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Aswad -> RE: A very disturbing trend: (7/13/2011 9:31:16 AM)
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~QR~
Noncompliance and overuse are the two major issues in resistance, apart from convenience. I live in Norway. We don't have an MRSA problem at all. Hell, good ole methicillin nukes just about any of the native bacteria. Same thing for most other potentially resistant organisms. The few cases that crop up, are generally in people who have been on vacation and picked it up abroad. So, how come we don't have a lot of resistant strains running around?
1. Doctors are more restrictive in prescribing antibiotics. People generally understand that sometimes you get ill and have to suck it up. Just one of the many occasional inconveniences of being a biological life form. Antibiotics are for treating things that can have lasting consequences, not for making people feel better.
2. Prescription of third line drugs (and sometimes second line drugs) is restricted to specialist health care. A general practicioner cannot prescribe drugs that are intended for resistant infections, as a general rule, and a specialist in the relevant area (e.g. dermatologist, opthamologist, gastroenterologist, etc.) must consult the patient for these to be used. When they are, the infection is always sampled and sent to the antibiotic resistance monitoring center for sequencing.
4. If an infection is not killed off by the second attempt, the strain is sequenced to match it to a susceptibility profile and the most narrow-spectrum effective antibiotic is used.
5. Three strikes and you go to the isolation unit at the hospital, along with anyone you may have contaminated (for screening). Here, they give you the equivalent of an antibiotic nuclear bomb that is targetted at the specific strain of the disease, and you are not allowed to leave until the infection has been eliminated completely, as a matter of public safety (resistant bacteria are, as people are starting to realize, a real threat to public safety). Single resistance is tolerated, sometimes two-drug resistance, though one can choose to be admitted. Multidrug resistance is not tolerated.
As an added benefit, the problem of non-compliance disappears with in-patient treatment.
Of course, with non-cooperative corporate socialism (e.g. USA), the battle is lost before it is even begun. Outpacing bacteria is never going to be financially viable, as they have greater numbers, no restrictions on ethics, no beurocracy, no need to test before deploying, and all the resources of our bodies at their disposal, along with the best motivation of all: losing the war means going extinct. Any illusion to the effect that such a battle can be won by the current approach is only maintained by borrowing against the future of our health, and taking the financial cost individually. And, eventually, the cost in lives. Tactics require cooperation and focus on non-corporate interests. Without tactics, it's David in an arm-wrestling match with Goliath, on the losing end.
Resistant gonorrhea isn't a major problem on the scale of things, really.
Unless one emphasizes abstinence, of course.
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