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FDA Takes Step To Preserve The Effectiveness Of Cephalosporin Drugs For Treating Disease In Humans

Image by the USDA Agricultural Research Service

Cephalosporins will be used in livestock only for very specific exceptions, after years of debate about the role of antibiotic resistance in farming and how it leads to new strains of microbes with the potential to shift into humans.

The FDA took this step to preserve the effectiveness of cephalosporin drugs for treating disease in humans, the agency announced in a press release.

In 2008, the FDA issued and then revoked an order that prohibited cephalosporins in food-producing animals with no exceptions. Three years later, the agency’s ban includes several exceptions:
–It doesn’t limit cephapirin, which the FDA doesn’t think contributes to antimicrobial resistance;
–Veterinarians will still be able to Read more »

*This blog post was originally published at ACP Internist*

Heartburn Bugs Have Become Antibiotic-Resistant

H. pylori dominated the GI news in the 1990s, and despite it disappearing from the front pages, it remains a common and important clinical problem. The dominant recommended initial treatment strategy has been a clarithromycin-based PPI triple therapy, with either amoxicillin or metronidazole as the third drug. This approach was based on clinical studies, ease of use, and tolerability factors. Bismuth-based quadruple therapy (a bismuth agent, metronidazole, tetracycline, and a PPI), despite demonstrating excellent activity, was usually relegated to second-line therapy because of the complexity of the dosing as well as compliance and tolerability issues.

However, duringthe last decade, the widespread use of macrolides in the general population has led to rising resistance to clarithromycin (by 30% or more of H. pylori strains in some areas), and when clarithromycin resistance is present, the efficacy of clarithromycin-containing triple therapy falls from about 80% to 50% or even lower. However, clarithromycin resistance does not affect the efficacy of bismuth-based quadruple therapy, and that efficacy of those regimens remains at about 90% when patients are compliant with the treatment.

So the questions for you to consider are:
1) Do you know what the clarithromycin resistance rate in H. pylori is in your community?
2) What first-line H. pylori treatment regimen do you use?
3) Are you planning to change your H. pylori treatment strategy now that clarithromycin resistance rates are rising?

Let us know what you think.

*This blog post was originally published at Gut Check on Gastroenterology*

A New Superbug?

newNYCfashion 300x199 New Superbug AlertScientists have discovered a new, highly-transmissible gene that could, quite easily in fact, open a frightening new front in the ongoing global war against superbugs.

The antibiotic-resistant gene, NDM-1, was first identified in 2008 a Swedish patient that had received hospital care in New Delhi. NDM-1 produces an enzyme that allows bacteria to destroy most antibiotics. It exists on plasmids, which are pieces of genetic material that are easily shared between bacteria including E coli and other species that can cause pneumonia, urinary tract infections, and blood stream infections.

NDM-1 probably evolved in parts of India where poor sanitation and overutilization of antibiotics provide a perfect environment for the creation of antibiotic-resistant bacteria.

The gene has been identified in three U.S. patients. All had received medical treatment in India, and all recovered from their infections. It has been found sporadically in Britain, Australia and nearly a dozen other countries as well. Most affected patients were “medical tourists” — that is, people seeking less expensive medical care in India.

“We need to be vigilant about this,” said Arjun Srinivasan, an epidemiologist at the CDC told the Washington Post. “This should not be a call to panic, but it should be a call to action. There are effective strategies we can take that will prevent the spread of these organisms.” Read more »

*This blog post was originally published at Pizaazz*

In The News: Political Doctors, Antibiotic Resistance, And Stem Cell Research

Medical organizations are donating heavily to doctors running for the U.S. House. Dentists, ophthalmologists, radiologists, surgeons, neurologists and ENTs have contributed heavily. The goal is to get doctors onto committees where they can have the most impact. So far, the candidates have trended heavily Republican and have, in at least one campaign, vowed to overturn healthcare reform. The stakes are high if opposing legislators succeed, because they could underfund or block portions of reform to the point that it works poorly or not at all. (Politico, New England Journal of Medicine)

Spurred by antibiotic resistance seen in almost every drug class, FDA Commissioner Margaret Hamburg, FACP, is turning the agency’s attention toward animal feed. With little to no development of new antibiotics in the pipeline, the agency is discussing regulations for animal feed and guidelines for human use. (Wall Street Journal)

Scientists should be able to use stem cells for biomedical research, according to a recent Harris Interactive/HealthDay poll. Almost three quarters of adults surveyed are in favor of using embryonic stem cells left over from in-vitro fertilization. These poll results remain consistent with a similar survey released in 2005. Read more »

*This blog post was originally published at ACP Internist*

Developing New Antibiotics: Thinking Beyond Bacteria Resistance

44s3uqhhro.jpgBacteria may be having a renaissance. Back in the days of the discovery of penicillin, doctors gleefully handed out antibiotics like they were candy and patients were more than happy to munch them down. They were quite effective too, but bacteria rapidly became resistant.

Doctors and scientists worry that we are approaching a time where if we don’t come up with novel antibiotic mechanisms, we will face an epidemic of untreatable bacterial infections. MRSA, methicillin-resistant staphylcoccal auerus, is probably one of the biggest fears.

John Rennie wrote about this issue in the PLoS blog The Gleaming Retort. He describes two strategies scientists are using to try to come up with new weapons in the great antibacterial war. So, naturally one of the first things they turned to was cockroach brains. Read more »

*This blog post was originally published at Medgadget*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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