Quote:
Originally Posted by ExNYer
Any ideas on whether this is an exaggerated concern (at least right now) or is the sky really falling? Here is the link:
http://www.guardian.co.uk/society/20...alyptic-threat
This quote is hard to believe:
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"Drug resistance is emerging in diseases across the board. Davies said 80% of gonorrhea was now resistant to the frontline antibiotic tetracycline, and infections were rising in young and middle-aged people. Multi-drug resistant TB was also a major threat, she said."
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80% of all gonorrhea cases are resistant to ALL drugs or just tetracycline?
This doesn't look good.
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I've been following STD treatment guidelines for several years now. I do not recall tetracycline *EVER* being in the list of recommended antibiotics for gonorrhea.
I did encounter a physician some years ago who believed that the usual doxycycline regimen (100 mg by mouth twice daily for 10 days) was effective against gonorrhea. I do not know if he was correct or not. The CDC strongly prefers single-dose regimens for sexually-transmitted diseases, as the dose can be given and witnessed in the doctor's office, guaranteeing proper compliance.
Ciprofloxacin was the recommended antibiotic for gonorrhea for some years, until resistant strains showed up. Ceftriaxone, cefixime, and spectinomycin were all alternatives.
Spectinomycin production halted world-wide some years ago. Not enough profit, or something.
Japan managed to breed a cefixime-resistant strain, and it has started to show up in North America. Ceftriaxone, given by intramuscular injection, is still effective. At the same time, the CDC doubled the recommended ceftriaxone dosage a year or two ago, and more recently added a recommendation for co-treatment with azithromycin 1000 mg by mouth single dose. (US physicians routinely did the co-treatment anyway, as azithromycin 1000 mg is the standard single-dose treatment for chlamydia, and chlamydia and gonorrhea routinely cohabitate. Chlamydia is frequently asymptomatic.)
Multiple-drug-resistant (MDR) and extremely-drug-resistant tuberculosis is a real and growing problem. Antibiotic-resistant staph (MRSA and related nasties) is also a real issue.
That's only part of the story. What is not really appreciated in some circles is the importance of antibiotics in surgery, and especially recovery from major orthopedic surgery. Fifty years ago, before penicillin, a post-operative infection on an orthopedic surgery wound site, that by definition opened a pathway all the way to the bone, was a very ugly death sentence. There wasn't anything the doctors could do. About their only hope was observing proper sterile and antiseptic procedure, and hoping no infection started. Today, post-op infections are considered routine nuisances, occurring in about 3% of cases even with the best of sterile procedure, and easily treated with modern antibiotics.
Meanwhile, we have no new antibiotics coming down the pike in the development process. The FDA's rules have always made drug development a very difficult, very lengthy, very expensive process, and the recent rule changes that all but shut down the pharmaceuticals industry is not helping any.
For gonorrhea, there are still one or two options. Spectinomycin production could be restarted. Cefixime was unavailable in the US for several years, and is becoming available again. Also, according to the prescribing literature, there is some evidence that azithromycin 2000 mg by mouth single dose is effective against gonorrhea. (However, 2 grams of azithromycin is going to be VERY rough on the patient's stomach, probably a lot less fun than clindamycin - which is NO picnic on an empty stomach, let me tell you.)
Summary: Yes, we have a problem developing.