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Totally drug-resistant TB emerges in India
31–40 of 44 posts
Re: Totally drug-resistant TB emerges in India
#32Earlier quoted context omitted.
Some of those would be easier to exterminate than others. Many animals carry influenza or plague, but isn't leprosy limited to humans and armadillos?
I don't know. But even if it's true, and even assuming we can develop a vaccine, how do you propose to go out and vaccinate every nine-banded armadillo, not missing even one population large enough to harbor the disease? This isn't an endangered species - they're all over the southeastern US.
You only need herd immunity. There is experience with vaccinating wild animal populations against rabies.
Re: Totally drug-resistant TB emerges in India
#33Earlier quoted context omitted.
I don't know. But even if it's true, and even assuming we can develop a vaccine, how do you propose to go out and vaccinate every nine-banded armadillo, not missing even one population large enough to harbor the disease? This isn't an endangered species - they're all over the southeastern US.
You only need herd immunity. There is experience with vaccinating wild animal populations against rabies.
Well, okay, but I notice rabies is pretty ubiquitous. Rabid bats turn up where I live on a regular basis.
Re: Totally drug-resistant TB emerges in India
#34That is to be expected when no new drugs are developed in half a century. We really should focus more on doing what we did with smallpox -- destroy it outright, rather than merely give it a bloody nose or two.
It's not quite that simple. This popped up on Reddit a few days back and in the comments a physician from India mentioned that a big part of the problem is that a) antibiotics are extremely over-used as they can be gotten over the counter and people do not understand that they do nothing for viral infections like the common cold, and b) his patients rarely finished an entire course even when they were directed to. Bo…
Unfortunately I'm a bit late to the party on this, but as a case in point, Norway has _very_ tight discipline on penicillin and antibiotics usage for this very reason. This has nothing to do with "medicines being outdated", it has to do with correct and disciplined usage of antibiotics.
Norwegian hospitals use forms of penicillin which simply do not work on patients from countries where antibiotics usage is more lax. Treating a patient from Spain with the same penicillin which is used for Norwegian patients would not have any effect and kill the patient. This is _solely_ because poor discipline in drug usage leads to antibiotics-risistant bacteria.
What needs to be done, and globally, is to
1) Stop treating livestock with prophylactic antibiotics 2) Stop prescribing antibiotics for conditions where it doesn't work (just because the patient has a cold and is complaining "can't you give me something?") 3) _Force_ patients to take their entire antibiotics course so even the small but drug-resistant minority of bacteria is killed off by the immune system and not transmitted further.
If the global community fails to do this, we will in the worst case end up with a world which looks the way it did in the 1800s - a simple bacterial infection will kill you, because it can't be treated.
This is a question of disciplined usage of medicines, not researching new and clever ways to kill bacteria. We can't eradicate every dangerous strain of bacteria on earth - it's simply not feasible.
Re: Totally drug-resistant TB emerges in India
#35Earlier quoted context omitted.
good question, terrible person
The negative impact of not finishing antibiotics was news to me, and now I know. I think it's ridiculous to call him a terrible person. Uninformed maybe. Although that's no longer the case.
You pay a doctor to give you advice. The doctor says take these pills on schedule for X days [1]. You ignore X. Why did you bother going to the doctor in the first place if you weren't going to follow her advice?
The only people who should be selectively following medical advice are people who have made an effort to understand the science behind the advice. The more serious the condition, the better your understanding of the treatment ought to be before you disregard advice.
If a patient has a working understanding of what bacteria are, and how antibiotics work [2], then the patent understands why taking antibiotics for W (where WThat type of patient would never ask why X matters.
[1] Determining X on a per-case basis would involve way too much testing, so the medical community reaches a consensus based on studies (which may or may not be any good), and prescribes drug X for time T based on that consensus. Even if you could afford to get fast test results every few hours to monitor your infection status and see how well the antibiotics were working, and even if you could see what percentage of your infectious colony is resistant, you probably wouldn't want to. Spending that much time in a hospital or clinic is way more risky -- MRSA loves hanging out in those places -- than spending an extra day or three taking antibiotics even if fast accurate tests might show that you don't need to.
[2] It's not binary. It's all about how different concentrations of antibiotics result in different rates of bacterial survival. In any colony of clinically significant size, there are going to be different rates of resistance.
Re: Totally drug-resistant TB emerges in India
#36Earlier quoted context omitted.
Well I wouldn't say terrible person. The problem is that this is not well explained and so most people just do not understand the problems associated with not completing the antibiotic treatment prescribed by the doctor... It's good that he asked and now he will know why it's important and will do it.. It's a failure of education if intelligent and educated people are not aware of the consequences.
It doesn't have to be well explained. Instructions for antibiotic prescriptions from a licensed doctor/pharmacy tells you to take the full course of antibiotics and not quit part way through. I wonder what other prescription instructions he disregards... drug interaction warnings? You don't get to disregard those just because you're not familiar with the biochemistry involved. Or, what about, "Do not look into 1W las…
I don't doubt that you regularly do not follow instructions. Everyone knows many instructions err on the side of caution and not literally following them doesn't add any risks.
Almost everyone crosses the street when the light is red, but there is not a car in sight (and the view is clear). Many people will use perishable products after their guaranteed 'fresh until' period.
However, this also happens for instructions you don't actually know the reason for. People will mentally substitute a convenient reason. Take the antibiotics for 3 weeks? "Yeah, probably because it sometimes takes 3 weeks for the infection to be gone. It probably doesn't hurt to stop after 2 weeks; I mean, what could it do?". People are not even aware of reasoning in such a way and saying "it doesn't have to be well explained" disregards that well known fact about human psychology.
If you want people to do something, explain why. In fact, that even works when your reason doesn't make any sense. "Can I please use the copy machine before you, because I have to make some copies of these documents" will get more compliance than "Can I please use the copy machine before you".
Re: Totally drug-resistant TB emerges in India
#37I think that what is termed "totally drug resistant TB" is more a matter of semantics as the article points out. I was in medical training in Southern California about 8 years ago and spent some time with a large county tuberculosis surveillance unit as part of a public health assignment. There were about five cases of then termed "multi-drug resistant TB" whereby the patients were either confined to their homes or a…
We've still got MDR-TB. But now we have XDR-TB (extensively drug-resistant TB) and TDR-TB (totally drug-resistant TB). Each less desirable to encounter than the last. TDR-TB seems to be the real deal: http://cid.oxfordjournals.org/content/early/2011/11/24/cid.c... It's behind a paywall, but the gist is that some of these patients had TB resistant to ALL of the following: isoniazid, rifampicin, ethambutol, pyrazinamid…
In the UK they use linezolid for drug resistant infections of all kinds. I think there have been a few cases of resistance already. In the dept I work they use tazocin as first line (it was considered second line til recently)
Without innovation we will have major problems within 20 years
Re: Totally drug-resistant TB emerges in India
#38Earlier quoted context omitted.
It's not quite that simple. This popped up on Reddit a few days back and in the comments a physician from India mentioned that a big part of the problem is that a) antibiotics are extremely over-used as they can be gotten over the counter and people do not understand that they do nothing for viral infections like the common cold, and b) his patients rarely finished an entire course even when they were directed to. Bo…
Unfortunately I'm a bit late to the party on this, but as a case in point, Norway has _very_ tight discipline on penicillin and antibiotics usage for this very reason. This has nothing to do with "medicines being outdated", it has to do with correct and disciplined usage of antibiotics. Norwegian hospitals use forms of penicillin which simply do not work on patients from countries where antibiotics usage is more lax.…
Norwegian hospitals use forms of penicillin which simply do not work on patients from countries where antibiotics usage is more lax. Treating a patient from Spain with the same penicillin which is used for Norwegian patients would not have any effect and kill the patient. This is _solely_ because poor discipline in drug usage leads to antibiotics-risistant bacteria.
Wait what? The efficacy of an antibiotic is depended on the bacterial strain not the patient.
The rest makes perfect sense however and I strongly agree.
Re: Totally drug-resistant TB emerges in India
#39Earlier quoted context omitted.
We've still got MDR-TB. But now we have XDR-TB (extensively drug-resistant TB) and TDR-TB (totally drug-resistant TB). Each less desirable to encounter than the last. TDR-TB seems to be the real deal: http://cid.oxfordjournals.org/content/early/2011/11/24/cid.c... It's behind a paywall, but the gist is that some of these patients had TB resistant to ALL of the following: isoniazid, rifampicin, ethambutol, pyrazinamid…
I'm not up on my medical compounds, but how do the resistant strains respond to pre-penicillin compounds such as sulfa drugs and the like. Solfonamide: http://en.wikipedia.org/wiki/Sulfonamide_(medicine) I've read, years ago, some speculation that these might be used to help beat down if not extinguish, an infection. Seems that there was some work in this regards in the 1940s, but I don't see much since: http://chest…
The TB research community must know the state of the art, but I'm having a hard time finding it; I found some pubmed links supporting the use of sulfonamides, but nothing really since the 1940s. Not a lot of info about why these dropped off the map.
Re: Totally drug-resistant TB emerges in India
#40I think that what is termed "totally drug resistant TB" is more a matter of semantics as the article points out. I was in medical training in Southern California about 8 years ago and spent some time with a large county tuberculosis surveillance unit as part of a public health assignment. There were about five cases of then termed "multi-drug resistant TB" whereby the patients were either confined to their homes or a…
We've still got MDR-TB. But now we have XDR-TB (extensively drug-resistant TB) and TDR-TB (totally drug-resistant TB). Each less desirable to encounter than the last. TDR-TB seems to be the real deal: http://cid.oxfordjournals.org/content/early/2011/11/24/cid.c... It's behind a paywall, but the gist is that some of these patients had TB resistant to ALL of the following: isoniazid, rifampicin, ethambutol, pyrazinamid…
Ah, very good. Yes the term XDR-TB makes more sense in the absence of knowing if every potential antimicrobial therapy has been exhausted. Always found it interesting that the last line therapy is lobectomy or pneumonectomy. TB is a terrible disease for which we will hopefully always stay a few steps ahead.