003cbr>\n\u003c/strong>One suggestion that\u003ca href=\"http://kassenlab.weebly.com/\" target=\"_blank\" rel=\"noopener\"> my research group\u003c/a> has been exploring is to make use of \u003ca href=\"https://onlinelibrary.wiley.com/doi/abs/10.1002/evl3.43\" target=\"_blank\" rel=\"noopener\">drug sanctuaries, or drug-free environments\u003c/a> — to effectively reduce the strength of selection for resistance.\u003c/p>\n\u003cp>If drug-sensitive variants of microbes have a growth advantage over resistant ones when no drug is around, then sensitive variants would predominate in drug-free refuges and help keep resistant ones from taking over the population.\u003c/p>\n\u003cp>Drug sanctuaries could be used in hospitals. For example, different wards could restrict the use of certain drugs (generating a form of spatial sanctuary) or could alternate the use of a drug on the same ward over time (a form of temporal sanctuary).\u003c/p>\n\u003cp>Evolutionary models can help guide us here. Variation in time is like paying taxes: You can’t avoid it. A variant that evolves in a temporally varying environment is the one that does best across all conditions experienced.\u003c/p>\n\u003cp>Variation in space, on the other hand, provides more options because the different locations can act as refuges for the specialized variants of bacteria. Because those locations are always available, then specialists can coexist indefinitely. At least in theory.\u003c/p>\n\u003cp>\u003cstrong>Buying us time\u003cbr>\n\u003c/strong>This seems to be what happened when we did an experiment to test the theory.\u003c/p>\n\u003cp>Resistance to the commonly used antibiotic ciprofloxacin took longer to spread in laboratory populations of the opportunistic pathogen Pseudomonas aeruginosa — a bacterium that causes acute infections in hospitals, especially intensive- care units, and chronic infections in the lungs of cystic fibrosis patients — when drug sanctuaries were experienced in space rather than time.\u003c/p>\n\u003cp>Resistant and sensitive genetic variants actually coexisted in spatial sanctuaries because of a trade-off between resistance and growth rate.\u003c/p>\n\u003cp>Resistant variants could withstand the drug, but grew far more slowly than sensitive ones in the sanctuary. The result was that neither could be eliminated by natural selection.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>What surprised us, though, was that over time, this trade-off broke down.\u003c/p>\n\u003cdiv class=\"post__col \">\n\u003cdiv class=\"post__col-right\">\n\u003carticle>\n\u003cdiv class=\"body-text\">\n\u003cp>The resistant strains actually gained mutations that improved their ability to grow in the absence of the drug. By the end of the experiment, most populations in the spatial sanctuary were dominated by antibiotic-resistant strains.\u003c/p>\n\u003cp>Evidently drug sanctuaries in space could allow us to keep using drugs for longer, but not indefinitely. Eventually we will need new arrows in our quiver.\u003c/p>\n\u003cp>\u003cstrong>A challenge for evolutionary biology\u003cbr>\n\u003c/strong>Our experiments are highly contrived and restricted to one strain of one pathogen evolving in response to one drug in the defined and controlled conditions of a laboratory.\u003c/p>\n\u003cp>Whether our conclusions hold for other bugs and other drugs, or more complicated networks of transmission characteristic of hospitals and the communities they are embedded in, remains to be seen.\u003c/p>\n\u003cp>What our work allows us to do is get directly at the ecological and genetic mechanisms responsible for the emergence, coexistence and eventual demise of diversity.\u003c/p>\n\u003cp>Using these evolutionary principles in more complex, real-world situations to manage our arsenal of drugs for as long as possible will be a major challenge for evolutionary biology in the years to come.\u003c/p>\n\u003c/div>\n\u003c/article>\n\u003c/div>\n\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/441174/drug-sanctuaries-offer-hope-for-a-post-antibiotic-world","authors":["byline_futureofyou_441174"],"categories":["futureofyou_1","futureofyou_73"],"tags":["futureofyou_1184","futureofyou_697","futureofyou_952","futureofyou_1056","futureofyou_294"],"featImg":"futureofyou_441195","label":"source_futureofyou_441174"},"futureofyou_440512":{"type":"posts","id":"futureofyou_440512","meta":{"index":"posts_1591205157","site":"futureofyou","id":"440512","score":null,"sort":[1522179023000]},"guestAuthors":[],"slug":"antibiotic-resistance-is-globally-on-the-rise-raising-alarms","title":"Antibiotic Resistance is Globally On the Rise, Raising Alarms","publishDate":1522179023,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>The development of antibiotics in the middle of the 20th century was one of the greatest achievements of modern medicine. Penicillin and its pharmaceutical cousins \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/\" target=\"_blank\" rel=\"noopener\">saved millions\u003c/a> of lives. But like a magic potion given to the world by a stern fairy, antibiotics come with a catch — If you abuse them, you lose them.\u003c/p>\n\u003cp>For decades, scientists have been \u003ca href=\"https://www.kqed.org/futureofyou/100905/superbugs\" target=\"_blank\" rel=\"noopener\">warning that antibiotic resistance\u003c/a> is on the rise globally because of misuse of the drugs.\u003c/p>\n\u003cp>But a new report makes it clear that the world is not listening.[contextly_sidebar id=\"KJZOa7uMNIN4ArNMyMOA5manjU869PnC\"]\u003c/p>\n\u003cp>Between the year 2000 and 2015 human consumption of antibiotics globally rose 65 percent — to an astounding 42 billion doses a year. \"We wanted to examine global use of antibiotics because once resistance emerges in one place it can spread anywhere,\" says Eili Klein, a fellow at the Center for Disease Dynamics, Economics and Policy in Washington and the lead author of the new report, which was published Monday in the \u003ca href=\"http://www.pnas.org/content/early/2018/03/20/1717295115\" target=\"_blank\" rel=\"noopener\">Proceedings of the National Academy of Sciences\u003c/a>.\u003c/p>\n\u003cp>Along with his colleagues Klein found that there was a dramatic rise in antibiotic use over the last 15 years in low- and middle-income countries.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"A place like India, which has one of the highest populations in the world, saw enormous gains in antibiotic use both overall and on a per capita gain basis,\" says Klein.[contextly_sidebar id=\"SmtZzzk0FHpRcMcZ48thm4EPcrSnAjnT\"]\u003c/p>\n\u003cp>Antibiotic use more than doubled in India between the year 2000 and 2015. It was up 79 percent in China and 65 percent in Pakistan. Some of that increase was due to population growth but it wasn't just that. Overall sales were up.\u003c/p>\n\u003cp>So the report makes it clear that the average person in India, China or Pakistan is taking far more antibiotics now than they were a decade and half ago.\u003c/p>\n\u003cp>Western countries didn't see the sharp rise in antibiotics but they also failed to cut overall consumption.\u003c/p>\n\u003cp>\"In high-income countries reducing inappropriate use has not really ... in most countries ... driven down per capita use rates in the last 15 years,\" Klein says.\u003c/p>\n\u003cp>Lance Price, director of the Antibiotic Resistance Action Center at George Washington University, is concerned about this increase in antibiotic use.[contextly_sidebar id=\"lnBKX8143Mq00xj3zZD6AuQQqZq3rGIR\"]\u003c/p>\n\u003cp>\"The biggest driver for the evolution of superbugs is the use of antibiotics,\" Price says. Every time a bacteria is exposed to an antibiotic but isn't killed by it, it has the potential to develop resistance. The evolutionary math is fairly simple. \"The more we use antibiotics,\" he explains, \"the more we are going to encourage the growth of these bacteria that are resistant to them.\"\u003c/p>\n\u003cp>Hospitals around the world increasingly have been reporting bacterial infections that don't respond to traditional antibiotics.\u003c/p>\n\u003cp>\"Then you have these extreme cases like the woman [in Nevada] just about a year ago who died of an infection that was resistant to 26 different antibiotics,\" Price says. \"So the bacteria are out there that are resistant to everything, and they are becoming more and more prevalent.\"\u003c/p>\n\u003cp>Health officials worry about so much growth in antibiotic use in low- and middle-income countries because these drugs are often available there without a prescription. So the potential for misuse is high. Also Price notes that poor sanitation in impoverished nations adds to the problem. If a superbug develops in a patient who only has access to an outhouse, that bug is far more likely to spread into the local water supply than if that patient had access to a toilet connected to a sewage treatment plant.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>So the antibiotic fairy is not happy: If we don't change our ways she's going to slowly make the potion less and less powerful until one day it disappears.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Surge+In+Antibiotics+Is+A+Boon+For+Superbugs&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"Hospitals around the world are reporting bacterial infections that don't respond to routine antibiotics.","status":"publish","parent":0,"modified":1522179023,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":18,"wordCount":636},"headData":{"title":"Antibiotic Resistance is Globally On the Rise, Raising Alarms | KQED","description":"Hospitals around the world are reporting bacterial infections that don't respond to routine antibiotics.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Antibiotic Resistance is Globally On the Rise, Raising Alarms","datePublished":"2018-03-27T19:30:23.000Z","dateModified":"2018-03-27T19:30:23.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"440512 https://ww2.kqed.org/futureofyou/?p=440512","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/03/27/antibiotic-resistance-is-globally-on-the-rise-raising-alarms/","disqusTitle":"Antibiotic Resistance is Globally On the Rise, Raising Alarms","source":"Health","nprImageCredit":"Katie Park","nprByline":"Jason Beaubien\u003cbr />NPR Goats and Soda","nprImageAgency":"NPR","nprStoryId":"597014559","nprApiLink":"http://api.npr.org/query?id=597014559&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/goatsandsoda/2018/03/26/597014559/surge-in-antibiotics-is-a-boon-for-superbugs?ft=nprml&f=597014559","nprRetrievedStory":"1","nprPubDate":"Mon, 26 Mar 2018 21:49:00 -0400","nprStoryDate":"Mon, 26 Mar 2018 18:04:38 -0400","nprLastModifiedDate":"Mon, 26 Mar 2018 18:04:38 -0400","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2018/03/20180326_atc_antiobiotic_use_is_skyrocketing.mp3?orgId=1&topicId=1001&d=191&p=2&story=597014559&ft=nprml&f=597014559","nprAudioM3u":"http://api.npr.org/m3u/1597100833-ae8218.m3u?orgId=1&topicId=1001&d=191&p=2&story=597014559&ft=nprml&f=597014559","path":"/futureofyou/440512/antibiotic-resistance-is-globally-on-the-rise-raising-alarms","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2018/03/20180326_atc_antiobiotic_use_is_skyrocketing.mp3?orgId=1&topicId=1001&d=191&p=2&story=597014559&ft=nprml&f=597014559","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The development of antibiotics in the middle of the 20th century was one of the greatest achievements of modern medicine. Penicillin and its pharmaceutical cousins \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/\" target=\"_blank\" rel=\"noopener\">saved millions\u003c/a> of lives. But like a magic potion given to the world by a stern fairy, antibiotics come with a catch — If you abuse them, you lose them.\u003c/p>\n\u003cp>For decades, scientists have been \u003ca href=\"https://www.kqed.org/futureofyou/100905/superbugs\" target=\"_blank\" rel=\"noopener\">warning that antibiotic resistance\u003c/a> is on the rise globally because of misuse of the drugs.\u003c/p>\n\u003cp>But a new report makes it clear that the world is not listening.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Between the year 2000 and 2015 human consumption of antibiotics globally rose 65 percent — to an astounding 42 billion doses a year. \"We wanted to examine global use of antibiotics because once resistance emerges in one place it can spread anywhere,\" says Eili Klein, a fellow at the Center for Disease Dynamics, Economics and Policy in Washington and the lead author of the new report, which was published Monday in the \u003ca href=\"http://www.pnas.org/content/early/2018/03/20/1717295115\" target=\"_blank\" rel=\"noopener\">Proceedings of the National Academy of Sciences\u003c/a>.\u003c/p>\n\u003cp>Along with his colleagues Klein found that there was a dramatic rise in antibiotic use over the last 15 years in low- and middle-income countries.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"A place like India, which has one of the highest populations in the world, saw enormous gains in antibiotic use both overall and on a per capita gain basis,\" says Klein.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Antibiotic use more than doubled in India between the year 2000 and 2015. It was up 79 percent in China and 65 percent in Pakistan. Some of that increase was due to population growth but it wasn't just that. Overall sales were up.\u003c/p>\n\u003cp>So the report makes it clear that the average person in India, China or Pakistan is taking far more antibiotics now than they were a decade and half ago.\u003c/p>\n\u003cp>Western countries didn't see the sharp rise in antibiotics but they also failed to cut overall consumption.\u003c/p>\n\u003cp>\"In high-income countries reducing inappropriate use has not really ... in most countries ... driven down per capita use rates in the last 15 years,\" Klein says.\u003c/p>\n\u003cp>Lance Price, director of the Antibiotic Resistance Action Center at George Washington University, is concerned about this increase in antibiotic use.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"The biggest driver for the evolution of superbugs is the use of antibiotics,\" Price says. Every time a bacteria is exposed to an antibiotic but isn't killed by it, it has the potential to develop resistance. The evolutionary math is fairly simple. \"The more we use antibiotics,\" he explains, \"the more we are going to encourage the growth of these bacteria that are resistant to them.\"\u003c/p>\n\u003cp>Hospitals around the world increasingly have been reporting bacterial infections that don't respond to traditional antibiotics.\u003c/p>\n\u003cp>\"Then you have these extreme cases like the woman [in Nevada] just about a year ago who died of an infection that was resistant to 26 different antibiotics,\" Price says. \"So the bacteria are out there that are resistant to everything, and they are becoming more and more prevalent.\"\u003c/p>\n\u003cp>Health officials worry about so much growth in antibiotic use in low- and middle-income countries because these drugs are often available there without a prescription. So the potential for misuse is high. Also Price notes that poor sanitation in impoverished nations adds to the problem. If a superbug develops in a patient who only has access to an outhouse, that bug is far more likely to spread into the local water supply than if that patient had access to a toilet connected to a sewage treatment plant.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>So the antibiotic fairy is not happy: If we don't change our ways she's going to slowly make the potion less and less powerful until one day it disappears.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Surge+In+Antibiotics+Is+A+Boon+For+Superbugs&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/440512/antibiotic-resistance-is-globally-on-the-rise-raising-alarms","authors":["byline_futureofyou_440512"],"categories":["futureofyou_1060","futureofyou_1","futureofyou_73"],"tags":["futureofyou_1184","futureofyou_952","futureofyou_61","futureofyou_177","futureofyou_173"],"collections":["futureofyou_1093"],"featImg":"futureofyou_440513","label":"source_futureofyou_440512"},"futureofyou_435129":{"type":"posts","id":"futureofyou_435129","meta":{"index":"posts_1591205157","site":"futureofyou","id":"435129","score":null,"sort":[1504508465000]},"guestAuthors":[],"slug":"column-the-never-ending-debate-over-finishing-your-antibiotics","title":"The Never-Ending Debate Over Finishing Your Antibiotics","publishDate":1504508465,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>One of the most well-known concepts in medicine, to both doctors and patients, is that you must absolutely finish a course of antibiotics. The thinking goes that if you don’t eradicate every last bacterium causing your illness, the survivors can develop resistance and wreak further havoc.\u003c/p>\n\u003cp>This concern was voiced by the venerated Alexander Fleming himself — discoverer of penicillin, the first true antibiotic — which is part of why the idea is so enduring. Toward the end of his 1945 Nobel Prize acceptance speech, Fleming warned that “there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to nonlethal quantities of the drug make them resistant.”\u003c/p>\n\u003caside class=\"pullquote alignright\">Overdosing antibiotics is a bigger threat than underdosing.\u003c/aside>\n\u003cp>This proclamation is only half true. If humanity truly wants to slow the spread of antibiotic resistance, we need to also look at the overprescription of antibiotics.\u003c/p>\n\u003cp>Recently, a group of British health professionals penned a compelling analysis in The BMJ, advocating for shorter antibiotics courses — even going so far as to say that maybe patients should stop taking antibiotics once they feel better.\u003c/p>\n\u003cp>That’s because Fleming only described one version of resistance: Where bad bugs get worse by surviving an “underdosing” of antibiotics. Researchers call that “target selection.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But there’s a flip side: Overusing antibiotics can cause usually nice bugs, with which we coexist, to gain resistance. The germs jump at the opportunity to take over ecological niches, like the gut of a patient on antibiotics. This form of resistance is called “collateral selection.”\u003c/p>\n\u003cp>The BMJ analysis, led by infectious disease specialist Martin Llewelyn, proposes that “most of the bacterial species now posing the greatest problems do not develop resistance through target selection” and that “collateral selection is the predominant driver of the important forms of antibiotic resistance affecting patients today.”\u003c/p>\n\u003cfigure id=\"attachment_435130\" class=\"wp-caption alignleft\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-435130\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/08/infographic-800x800.png\" alt=\"\" width=\"800\" height=\"800\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic-800x800.png 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic-160x160.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic-768x768.png 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic-960x960.png 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic-240x240.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic-375x375.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic-520x520.png 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic-32x32.png 32w, https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic-50x50.png 50w, https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic-64x64.png 64w, https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic-96x96.png 96w, https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic-128x128.png 128w, https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic-150x150.png 150w, https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic.png 1000w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">The different mechanisms by which bacteria acquire antibiotic resistance. \u003ccite>(Fedor Kossakovski)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In other words, overdosing antibiotics is a bigger threat than underdosing.\u003c/p>\n\u003cp>Yet many health practitioners and patients are so worried about breeding superbugs through underdosing that antibiotics courses are often unnecessarily long. The researchers’ analysis showed that shorter courses of several quinolone-class antibiotics are just as effective as the longer courses that are currently prescribed. But the team conceded that more research on the topic is needed.\u003c/p>\n\u003cp>“No such data exist for β-lactams, which are the main antibiotic class used,” Llewelyn and colleagues wrote. “Current international guidelines recommend 10-14 days’ treatment with β-lactams, based purely on absence of data for shorter courses.”\u003c/p>\n\u003cp>Many health professionals are so worried about underdosing that most antibiotics prescriptions for adults are not calibrated to account for differences in patients. For example, “under current practices, a 200-pound, 6-foot-2-inch man diagnosed with pneumonia would receive the same dose of antibiotics as a 124-pound, 5-foot woman with the same condition, despite their dramatically different body sizes.”\u003c/p>\n\u003cp>Though antibiotic resistance is a growing problem due to overuse of the drugs at home, the issue is already grave in hospitals where the concentration of antibiotics and at-risk people is high. That’s why hospital staffs around the world are on the front lines of developing more appropriate protocols for using antibiotics through a collective effort called “antimicrobial stewardship.”\u003c/p>\n\u003cp>During our recent reporting for the PBS NewsHour series “Stopping Superbugs,” science correspondent Miles O’Brien met some antimicrobial stewards at Tufts Medical Center in Boston.\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=F42NPOnMIwQ\u003c/p>\n\u003cp>\u003cem>As the list of antibiotic resistant bacteria grows, so have the extraordinary efforts to prevent the spread of infection. Science correspondent Miles O’Brien and economics correspondent Paul Solman team up for a report.\u003c/em>\u003c/p>\n\u003cp>“We’re facing a crisis,” said Dr. Shira Doron, physician director of the antimicrobial stewardship program at Tufts. “What we need to be doing is treating until the person feels better and then stopping.”\u003c/p>\n\u003cp>This approach is not without its risks, Doron acknowledged: “Some of those people may have a recurrence of infection. But the number of antibiotic days that you’re saving the general population if you take that approach is so large and the impact is so large that it needs to be sort of the next phase of medicine.”\u003c/p>\n\u003cp>But carefully managing antibiotics courses is a tough ask for already overworked doctors. A multitude of factors pressure doctors to overprescribe antibiotics, added Dr. Helen Boucher, one of Doran’s colleagues.\u003c/p>\n\u003cp>“I think that especially in America, patients come in with an agenda,” Boucher said. “They expect an antibiotic. It takes longer to not give an antibiotic. We have shorter and shorter times per interaction with patients. When I started, it was 30 to 60 minutes, now it’s 15 to 30 minutes. It’s harder to have that conversation to explain that we’re going to do this test, see how you do, and then decide about an antibiotic and I’ll call you tomorrow. That’s a lot of work.”\u003c/p>\n\u003cp>Dr. Helen Boucher said patients should ask doctors for shorter courses of antibiotics. Patients should take to heart the lessons learned by antimicrobial stewards in hospitals and do their own part in preventing the overuse of antibiotics.\u003c/p>\n\u003cp>“We’ve learned for a very few infections, ear infections in two year olds, you need to treat for the whole course. But for many others, we’re learning that shorter is fine,” Boucher said. “So, I think if you’re a patient at a doctor you should ask, ‘Do I need to take it all or not?’ And oftentimes, the answer will be ‘No.'”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This column originally appeared on Miles O’Brien Productions.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Some health professionals are advocating for shorter antibiotics courses, going so far as to say maybe patients should stop taking antibiotics once they feel better.","status":"publish","parent":0,"modified":1514510963,"stats":{"hasAudio":false,"hasVideo":true,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":23,"wordCount":1010},"headData":{"title":"The Never-Ending Debate Over Finishing Your Antibiotics | KQED","description":"Some health professionals are advocating for shorter antibiotics courses, going so far as to say maybe patients should stop taking antibiotics once they feel better.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"The Never-Ending Debate Over Finishing Your Antibiotics","datePublished":"2017-09-04T07:01:05.000Z","dateModified":"2017-12-29T01:29:23.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"435129 https://ww2.kqed.org/futureofyou/?p=435129","disqusUrl":"https://ww2.kqed.org/futureofyou/2017/09/04/column-the-never-ending-debate-over-finishing-your-antibiotics/","disqusTitle":"The Never-Ending Debate Over Finishing Your Antibiotics","nprByline":"Fedor Kossakovski\u003c/br>PBS Newshour","path":"/futureofyou/435129/column-the-never-ending-debate-over-finishing-your-antibiotics","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>One of the most well-known concepts in medicine, to both doctors and patients, is that you must absolutely finish a course of antibiotics. The thinking goes that if you don’t eradicate every last bacterium causing your illness, the survivors can develop resistance and wreak further havoc.\u003c/p>\n\u003cp>This concern was voiced by the venerated Alexander Fleming himself — discoverer of penicillin, the first true antibiotic — which is part of why the idea is so enduring. Toward the end of his 1945 Nobel Prize acceptance speech, Fleming warned that “there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to nonlethal quantities of the drug make them resistant.”\u003c/p>\n\u003caside class=\"pullquote alignright\">Overdosing antibiotics is a bigger threat than underdosing.\u003c/aside>\n\u003cp>This proclamation is only half true. If humanity truly wants to slow the spread of antibiotic resistance, we need to also look at the overprescription of antibiotics.\u003c/p>\n\u003cp>Recently, a group of British health professionals penned a compelling analysis in The BMJ, advocating for shorter antibiotics courses — even going so far as to say that maybe patients should stop taking antibiotics once they feel better.\u003c/p>\n\u003cp>That’s because Fleming only described one version of resistance: Where bad bugs get worse by surviving an “underdosing” of antibiotics. Researchers call that “target selection.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But there’s a flip side: Overusing antibiotics can cause usually nice bugs, with which we coexist, to gain resistance. The germs jump at the opportunity to take over ecological niches, like the gut of a patient on antibiotics. This form of resistance is called “collateral selection.”\u003c/p>\n\u003cp>The BMJ analysis, led by infectious disease specialist Martin Llewelyn, proposes that “most of the bacterial species now posing the greatest problems do not develop resistance through target selection” and that “collateral selection is the predominant driver of the important forms of antibiotic resistance affecting patients today.”\u003c/p>\n\u003cfigure id=\"attachment_435130\" class=\"wp-caption alignleft\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-435130\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/08/infographic-800x800.png\" alt=\"\" width=\"800\" height=\"800\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic-800x800.png 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic-160x160.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic-768x768.png 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic-960x960.png 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic-240x240.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic-375x375.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic-520x520.png 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic-32x32.png 32w, https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic-50x50.png 50w, https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic-64x64.png 64w, https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic-96x96.png 96w, https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic-128x128.png 128w, https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic-150x150.png 150w, https://ww2.kqed.org/app/uploads/sites/13/2017/08/infographic.png 1000w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">The different mechanisms by which bacteria acquire antibiotic resistance. \u003ccite>(Fedor Kossakovski)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In other words, overdosing antibiotics is a bigger threat than underdosing.\u003c/p>\n\u003cp>Yet many health practitioners and patients are so worried about breeding superbugs through underdosing that antibiotics courses are often unnecessarily long. The researchers’ analysis showed that shorter courses of several quinolone-class antibiotics are just as effective as the longer courses that are currently prescribed. But the team conceded that more research on the topic is needed.\u003c/p>\n\u003cp>“No such data exist for β-lactams, which are the main antibiotic class used,” Llewelyn and colleagues wrote. “Current international guidelines recommend 10-14 days’ treatment with β-lactams, based purely on absence of data for shorter courses.”\u003c/p>\n\u003cp>Many health professionals are so worried about underdosing that most antibiotics prescriptions for adults are not calibrated to account for differences in patients. For example, “under current practices, a 200-pound, 6-foot-2-inch man diagnosed with pneumonia would receive the same dose of antibiotics as a 124-pound, 5-foot woman with the same condition, despite their dramatically different body sizes.”\u003c/p>\n\u003cp>Though antibiotic resistance is a growing problem due to overuse of the drugs at home, the issue is already grave in hospitals where the concentration of antibiotics and at-risk people is high. That’s why hospital staffs around the world are on the front lines of developing more appropriate protocols for using antibiotics through a collective effort called “antimicrobial stewardship.”\u003c/p>\n\u003cp>During our recent reporting for the PBS NewsHour series “Stopping Superbugs,” science correspondent Miles O’Brien met some antimicrobial stewards at Tufts Medical Center in Boston.\u003c/p>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/F42NPOnMIwQ'\n title='//www.youtube.com/embed/F42NPOnMIwQ'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>\u003cem>As the list of antibiotic resistant bacteria grows, so have the extraordinary efforts to prevent the spread of infection. Science correspondent Miles O’Brien and economics correspondent Paul Solman team up for a report.\u003c/em>\u003c/p>\n\u003cp>“We’re facing a crisis,” said Dr. Shira Doron, physician director of the antimicrobial stewardship program at Tufts. “What we need to be doing is treating until the person feels better and then stopping.”\u003c/p>\n\u003cp>This approach is not without its risks, Doron acknowledged: “Some of those people may have a recurrence of infection. But the number of antibiotic days that you’re saving the general population if you take that approach is so large and the impact is so large that it needs to be sort of the next phase of medicine.”\u003c/p>\n\u003cp>But carefully managing antibiotics courses is a tough ask for already overworked doctors. A multitude of factors pressure doctors to overprescribe antibiotics, added Dr. Helen Boucher, one of Doran’s colleagues.\u003c/p>\n\u003cp>“I think that especially in America, patients come in with an agenda,” Boucher said. “They expect an antibiotic. It takes longer to not give an antibiotic. We have shorter and shorter times per interaction with patients. When I started, it was 30 to 60 minutes, now it’s 15 to 30 minutes. It’s harder to have that conversation to explain that we’re going to do this test, see how you do, and then decide about an antibiotic and I’ll call you tomorrow. That’s a lot of work.”\u003c/p>\n\u003cp>Dr. Helen Boucher said patients should ask doctors for shorter courses of antibiotics. Patients should take to heart the lessons learned by antimicrobial stewards in hospitals and do their own part in preventing the overuse of antibiotics.\u003c/p>\n\u003cp>“We’ve learned for a very few infections, ear infections in two year olds, you need to treat for the whole course. But for many others, we’re learning that shorter is fine,” Boucher said. “So, I think if you’re a patient at a doctor you should ask, ‘Do I need to take it all or not?’ And oftentimes, the answer will be ‘No.'”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This column originally appeared on Miles O’Brien Productions.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/435129/column-the-never-ending-debate-over-finishing-your-antibiotics","authors":["byline_futureofyou_435129"],"categories":["futureofyou_1"],"tags":["futureofyou_1184","futureofyou_697"],"featImg":"futureofyou_435131","label":"futureofyou"},"futureofyou_334042":{"type":"posts","id":"futureofyou_334042","meta":{"index":"posts_1591205157","site":"futureofyou","id":"334042","score":null,"sort":[1487105686000]},"guestAuthors":[],"slug":"maybe-you-shouldnt-take-all-your-antibiotics-after-all","title":"Maybe You Shouldn't Take All of Your Antibiotics, After All","publishDate":1487105686,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>You’ve heard it many times before from your doctor: If you’re taking antibiotics, don’t stop taking them until the pill vial is empty, even if you feel better.\u003c/p>\n\u003caside class=\"pullquote alignright\">'An argument can be made for stopping a course of antibiotics immediately after a bacterial infection has been ruled out … or when the signs and symptoms of a mild infection have disappeared.'\u003ccite>From a World Health Organization report\u003c/cite>\u003c/aside>\n\u003cp>The rationale behind this commandment has always been that stopping treatment too soon would fuel the development of antibiotic resistance—the ability of bugs to evade these drugs. Information campaigns aimed at getting the public to take antibiotics properly have been driving home this message for decades.\u003c/p>\n\u003cp>But the warning, a growing number of experts say, is misguided and may actually be exacerbating antibiotic resistance.\u003c/p>\n\u003cp>The reasoning is simple: Exposure to antibiotics is what drives bacteria to develop resistance. Taking drugs when you aren’t sick anymore simply gives the hordes of bacteria in and on your body more incentive to evolve to evade the drugs, so the next time you have an infection, they may not work.\u003c/p>\n\u003cp>The traditional reasoning from doctors “never made any sense. It doesn’t make any sense today,” Dr. Louis Rice, chairman of the department of medicine at the Warren Alpert Medical School at Brown University, told STAT.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Some colleagues credit Rice with being the first person to declare the emperor was wearing no clothes, and it is true that he challenged the dogma in lectures at major meetings of infectious diseases physicians and researchers in 2007 and 2008. A number of researchers now share his skepticism of health guidance that has been previously universally accepted.\u003c/p>\n\u003cp>The question of whether this advice is still appropriate will be raised at a World Health Organization meeting next month in Geneva. A report prepared for that meeting—the agency’s expert committee on the selection and use of essential medicine—already notes that the recommendation isn’t backed by science.\u003c/p>\n\u003cp>In many cases “an argument can be made for stopping a course of antibiotics immediately after a bacterial infection has been ruled out … or when the signs and symptoms of a mild infection have disappeared,” suggests the report, which analyzed information campaigns designed to get the public on board with efforts to fight antibiotic resistance.\u003c/p>\n\u003cp>No one is doubting the lifesaving importance of antibiotics. They kill bacteria. But the more the bugs are exposed to the drugs, the more survival tricks the bacteria acquire. And the more resistant the bacteria become, the harder they are to treat.\u003c/p>\n\u003cp>The concern is that the growing number of bacteria that are resistant to multiple antibiotics will lead to more incurable infections that will threaten medicine’s ability to conduct routine procedures like hip replacements or open heart surgery without endangering lives.\u003c/p>\n\u003cp>So how did this faulty paradigm become entrenched in medical practice? The answer lies back in the 1940s, the dawn of antibiotic use.\u003c/p>\n\u003cp>At the time, resistance wasn’t a concern. After the first antibiotic, penicillin, was discovered, more and more gushed out of the pharmaceutical product pipeline.\u003c/p>\n\u003cp>Doctors were focused only on figuring out how to use the drugs effectively to save lives. An ethos emerged: Treat patients until they get better, and then for a little bit longer to be on the safe side. Around the same time, research on how to cure tuberculosis suggested that under-dosing patients was dangerous—the infection would come back.\u003c/p>\n\u003cp>The idea that stopping antibiotic treatment too quickly after symptoms went away might fuel resistance took hold.\u003c/p>\n\u003cp>“The problem is once it gets baked into culture, it’s really hard to excise it,” said Dr. Brad Spellberg, who is also an advocate for changing this advice. Spellberg is an infectious diseases specialist and chief medical officer at the Los Angeles County-University of Southern California Medical Center in Los Angeles.\u003c/p>\n\u003cp>We think of medicine as a science, guided by mountains of research. But doctors sometimes prescribe antibiotics based more on their experience and intuition than anything else. There are treatment guidelines for different infections, but some provide scant advice on how long to continue treatment, Rice acknowledged. And response to treatment will differ from patient to patient, depending on, among other things, how old they are, how strong their immune systems are, or how well they metabolize drugs.\u003c/p>\n\u003cp>There’s little incentive for pharmaceutical companies to conduct expensive studies aimed at finding the shortest duration of treatment for various conditions. But in the years since Rice first raised his concerns, the National Institutes of Health has been funding such research and almost invariably the ensuing studies have found that many infections can be cured more quickly than had been thought. Treatments that were once two weeks have been cut to one, 10 days have been reduced to seven and so on.\u003c/p>\n\u003cp>There have been occasional exceptions. Just before Christmas, scientists at the University of Pittsburgh reported that 10 days of treatment for otitis media—middle ear infections—was better than five days for children under 2 years of age.\u003c/p>\n\u003cp>It was a surprise, said Spellberg, who noted that studies looking at the same condition in children 2 and older show the shorter treatment works.\u003c/p>\n\u003cp>More of this work is needed, Rice said. “I’m not here saying that every infection can be treated for two days or three days. I’m just saying: Let’s figure it out.”\u003c/p>\n\u003cp>In the meantime, doctors and public health agencies are in a quandary. How do you put the new thinking into practice? And how do you advise the public? Doctors know full well some portion of people unilaterally decide to stop taking their antibiotics because they feel better. But that approach is not safe in all circumstances—for instance tuberculosis or bone infections. And it’s not an approach many physicians feel comfortable endorsing.\u003c/p>\n\u003cp>“This is a very tricky question. It’s not easy to make a blanket statement about this, and there isn’t a simple answer,” Dr. Lauri Hicks, director of the Centers for Disease Control and Prevention’s office of antibiotic stewardship, told STAT in an email.\u003c/p>\n\u003cp>“There are certain diagnoses for which shortening the course of antibiotic therapy is not recommended and/or potentially dangerous. … On the other hand, there are probably many situations for which antibiotic therapy is often prescribed for longer than necessary and the optimal duration is likely ‘until the patient gets better.’”\u003c/p>\n\u003cp>CDC’S Get Smart campaign, on appropriate antibiotic use, urges people never to skip doses or stop the drugs because they’re feeling better. But Hicks noted the CDC recently revised it to add “unless your healthcare professional tells you to do so” to that advice.\u003c/p>\n\u003cp>And that’s one way to deal with the situation, said Dr. James Johnson, a professor of infectious diseases medicine at the University of Minnesota and a specialist at the Minnesota VA Medical Center.\u003c/p>\n\u003cp>“In fact sometimes some of us give that instruction to patients. ‘Here, I’m going to prescribe you a week. My guess is you won’t need it more than, say, three days. If you’re all well in three days, stop then. If you’re not completely well, take it a little longer. But as soon as you feel fine, stop.’ And we can give them permission to do that.”\u003c/p>\n\u003cp>Spellberg is more comfortable with the idea of people checking back with their doctor before stopping their drugs — an approach that requires doctors to be willing to have that conversation. “You should call your doc and say ‘Hey, can I stop?’ … If your doctor won’t get on the phone with you for 20 seconds, you need to find another doctor.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2017/02/09/antibiotics-resistance-superbugs/\" target=\"_blank\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"You’ve heard it many times from your doctor: Even if you feel better, don’t stop taking your antibiotics until the pill vial is empty. But a growing number of experts say that advice is misguided.","status":"publish","parent":0,"modified":1487121873,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":30,"wordCount":1374},"headData":{"title":"Maybe You Shouldn't Take All of Your Antibiotics, After All | KQED","description":"You’ve heard it many times from your doctor: Even if you feel better, don’t stop taking your antibiotics until the pill vial is empty. But a growing number of experts say that advice is misguided.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Maybe You Shouldn't Take All of Your Antibiotics, After All","datePublished":"2017-02-14T20:54:46.000Z","dateModified":"2017-02-15T01:24:33.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"334042 https://ww2.kqed.org/futureofyou/?p=334042","disqusUrl":"https://ww2.kqed.org/futureofyou/2017/02/14/maybe-you-shouldnt-take-all-your-antibiotics-after-all/","disqusTitle":"Maybe You Shouldn't Take All of Your Antibiotics, After All","source":"KQED Future of You","nprByline":"Helen Branswell\u003cbr />\u003ca href=\"https://www.statnews.com/\">STAT\u003c/a>","path":"/futureofyou/334042/maybe-you-shouldnt-take-all-your-antibiotics-after-all","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>You’ve heard it many times before from your doctor: If you’re taking antibiotics, don’t stop taking them until the pill vial is empty, even if you feel better.\u003c/p>\n\u003caside class=\"pullquote alignright\">'An argument can be made for stopping a course of antibiotics immediately after a bacterial infection has been ruled out … or when the signs and symptoms of a mild infection have disappeared.'\u003ccite>From a World Health Organization report\u003c/cite>\u003c/aside>\n\u003cp>The rationale behind this commandment has always been that stopping treatment too soon would fuel the development of antibiotic resistance—the ability of bugs to evade these drugs. Information campaigns aimed at getting the public to take antibiotics properly have been driving home this message for decades.\u003c/p>\n\u003cp>But the warning, a growing number of experts say, is misguided and may actually be exacerbating antibiotic resistance.\u003c/p>\n\u003cp>The reasoning is simple: Exposure to antibiotics is what drives bacteria to develop resistance. Taking drugs when you aren’t sick anymore simply gives the hordes of bacteria in and on your body more incentive to evolve to evade the drugs, so the next time you have an infection, they may not work.\u003c/p>\n\u003cp>The traditional reasoning from doctors “never made any sense. It doesn’t make any sense today,” Dr. Louis Rice, chairman of the department of medicine at the Warren Alpert Medical School at Brown University, told STAT.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Some colleagues credit Rice with being the first person to declare the emperor was wearing no clothes, and it is true that he challenged the dogma in lectures at major meetings of infectious diseases physicians and researchers in 2007 and 2008. A number of researchers now share his skepticism of health guidance that has been previously universally accepted.\u003c/p>\n\u003cp>The question of whether this advice is still appropriate will be raised at a World Health Organization meeting next month in Geneva. A report prepared for that meeting—the agency’s expert committee on the selection and use of essential medicine—already notes that the recommendation isn’t backed by science.\u003c/p>\n\u003cp>In many cases “an argument can be made for stopping a course of antibiotics immediately after a bacterial infection has been ruled out … or when the signs and symptoms of a mild infection have disappeared,” suggests the report, which analyzed information campaigns designed to get the public on board with efforts to fight antibiotic resistance.\u003c/p>\n\u003cp>No one is doubting the lifesaving importance of antibiotics. They kill bacteria. But the more the bugs are exposed to the drugs, the more survival tricks the bacteria acquire. And the more resistant the bacteria become, the harder they are to treat.\u003c/p>\n\u003cp>The concern is that the growing number of bacteria that are resistant to multiple antibiotics will lead to more incurable infections that will threaten medicine’s ability to conduct routine procedures like hip replacements or open heart surgery without endangering lives.\u003c/p>\n\u003cp>So how did this faulty paradigm become entrenched in medical practice? The answer lies back in the 1940s, the dawn of antibiotic use.\u003c/p>\n\u003cp>At the time, resistance wasn’t a concern. After the first antibiotic, penicillin, was discovered, more and more gushed out of the pharmaceutical product pipeline.\u003c/p>\n\u003cp>Doctors were focused only on figuring out how to use the drugs effectively to save lives. An ethos emerged: Treat patients until they get better, and then for a little bit longer to be on the safe side. Around the same time, research on how to cure tuberculosis suggested that under-dosing patients was dangerous—the infection would come back.\u003c/p>\n\u003cp>The idea that stopping antibiotic treatment too quickly after symptoms went away might fuel resistance took hold.\u003c/p>\n\u003cp>“The problem is once it gets baked into culture, it’s really hard to excise it,” said Dr. Brad Spellberg, who is also an advocate for changing this advice. Spellberg is an infectious diseases specialist and chief medical officer at the Los Angeles County-University of Southern California Medical Center in Los Angeles.\u003c/p>\n\u003cp>We think of medicine as a science, guided by mountains of research. But doctors sometimes prescribe antibiotics based more on their experience and intuition than anything else. There are treatment guidelines for different infections, but some provide scant advice on how long to continue treatment, Rice acknowledged. And response to treatment will differ from patient to patient, depending on, among other things, how old they are, how strong their immune systems are, or how well they metabolize drugs.\u003c/p>\n\u003cp>There’s little incentive for pharmaceutical companies to conduct expensive studies aimed at finding the shortest duration of treatment for various conditions. But in the years since Rice first raised his concerns, the National Institutes of Health has been funding such research and almost invariably the ensuing studies have found that many infections can be cured more quickly than had been thought. Treatments that were once two weeks have been cut to one, 10 days have been reduced to seven and so on.\u003c/p>\n\u003cp>There have been occasional exceptions. Just before Christmas, scientists at the University of Pittsburgh reported that 10 days of treatment for otitis media—middle ear infections—was better than five days for children under 2 years of age.\u003c/p>\n\u003cp>It was a surprise, said Spellberg, who noted that studies looking at the same condition in children 2 and older show the shorter treatment works.\u003c/p>\n\u003cp>More of this work is needed, Rice said. “I’m not here saying that every infection can be treated for two days or three days. I’m just saying: Let’s figure it out.”\u003c/p>\n\u003cp>In the meantime, doctors and public health agencies are in a quandary. How do you put the new thinking into practice? And how do you advise the public? Doctors know full well some portion of people unilaterally decide to stop taking their antibiotics because they feel better. But that approach is not safe in all circumstances—for instance tuberculosis or bone infections. And it’s not an approach many physicians feel comfortable endorsing.\u003c/p>\n\u003cp>“This is a very tricky question. It’s not easy to make a blanket statement about this, and there isn’t a simple answer,” Dr. Lauri Hicks, director of the Centers for Disease Control and Prevention’s office of antibiotic stewardship, told STAT in an email.\u003c/p>\n\u003cp>“There are certain diagnoses for which shortening the course of antibiotic therapy is not recommended and/or potentially dangerous. … On the other hand, there are probably many situations for which antibiotic therapy is often prescribed for longer than necessary and the optimal duration is likely ‘until the patient gets better.’”\u003c/p>\n\u003cp>CDC’S Get Smart campaign, on appropriate antibiotic use, urges people never to skip doses or stop the drugs because they’re feeling better. But Hicks noted the CDC recently revised it to add “unless your healthcare professional tells you to do so” to that advice.\u003c/p>\n\u003cp>And that’s one way to deal with the situation, said Dr. James Johnson, a professor of infectious diseases medicine at the University of Minnesota and a specialist at the Minnesota VA Medical Center.\u003c/p>\n\u003cp>“In fact sometimes some of us give that instruction to patients. ‘Here, I’m going to prescribe you a week. My guess is you won’t need it more than, say, three days. If you’re all well in three days, stop then. If you’re not completely well, take it a little longer. But as soon as you feel fine, stop.’ And we can give them permission to do that.”\u003c/p>\n\u003cp>Spellberg is more comfortable with the idea of people checking back with their doctor before stopping their drugs — an approach that requires doctors to be willing to have that conversation. “You should call your doc and say ‘Hey, can I stop?’ … If your doctor won’t get on the phone with you for 20 seconds, you need to find another doctor.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2017/02/09/antibiotics-resistance-superbugs/\" target=\"_blank\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/334042/maybe-you-shouldnt-take-all-your-antibiotics-after-all","authors":["byline_futureofyou_334042"],"categories":["futureofyou_452","futureofyou_1","futureofyou_73"],"tags":["futureofyou_1184","futureofyou_697"],"featImg":"futureofyou_336943","label":"source_futureofyou_334042"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. 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You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg","imageAlt":"\"KQED Bay Curious","officialWebsiteLink":"/news/series/baycurious","meta":{"site":"news","source":"kqed","order":"4"},"link":"/podcasts/baycurious","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/bay-curious/id1172473406","npr":"https://www.npr.org/podcasts/500557090/bay-curious","rss":"https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvbmV3cy9jYXRlZ29yeS9iYXktY3VyaW91cy1wb2RjYXN0L2ZlZWQvcG9kY2FzdA","stitcher":"https://www.stitcher.com/podcast/kqed/bay-curious","spotify":"https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"}},"bbc-world-service":{"id":"bbc-world-service","title":"BBC World Service","info":"The day's top stories from BBC News compiled twice daily in the week, once at weekends.","airtime":"MON-FRI 9pm-10pm, TUE-FRI 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.bbc.co.uk/sounds/play/live:bbc_world_service","meta":{"site":"news","source":"BBC World Service"},"link":"/radio/program/bbc-world-service","subscribe":{"apple":"https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2","tuneIn":"https://tunein.com/radio/BBC-World-Service-p455581/","rss":"https://podcasts.files.bbci.co.uk/p02nq0gn.rss"}},"code-switch-life-kit":{"id":"code-switch-life-kit","title":"Code Switch / Life Kit","info":"\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. 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On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. 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For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us","airtime":"SUN 2pm-3pm, MON 12am-1am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/onTheMedia.png","officialWebsiteLink":"https://www.wnycstudios.org/shows/otm","meta":{"site":"news","source":"wnyc"},"link":"/radio/program/on-the-media","subscribe":{"apple":"https://itunes.apple.com/us/podcast/on-the-media/id73330715?mt=2","tuneIn":"https://tunein.com/radio/On-the-Media-p69/","rss":"http://feeds.wnyc.org/onthemedia"}},"our-body-politic":{"id":"our-body-politic","title":"Our Body Politic","info":"Presented by KQED, KCRW and KPCC, and created and hosted by award-winning journalist Farai Chideya, Our Body Politic is unapologetically centered on reporting on not just how women of color experience the major political events of today, but how they’re impacting those very issues.","airtime":"SAT 6pm-7pm, SUN 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Our-Body-Politic-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://our-body-politic.simplecast.com/","meta":{"site":"news","source":"kcrw"},"link":"/radio/program/our-body-politic","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/our-body-politic/id1533069868","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5zaW1wbGVjYXN0LmNvbS9feGFQaHMxcw","spotify":"https://open.spotify.com/show/4ApAiLT1kV153TttWAmqmc","rss":"https://feeds.simplecast.com/_xaPhs1s","tuneIn":"https://tunein.com/podcasts/News--Politics-Podcasts/Our-Body-Politic-p1369211/"}},"pbs-newshour":{"id":"pbs-newshour","title":"PBS NewsHour","info":"Analysis, background reports and updates from the PBS NewsHour putting today's news in context.","airtime":"MON-FRI 3pm-4pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.pbs.org/newshour/","meta":{"site":"news","source":"pbs"},"link":"/radio/program/pbs-newshour","subscribe":{"apple":"https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2","tuneIn":"https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/","rss":"https://www.pbs.org/newshour/feeds/rss/podcasts/show"}},"perspectives":{"id":"perspectives","title":"Perspectives","tagline":"KQED's series of of daily listener commentaries since 1991","info":"KQED's series of of daily listener commentaries since 1991.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Perspectives-Podcast-Tile-703x703-1.jpg","officialWebsiteLink":"/perspectives/","meta":{"site":"radio","source":"kqed","order":"15"},"link":"/perspectives","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/id73801135","npr":"https://www.npr.org/podcasts/432309616/perspectives","rss":"https://ww2.kqed.org/perspectives/category/perspectives/feed/","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvcGVyc3BlY3RpdmVzL2NhdGVnb3J5L3BlcnNwZWN0aXZlcy9mZWVkLw"}},"planet-money":{"id":"planet-money","title":"Planet Money","info":"The economy explained. 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The result is stories that inform and inspire, arming our listeners with information to right injustices, hold the powerful accountable and improve lives.Reveal is hosted by Al Letson and showcases the award-winning work of CIR and newsrooms large and small across the nation. In a radio and podcast market crowded with choices, Reveal focuses on important and often surprising stories that illuminate the world for our listeners.","airtime":"SAT 4pm-5pm","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/reveal300px.png","officialWebsiteLink":"https://www.revealnews.org/episodes/","meta":{"site":"news","source":"npr"},"link":"/radio/program/reveal","subscribe":{"apple":"https://itunes.apple.com/us/podcast/reveal/id886009669","tuneIn":"https://tunein.com/radio/Reveal-p679597/","rss":"http://feeds.revealradio.org/revealpodcast"}},"says-you":{"id":"says-you","title":"Says You!","info":"Public radio's game show of bluff and bluster, words and whimsy. 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