Thai Doctor Warns New Bacteria Resistant To Every Antibiotic

[webfact]

Doctor warns new bacteria resistant to every antibiotic

BANGKOK, 17 February 2011 (NNT)-Assistant Professor Kamthorn Malatham of Mahidol University’s Faculty of Medicine revealed a new mutation that makes bacteria resistant to every antibiotic known to man has become more prevalent and soon no treatment will be able to cure patients who have them.

Assistant Professor Kamthorn said from his observation in Thailand that a number of bacteria developing resistance to antibiotic drugs have doubled in the past ten years. He cited Acinetobacter Baumannii as one of bacteria that has grown 30 times stronger in resistance.

The same bacteria are thought to have caused further sickness in patients in hospital as no drugs could kill them. Assistant Professor added that even the strongest antibiotic as carbapenems could do very little to harm Acinetobacter Baumannii.

Antibiotic drugs are the most popular type of treatment in Thailand which account for 20% of all drugs used. Among them, Carbapenems is the most sought after drug in the country. However, bacteria’s resistance to drugs has increased at an alarming rate, given that from 2000-2010 they have become 51% less vulnerable to antibiotics.

According to the Assistant Professor Kamthorn, scientists are now developing a new replacement for carbapenems which is believed to be more powerful in combating the bacteria.

He also blamed incorrect usage of antibiotics such as those who stop taking them as prescribed by doctors thinking they don’t need anymore as they feel better and people who take them when their bodies are already immune to the diseases. He said people who have a flu, diarrhea and bleeding wounds do not need to take antibiotics.

-- NNT 2011-02-17

[TAWP]

Yes, I don't know how many times I have to tell people to take the fully prescribed cure and not stop after 2-3 days...

[Thaddeus]

Yes, I don't know how many times I have to tell people to take the fully prescribed cure and not stop after 2-3 days...

And I don't know how many times I have had to tell people not to take antibiotics when they have a cold.

[aaacorp]

The main problem is that thai doctors prescribe antibiotics for every kind of desease. If desease is a virus, antibiotic is useless and using antibiotics everytime just makes bacterias stronger

[Steely Dan]

Yes, I don't know how many times I have to tell people to take the fully prescribed cure and not stop after 2-3 days...

Overprescription combined with very little awareness or education concerning the use of antibiotics means that any antibiotic made available to the Thai medical fraternity has it's effective days numbered, and sadly I doubt this problem is confined only to Thailand.

[jonclark]

Yes, I don't know how many times I have to tell people to take the fully prescribed cure and not stop after 2-3 days...

Overprescription combined with very little awareness or education concerning the use of antibiotics means that any antibiotic made available to the Thai medical fraternity has it's effective days numbered, and sadly I doubt this problem is confined only to Thailand.

Sadly it's not; in the UK we have MSRA the first of the superbugs, which if memory serves me right, several hospital outbreaks have resulted in whole hospital becoming quarantined [no visitors, and only emergence treatment], until they could control the outbreak.

Doctors have been warning of this for years. I wouldn't be so harsh as to point the accusing finger directly at doctors, although some of the less ..ahem.. professionally driven, do give out antibiotics like sweets. The old 'raan yaa' or chemist needs to take a large percentage of the blame. Many of these places sell antibiotics with only cursory instructions on how to use them. once after meals if your lucky is the best you'll probably get. Let along strict instructions to complete the whole course. Chemists should be where you get your lemsip, paracetamol and condoms, not where you get over the counter antibiotics, (unless you have a prescription of course)

[TAWP]

Yes, I don't know how many times I have to tell people to take the fully prescribed cure and not stop after 2-3 days...

And I don't know how many times I have had to tell people not to take antibiotics when they have a cold.

Yes, that too, but when people are taking the antibiotics for valid cases they are merely conditioning and growing stronger ones by finishing the cures early -- and then it comes back twice as hard and they seem surprised...

[Misterwhisper]

That happens when you shell out antibiotics to patients like you'd dispense candies without any control whether they'll actually finish the full course, because charging inflated hospital prices for those drugs is more important than deciding whether they are actually absolutely necessary or not. I was frequently flabbergasted when I received a bagful of yellow, pink, green and red antibiotic pills and capsules just for presenting with a light fever. I equally frequently declined to the great shock of the "treating" doctors. Like in many other developing countries antibiotics are unfortunately regarded as cure-it-alls.

[Crushdepth]

Antibiotic drugs are the most popular type of treatment in Thailand

And there is the problem. IMHO doctors that hand out antibiotics like lollies should be deregistered.

[HipHopYngve]

Not to forget what’s “MAYBE” the worst of all. Feedstuff for livestock. They add antibiotic and hormones to all the feedstuff and we’re all eating it.

Waste from the pharmaceutical industry, the latest example is from India where they found very high levels of all kinds of different medicines.

They found many different kinds of medicines at a sewage treatment plant in Patancheru, a industrial area outside Hyderabad. Among these, ciprofloxacin, an antibiotic used to cure pneumonia and urinary infection. 45 kg PER DAY just out in the river and the levels was measured higher in the water than in the blood in a human currently undergoing a cure for urinary infection or pneumonia

[Beechboy]

Whilst agreeing with all of the above, the easy acquisition of doxycycline and norfloxacin from street chemists has saved many an unsuspecting male from the more serious consequences of STDs after a careless, drunken night. I refer mainly to Gon and Syph.

The girls use them as well, to the good of all, but would find the cost of the doctor/prescription route prohibitive on occasions.

[Scott]

The inherent consequences of over use and under-dosage of antibiotics is well known. This article, though, doesn't site the source of the doctor's information.

Is Thailand doing research? Are they working on developing new antibiotics or did he read a journal and decide to insinuate that it is his own. He doesn't claim the research, but he doesn't site his source.

Anybody know a more thorough source of his information?

[SiangDeeMahk]

I too frequently see a huge abuse of oral (and even injected) antibiotics in Thailand.

It's prescribed for the most trivial illness, everything from a slight sniffle (common cold) to a sore muscle to a minor abrasion. Or even as a treatment for simple diarrhea (and not every bout of upset stomach is the result of a bacterial infection). Often, it's prescribed by pharmacists, without even a basic examination, but simply handed over to the customer after a 20 second conversation over the glass counter. No background (existing condition) check, no drug allergy or interaction check for multiple medications,and certainly no instructions as to how important it is to finish the full course.

The fact that the pharmacists don't give implicit instructions may not matter; because it also doesn't seem to matter how imperatively I explain why a full course of antibiotics has to be followed to it's conclusion; the Thais in my life simply don't pay any attention. They seem to treat it as some kind of painkiller. They stupidly believe that if "it doesn't hurt anymore", they don't need to continue to take the medication, coupled with a foolish goal of intentionally only using half the prescription (so as to still have a remaining dosage for some future day when they have a slight fever or a stuffy nose). They keep it around the house (for extensive periods), occasionally dipping into it when they're a bit under the weather, treating it like it's aspirin. (I force my GF not to take it unless it's really indicated, or to finish the course fully, if it is, but the others in the family? no way). I've found that doctors/pharmacists really lose their minds in terms of over-prescribing oral antibiotics for babies, who just have a simple cold or a cough (often exacerbated by being forced to sleep in a constant chilling blast from a fan, set up in their face by a clueless Thai grandparent that somehow "feels" that the baby หายใจไม่ออก {can't breath}... but don't get me started on that!).

Proper health care (even the most basic tenants of it, like refrigerated raw foods, hot foods being kept hot, washing hands with soap often {especially before eating}, not sharing saliva-soaked silverware, covering your mouth when you cough or sneeze, not discarding bacteria-filled soft contact lenses for years on end, only using potable water, proper disposal of infectious or toxic refuse, etc, etc), seems to be an inscrutable mystery to 80%+ of the rural Thais that I know (and still a good chunk of the urban ones). But the overuse of antibiotics is just off the chart.

It's no wonder the super-bugs are on a fasttrack to overwhelming even the most powerful antibiotics here.

[SiangDeeMahk]

Whilst agreeing with all of the above, the easy acquisition of doxycycline and norfloxacin from street chemists has saved many an unsuspecting male from the more serious consequences of STDs after a careless, drunken night. I refer mainly to Gon and Syph.

The girls use them as well, to the good of all, but would find the cost of the doctor/prescription route prohibitive on occasions.

But... the indication of an antibiotic course for those diseases is correct..

http://www.ncbi.nlm....sease.treatment

No one's complaining about the correct usage of antibiotics (even when sold by pharmacists). The issue isnt that it's available in drugstores without the need for a doctor's perscription. The problem that's being discussed is the mis-use or over-use of them, making superbugs advance more rapidly here than in other locals.

[Beechboy]

True Siang ... but the easy acquisition of these medications from chemists whilst leading to misuse, also has some enormous benefits. with regards to the on-going problem of STDs. I will add chlamydia to my list.

[Richb2004v2]

Yes, I don't know how many times I have to tell people to take the fully prescribed cure and not stop after 2-3 days...

Overprescription combined with very little awareness or education concerning the use of antibiotics means that any antibiotic made available to the Thai medical fraternity has it's effective days numbered, and sadly I doubt this problem is confined only to Thailand.

Sadly it's not; in the UK we have MSRA the first of the superbugs, which if memory serves me right, several hospital outbreaks have resulted in whole hospital becoming quarantined [no visitors, and only emergence treatment], until they could control the outbreak.

Doctors have been warning of this for years. I wouldn't be so harsh as to point the accusing finger directly at doctors, although some of the less ..ahem.. professionally driven, do give out antibiotics like sweets. The old 'raan yaa' or chemist needs to take a large percentage of the blame. Many of these places sell antibiotics with only cursory instructions on how to use them. once after meals if your lucky is the best you'll probably get. Let along strict instructions to complete the whole course. Chemists should be where you get your lemsip, paracetamol and condoms, not where you get over the counter antibiotics, (unless you have a prescription of course)

The MRSA thing was in part blown out of all proportion by the British media. Although the instances are high they are nothing like as bad as the media like to portray. MRSA is not totally resistant to antibiotics. VRSA is another story and is one step on again.

[SiangDeeMahk]

Whilst agreeing with all of the above, the easy acquisition of doxycycline and norfloxacin from street chemists has saved many an unsuspecting male from the more serious consequences of STDs after a careless, drunken night. I refer mainly to Gon and Syph.

The girls use them as well, to the good of all, but would find the cost of the doctor/prescription route prohibitive on occasions.

But... the indication of an antibiotic course for those diseases is correct..

http://www.ncbi.nlm....sease.treatment

No one's complaining about the correct usage of antibiotics (even when sold by pharmacists). The issue isnt that it's available in drugstores without the need for a doctor's perscription. The problem that's being discussed is the mis-use or over-use of them, making superbugs advance more rapidly here than in other locals.

True Siang ... but the easy acquisition of these medications from chemists whilst leading to misuse, also has some enormous benefits. with regards to the on-going problem of STDs. I will add chlamydia to my list.

Again, your point is already being made by the fact that no one is saying chemists shouldn't have antibiotics (to be made easily available for the properly indicated treatment of actual bacterial infections). If there was a "crackdown" on the over-dispensing of antibiotics for NON-INDICATED use (such as viral infections, or other non-bacterial maladies), that wouldn't make them any less {easily} available to be properly dispensed for treatment of bacterial VD.

So, I'm not really sure what your "we should be glad that it's available for VD treatment" statement really means.. It's seems to sound as if you think it could be in danger of not being available (at all), if doctors and chemists weren't over-prescribing it?

That's confusing, sir.

[WarpSpeed]

Yes, I don't know how many times I have to tell people to take the fully prescribed cure and not stop after 2-3 days...

And I don't know how many times I have had to tell people not to take antibiotics when they have a cold.

Cha ching!!!! Or a hang nail ....

Edited February 17, 2011 by WarpSpeed

[WarpSpeed]

The inherent consequences of over use and under-dosage of antibiotics is well known. This article, though, doesn't site the source of the doctor's information.

Is Thailand doing research? Are they working on developing new antibiotics or did he read a journal and decide to insinuate that it is his own. He doesn't claim the research, but he doesn't site his source.

Anybody know a more thorough source of his information?

Yes, first rate reporting if there ever was any.....

[webfact]

Four common bacteria strains see high drug resistance

By The Nation

Resistance to drugs treating four frequently occurring bacterial infections has risen significantly in Thailand over the past decade, with some types of bacteria increasing their drug resistance by 30 times, Deputy Public Health Minister Pansiri Kulnartsiri told a news conference yesterday ahead of World Health Day, which is April 7.

Pointing out that this problem resulted from unnecessary use of antibiotics, tendency to use strong medicine, and incomplete dosage, the Disease Control Department is hosting an essay contest to campaign for proper medication.

The World Health Organisation (WHO), setting the World Health Day theme as "Combat Drug Resistance - No Action Today, No Cure Tomorrow", urged its member countries to educate the public about the issue and get all parties involved to avoid using antibiotics unnecessarily and, when needed, using appropriate dosages to prevent drug resistance.

Thailand's Medical Science Department has over the past decade identified four highly drug-resistant bacteria.

Streptococcus pneumoniae, which causes pneumonia, the No 1 killer of children under five years of age, was found to have increased its resistance to penicillin from 47 per cent in 1998 to 64 per cent in 2010, and resistance to erythromycin from 27 per cent to 54 per cent. Some newly developed drugs have also encountered some cases of resistance.

Escherichia coli, which infects the urinary tract and abdomen, was found to have increased its resistance to broad-spectrum antibiotics from 19 per cent in 1999 to 52 per cent in 2005. E coli also resists fluoroquinolone, which is highly accessible via over-the-counter sales and yields fewer side effects than other drugs, at 60 per cent.

Acinetobacter baumannii was found to resist the strong antibiotic carbapenem, from 2.1 per cent in 2000 to 63 per cent in 2010, and to resist the latest and strongest medicine for this bacterium, cefoperazone-sulbactam, from 3 per cent to 44 per cent and counting.

Pseudomonas aeruginosa, an opportunistic germ that infects the respiratory tract, urinary tract and blood-circulation system, was found to resist drugs at 20-40 per cent.

The drug resistance resulted from: unnecessary use of antibiotics to treat diseases such as flu and diarrhoea, which were caused by viruses, not bacteria; inappropriate use of drugs to treat certain bacteria; and the public's lack of understanding about disease and antibiotics, making them take antibiotics too quickly, change medicines too often and take incomplete dosages.

The Food and Drug Administration (FDA) reported that Thailand since 2000 had imported antiseptic drugs, including antibiotics, in the amount of Bt20 billion or 20 per cent of the value of all medications, as of 2007.

The essay contest - which will accept submissions until March 23 and announce the winners on March 31 - is in three categories: secondary students, university students and general public. Each category will have six prizes, including the top prize of Bt20,000 cash. For details, go to www.hed.go.th or www.ddc.moph.go.th or call 0-2590-1623.

Pansiri said the ministry was working to control antibiotic use at hospitals, urging them to apply the drugs only when necessary. It was also strictly watching for infections at hospitals, establishing a national drug-resistance watch centre at the Medical Science Department, and launching a project called "Antibiotics Smart Use" overseen by the FDA to ensure that medical personnel and the public use antibiotics safely and effectively.

-- The Nation 2011-02-18

[jaltsc]

The inherent consequences of over use and under-dosage of antibiotics is well known. This article, though, doesn't site the source of the doctor's information.

Is Thailand doing research? Are they working on developing new antibiotics or did he read a journal and decide to insinuate that it is his own. He doesn't claim the research, but he doesn't site his source.

Anybody know a more thorough source of his information?

Yes, first rate reporting if there ever was any.....

He copied it from the doctor sitting in front of him in class

[Nisa]

I am not a scientist but I don't understand how over prescribing antibiotics is going to cause any bacterial illness to gain strength. I can see how it might make an individual's immune system weaker but not make the bacteria stronger. I am guessing I am missing something because I hear this stated a lot.

If somebody doesn't take all their medication and the bacteria is not fully killed then I can see how that bacteria may treat the antibiotics as a sort of vaccine against the antibiotic. Similar to doctors giving you a safe dose of a specific disease to cause your body to build a resistance to it. So, if somebody was to not kill the bacteria it could reappear stronger and spread to others and in a sense cause a new strain of that bacteria.

But even in terms of not taking all the prescribed antibiotics isn't there still the same chance that the bacteria can spread after it has been attacked by the antibiotics? Clearly the antibiotics don't kill it right off and a normal course of antibiotics is approx. 5-days..

It would just seem logical, in my mind, that bacteria is always going to try to find a way to mutate (as all life does) in order to survive regardless. However I can see how not taking all ones medicine can facilitate this happening.

The above seems like logic to me but again I am not a chemist, scientist or physician and I have heard this kind of reporting many times. Just not sure what I am missing beyond beyond being part of the pharmacological industry that makes incredibly HUGE amounts of money when they come out with a new drug and also get plenty of money handed to them to come up with new drugs if the public/government is convinced a health issue is at stake.

[exbelg]

doctors are to blame... for anything they will prescribe antibiotics and when it is really needed, they give you a cure for only 2-3 days instead of a real full cure that should be around one week

[SantiSuk]

I agree. Thai doctors tend to prescribe 3-5 days of antibiotics and UK doctors typically prescribe 7-10 days with an instruction to come back if it is not cleared to get another (typically one week's) prescription.

[sirchai]

The main problem is that thai doctors prescribe antibiotics for every kind of desease. If desease is a virus, antibiotic is useless and using antibiotics everytime just makes bacterias stronger

To be honest, it's an International problem. Of course Thais always take Amoxicillin in high doses, even when they're not really sick.

The type of bacteria they're talking about is also in European hospitals and killing many people every day. I had to go to one of the best hospitals in Germany, well known for their orthopedic surgeries.

After an accident in Thailand 2009 where they implanted a plate incorrectly I had to fly to Europe, receiving an artificial knee.

But everything went wrong, because they also implanted strange bacteria that nobody even realized. It went on for such a long time that I had to go through seven, instead of two operations and almost lost my right leg.

The problem is that these bacteria types are developing more and more and in the near future there'll be much more of resistant types.

Staphylococcus aureus (MRSA) is very hard to get rid of. A so called CRP test, very seldom made in Thailand's hospitals, will show through a blood test, normally ranging from 0.0 to 0.8.

A high or increasing amount of CRP in your blood suggests that you have an acute infection or inflammation.

Guess it's necessary to educate doctors, nurses, and others to heal people instead of killing them with a bacteria. :jap:

Edited February 18, 2011 by sirchai

[Nisa]

If there is a correlation between over use then one solution would be to stop allowing them to be sold over the counter here but not sure if that will help since doctors, hospitals and clinics seem to make most their money from selling drugs. I have never seen anybody go to any of these three here and walk away with less than 5 different drugs.

[rundmw]

I am not a scientist but I don't understand how over prescribing antibiotics is going to cause any bacterial illness to gain strength. I can see how it might make an individual's immune system weaker but not make the bacteria stronger. I am guessing I am missing something because I hear this stated a lot.

If somebody doesn't take all their medication and the bacteria is not fully killed then I can see how that bacteria may treat the antibiotics as a sort of vaccine against the antibiotic. Similar to doctors giving you a safe dose of a specific disease to cause your body to build a resistance to it. So, if somebody was to not kill the bacteria it could reappear stronger and spread to others and in a sense cause a new strain of that bacteria.

But even in terms of not taking all the prescribed antibiotics isn't there still the same chance that the bacteria can spread after it has been attacked by the antibiotics? Clearly the antibiotics don't kill it right off and a normal course of antibiotics is approx. 5-days..

It would just seem logical, in my mind, that bacteria is always going to try to find a way to mutate (as all life does) in order to survive regardless. However I can see how not taking all ones medicine can facilitate this happening.

The above seems like logic to me but again I am not a chemist, scientist or physician and I have heard this kind of reporting many times. Just not sure what I am missing beyond beyond being part of the pharmacological industry that makes incredibly HUGE amounts of money when they come out with a new drug and also get plenty of money handed to them to come up with new drugs if the public/government is convinced a health issue is at stake.

Essentially, it's an issue of evolution and population dynamics. By stopping the treatment before the fully prescribed cycle, you kill the microbes that are most vulnerable to the medicine, but you leave in place the ones that have some incremental resistance. With the non-resistant microbes now killed, the more-resistant ones come to dominate the population. Since genes for resistance can often jump cross-species, increasing the frequency of resistance genes in entire microbe population raises the chance of that resistance gene appearing in a pathogen microbe.

See a reprint of a Scientific American article on the subject: http://www.chiro.org/LINKS/FULL/Challenge_of_Antibiotic_Resistance.shtml

[scotbeve]

Yes, I don't know how many times I have to tell people to take the fully prescribed cure and not stop after 2-3 days...

And I don't know how many times I have had to tell people not to take antibiotics when they have a cold.

Agreed! Chicken broth, warm water, green tea, diluted aspirin, and more HEALTHY ALTERNATIVES to the mass produced, unnatural, and highly addictive pharmaceuticals pushed on us by the same doctors paid back-handers by the mega corporation pharmaceutical companies. Can't beat mother nature and a healthy life style.... natural selection was / is the scientific way of population control - remember folks, WE are the bacteria on this planet!

[Richb2004v2]

The main problem is that thai doctors prescribe antibiotics for every kind of desease. If desease is a virus, antibiotic is useless and using antibiotics everytime just makes bacterias stronger

Staphylococcus aureus (MRSA) is very hard to get rid of. A so called CRP test, very seldom made in Thailand's hospitals, will show through a blood test, normally ranging from 0.0 to 0.8.

Staphylococcus aureus should not be difficult to eliminate with Methacilin. It is the Methacilin resistant Staphylococcus aureus (MRSA) which is the problem, not the normal variety which exists in numerous none problematic forms, and is certainly nothing new. However another antiboitic is now used, the name of which I can't remember, I think ventacilin or similar. This does destroy the MRSA.

[Nisa]

I am not a scientist but I don't understand how over prescribing antibiotics is going to cause any bacterial illness to gain strength. I can see how it might make an individual's immune system weaker but not make the bacteria stronger. I am guessing I am missing something because I hear this stated a lot.

If somebody doesn't take all their medication and the bacteria is not fully killed then I can see how that bacteria may treat the antibiotics as a sort of vaccine against the antibiotic. Similar to doctors giving you a safe dose of a specific disease to cause your body to build a resistance to it. So, if somebody was to not kill the bacteria it could reappear stronger and spread to others and in a sense cause a new strain of that bacteria.

But even in terms of not taking all the prescribed antibiotics isn't there still the same chance that the bacteria can spread after it has been attacked by the antibiotics? Clearly the antibiotics don't kill it right off and a normal course of antibiotics is approx. 5-days..

It would just seem logical, in my mind, that bacteria is always going to try to find a way to mutate (as all life does) in order to survive regardless. However I can see how not taking all ones medicine can facilitate this happening.

The above seems like logic to me but again I am not a chemist, scientist or physician and I have heard this kind of reporting many times. Just not sure what I am missing beyond beyond being part of the pharmacological industry that makes incredibly HUGE amounts of money when they come out with a new drug and also get plenty of money handed to them to come up with new drugs if the public/government is convinced a health issue is at stake.

Essentially, it's an issue of evolution and population dynamics. By stopping the treatment before the fully prescribed cycle, you kill the microbes that are most vulnerable to the medicine, but you leave in place the ones that have some incremental resistance. With the non-resistant microbes now killed, the more-resistant ones come to dominate the population. Since genes for resistance can often jump cross-species, increasing the frequency of resistance genes in entire microbe population raises the chance of that resistance gene appearing in a pathogen microbe.

See a reprint of a Scientific American article on the subject: http://www.chiro.org...esistance.shtml

Thanks and WOW ... from your link:

The same drugs prescribed for human therapy are widely exploited in animal husbandry and agriculture. More than 40 percent of the antibiotics manufactured in the U.S. are given to animals. Some of that amount goes to treating or preventing infection, but the lion's share is mixed into feed to promote growth.