NDM-1: The Resistant Bacteria Threat Accelerates

NDM-1: The Resistant Bacteria Threat Accelerates

“Remember to give all of the antibiotics even if your child is feeling better…”  NOT!

Antibiotics were among the greatest advances of the 20th century, preventing untold suffering and saving countless lives. But almost immediately, the bacteria began fighting back.

Penicillin was first used to treat people with bacterial infection in 1942; by 1945, twenty percent of all Staph bacteria found in hospitals had already become resistant to penicillin, and the resistant genes began to spread worldwide.

A parade of new antibiotics has been introduced in the years since. Each was effective for a while, but the march of bacterial resistance has been relentless.

Crossing the Line

In 2008, we crossed a new threshold, when scientists discovered bacteria that had learned not only to resist antibiotics, but that had become able to live on antibiotics as their only food! These bacteria were found, not in hospitals, but in soil samples from across the US.

The “Indian Superbug”

Now some bacteria have learned a new method of protecting themselves, even from our strongest antibiotics. They use an enzyme called NDM-1 (New Delhi metallo-B-lactamase 1) to shred the antibiotic. Here’s the sobering detail: the gene for making this enzyme is found on a bit of hot-swappable DNA called a plasmid, making it very easy to share and spread, without even taking the time to reproduce.

The first cases of human patients infected with these bacteria were reported in the September 2010 issue of Lancet Infectious Diseases. While this type of bacteria appears to have begun in India, before the digital ink was even dry on this study these infections had already been reported in 14 additional countries, including the US and Canada.

Solutions

Greater resistance is inevitable the more time bacteria spend in the presence of antibiotics. We protect our own children by increasing their resistance to bacteria (good food, good sleep, good exercise, good support system, clean hands, probiotics, plenty of vitamin D from the sun or from another source).

We prevent emerging bacterial resistance by minimizing the contact between bacteria and antibiotics:

  1. Get unnecessary antibiotics out of our food system. Far more antibiotics are used to grow our livestock – when well! – than are used to treat all human illnesses combined. Organic meat and poultry and organic milk and eggs doesn’t allow this.
  2. Consider stopping antibiotics as soon as you are feeling better. Of course, you’d want to discuss this with your doctor first. Even though most doctors (and the CDC) urge us to finish up the entire prescription of antibiotics even if a person is feeling better, in order to prevent resistance – this appears to me to be well intentioned, but backwards. My view here is quite controversial, but the main take-home message from the Science 2008 special issue examining the drug resistance threat was that only using antibiotics until the worst of the infection was over should lessen resistance. Adequate studies on ultra-short courses of antibiotics haven’t been done yet (and they should), but in the meantime this makes more sense to me than the conventional approach, with its proven track record of rampant resistance.
  3. Avoid antibiotic or antibacterial products such as soaps, toothbrushes, dishwashing detergents, window cleaners, chopsticks, hand lotions, pillows, sheets, towels, or slippers. These could all breed resistant bacteria. Hand sanitizers, disinfectant sprays, and disinfectant wipes are a different story: they physically destroy the bacteria, so resistance shouldn’t be an issue, and they can decrease the need for antibiotics.
  4. Only use antibiotics when they are the best choice. Antibiotics don’t work for viral infections such as most bronchitis, sore throats, or upper respiratory infections. They are still too commonly prescribed. Beyond this, the American Academy of Pediatrics now recognizes that even some bacterial infections (including most ear infections) get better results for the patient when treated without antibiotics. Don’t hesitate to use antibiotics when needed, but “print this sheet” and bring it with you to the doctor.
  5. Ask for the narrowest-spectrum antibiotic that will do the job. Giving broad-spectrum antibiotics – the shotgun approach — is usually not the best choice, and even when it is, it’s often best to switch to a more targeted antibiotic within a few days.

This is a serious issue with important implications for the future. It deserves strong action. Today’s choices affect tomorrow’s health.

I’m heartened that the US FDA issued draft guidance in June 2010 saying that giving antibiotics to animals in order to increase food production is a threat to public health and should be stopped.  They have no problem with veterinarians giving antibiotics to sick animals, but they are against industrial farming operations routinely giving antibiotics just to make animals gain weight faster.

But in spite of their new statement, the FDA is not prohibiting this practice, not limiting this practice, and not even overseeing it. They are calling for voluntary change from agriculture. Let’s help make them want to change.

As parents, our actions, our choices, and our purchases – how we eat, how we sleep, how we brush our teeth, how we treat our sick children — may be the fastest way toward turning the tide on bacterial resistance.

Kumarasamy KK, et al. “Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study.” Lancet Infectious Diseases Sep 2010; 10(9):597-602.

Sharfstein JM. “Antibiotic resistance and the use of antibiotics in animal agriculture.” http://www.fda.gov/NewsEvents/Testimony/ucm219015.htm

Taubes G. “The bacteria fight back.” Science. 18 Jul 2008; 321:356-361.

Dantas G, Sommer, MOA, Oluwasegun RD, and Church GM. “Bacteria subsisting on antibiotics.” Science. 4 Apr 2008; 320:100-103.

Levy SB. “Antibacterial household products: cause for concern.” Emerging Infectious Disease. Jun 2001 7(3):513-515.

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Dr. Alan Greene

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

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