antibiotics | MY SPECIAL DOCTOR

Influenza: spread and prevention. Is vaccination appropriate?

22 February 20246 January 2024 by rosanna.feroldi

If you have been lucky enough not to have fallen ill yet, it is not the case to tempt fate further. Better to plan for seasonal flu vaccination as soon as possible to be fully protected by specific antibodies against the viruses before Christmas arrives, when the more intense cold and multiple close contacts typical of the holidays will greatly increase the spread of viruses.

In this regard, it should be mentioned that the seasonal flu vaccine., which can be purchased in pharmacies and administered by a physician or nurse practitioner with a subcutaneous injection into the upper arm or thigh (completely painless), is beneficial to all because it is safe, essentially free of side effects, and able to protect completely (or most) from the discomforts associated with influenza and its complications (particularly acute respiratory distress syndromes and pneumonia).

It can, therefore, be safely taken by children, adults, the elderly and pregnant women and should be used especially by those with diseases that increase the risk of complications (even with an inauspicious outcome) in case of influenza (heart disease, chronic respiratory diseases, diabetes, etc.), by those who work in contact with the public and/or with frail/at-risk people (doctors, nurses, caterers, sales clerks, veterinarians, etc.), as well as by people with public utility duties (staff of public transportation companies, law enforcement, firefighters, etc.).

Does this year’s flu still seem too uncommon and not severe enough to warrant vaccine use? Make no mistake. This muted start, similar to last year’s, is mainly due to the persistence of slightly higher average ambient temperatures than expected for the season. A few extra degrees on the thermometer constitute a significant brake on the spread and aggressiveness of flu viruses, which will not fail, however, to be activated en masse when real winter arrives. So, better be prepared.

Taking the vaccine protects against the most prevalent influenza viruses in a given season (October-March each year), but not against all possible types of circulating respiratory viruses, which are usually, fortunately, less harmful to orgasnism. Therefore, even if vaccinated against the flu, you may still be affected by colds, fever, headache, but throat and cough, as well as sometimes nausea and vomiting.

To reduce discomfort and recover quickly, the most important thing is to stay on rest (preferably in bed if there is a fever) to give the immune system a chance to fight the viruses with maximum efficiency. Antifebrile and nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to reduce symptoms (sparingly and adhering to the treatment directions on the package insert) if there are no specific contraindications highlighted by the physician.

Antibiotics, on the other hand, in common flu or flu syndromes should be avoided because these drugs, in addition to being completely inactive against viruses, weaken the body, reducing its ability to recover spontaneously. If bacterial complications arise such that they become necessary, the doctor will prescribe them, including specifying when to take them, at what dosage, and for how long-all of which must be followed faithfully, without exception.

Sources

Ministry of Health – Influenza(http://www.salute.gov.it/portale/influenza/homeInfluenza.jsp)
InfluNet – Superior Institute of Health (https://old.iss.it/site/RMI/influnet/pagine/rapportoInflunet.aspx;

Flouroquinolones: when it is best to avoid them

21 February 20246 January 2024 by rosanna.feroldi

All
antibiotics
should be used with caution, only when prescribed by a physician to treat a bacterial infection of some importance that could not heal on its own, and should be taken by carefully following the directions regarding dosage, timing, and mode of administration. The use of some antibiotics, however, requires more caution than others because the side effects that may result from their action in the body are particularly severe.

Among them are the fluoroquinolones: a class of broad-spectrum (i.e., effective against an extensive number of Gram+ and Gram- bacteria) antibiotics that have been used for more than 30 years for the treatment of serious and life-threatening bacterial infections, especially of the respiratory and urinary tracts, the gastrointestinal tract, and the bones.

In addition to the already known adverse events of these drugs, two reviews conducted by the European Medicine Agency(EMA) and the similar U.S. agency (FDA, Food and Drug Administration) during 2018 revealed additional significant critical issues that dictate that the use of systemically administered fluoroquinolones (i.e., by mouth, through injections, or by inhalation) should be limited exclusively to situations where no effective therapeutic alternatives are available to clear the body of infections so severe that they are life-threatening.

As early as November, the EMA had reported that taking systemic fluoroquinolones may be associated with Severe and disabling adverse events, long-lasting and potentially permanent, at the level of the muscles, bones, joints, and nervous system, in addition to those already known to affect the gastrointestinal system (risk of severe diarrhea, especially from Clostridium difficile) and cardiac (with contraindication for use in people with long QT syndrome and/or bradycardia, i.e., slow heartbeat).

These serious side effects of commercially available fluoroquinolone antibiotics (ciprofloxacin, levofloxacin, lomefloxacin, moxifloxacin, norfloxacin, ofloxacin, pefloxacin, prulifloxacin, and rufloxacin) include inflammation and rupture of tendons (especially the Achilles tendon of the ankle), muscle pain or weakness and joint pain or swelling, difficulty in walking, neuropathy and paresthesias (feeling of pins and needles, burning, etc.), fatigue, depression, memory problems, impaired sleep, vision and hearing, impaired taste and smell.

The appearance of swelling and injury at the level of tendons can occur within two days of the start of treatment with a fluoroquinolone antibiotic or several months after its discontinuation, and it is this long interval between taking the therapy and the appearance of the side effect that for many years prevented physicians from understanding the actual correlation between the two events and, therefore, the significance of the risk associated with the use of these drugs.

The likelihood of occurrence of the mentioned adverse events is higher in people over 60 years old, in those who already have problems with Musculoskeletal or renal level or has received an organ transplant and in those who are also taking or have recently taken corticosteroid medication systemically (by mouth, injections, inhalation) or jointly (infiltrations) to treat other conditions.

But it is not over. Just before Christmas, the FDA added an additional and more alarming rationale for limiting the use of fluoroquinolones as much as possible. In fact, according to audits conducted by the U.S. agency, treatment with these antibiotics is also associated with an increased risk of dissection and rupture of the aorta: the body’s main artery that collects oxygenated blood exiting the heart and distributes it throughout the body.

At greatest risk of such events (which place the affected person in immediate life-threatening danger and therefore represent an absolute medical emergency) are especially the elderly and those who have or are at risk of developing aortic aneurysms, such as people suffering from atherosclerosis, high blood pressure, and/or certain predisposing genetic conditions such as Mafran syndrome and Ehlers-Danlos syndrome.

In all of the above cases, fluoroquinolones should not be used unless they represent the only class of drugs available to treat a life-threatening infection, and their eventual use should always be closely monitored by the physician, however.

All people on systemic fluoroquinolone antibiotic therapy should follow the doctor’s instructions, without spontaneously discontinuing treatment, and immediately report any onset of symptoms such as:

Pain or inflammation in the Achilles tendon (or other tendons);
Pain, burning, tingling, numbness, or weakness in the arms and legs or other parts of the body;
Severe pain behind the sternum or in the upper back (similar to that of a heart attack), radiating to the neck, shoulders, and jaw;
Severe abdominal or lower back pain radiating to the legs.

Source

Fluoroquinolone Antibiotics: Safety Communication – Increased Risk of Ruptures or Tears in the Aorta Blood Vessel in Certain Patients(https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm628960.htm)
Important Information Note on Medicines Containing Fluoroquinolones(http://www.aifa.gov.it/content/nota-informativa-importante-su-medicinali-contenenti-fluorochinoloni-23102018)
Disabling and potentially permanent side effects have led to discontinuation or restrictions in the use of quinolone and fluoroquinolone antibiotics. EMA/795349/2018 (https://www.ema.europa.eu/en/news/disabling-potentially-permanent-side-effects-lead-suspension-restrictions-quinolone-fluoroquinolone)

Antibiotic resistance worsened by environmental sanitation

18 February 20246 January 2024 by rosanna.feroldi

Antibiotic resistance, that is, the growing ability of pathogenic bacteria to survive in the presence of the drugs that are supposed to kill them, is one of the greatest challenges facing medicine today and on whose victory the chances of survival of humankind in the coming decades depend.

For those born in the era of antibiotics, it is difficult to realize this emergency, but to find oneself out of the blue without medication that can fight infectious diseases as severe as tuberculosis, pneumonia or bacterial gastroenteritis means being exposed to a very high risk of epidemics capable of claiming millions of lives and extremely difficult to contain.

In an effort to limit the spread of bacterial resistance, for more than two decades, the World Health Organization and other health institutions internationally recommend using antibiotics cautiously, sparingly, and properly: that is, only when essential, at the dosages and for the time period prescribed by the doctor, and never on a do-it-yourself basis.

However,antibiotic resistance can also be promoted in non-health care settings. The best known of these is animal farms, where antibiotics are often used to protect livestock from infection. New evidence now indicates that the hygiene of closed environments such as homes and offices can also facilitate the selection of “super-bacteria.”

Specifically, research recently published in the scientific journal Nature Communications reports that in the enclosed rooms of buildings of any type, the biodiversity of bacteria is less than that typical of the outdoor environment (urban or natural), and that the strains less sensitive to commonly used antibiotics are more likely to be represented.

According to the researchers, this finding may be a consequence not only of the type of occupancy and human activities carried out in the buildings and the more or less pronounced isolation from the outside environment, but also of the products and methods used to clean the surfaces. In particular, it is hypothesized that theuse of broad-spectrumantibacterial detergents may play an unfavorable role, rewarding the “stronger” bacteria that would be able to multiply prevalently.

Given that domestic cleanliness, the premises and buildings frequented by many people is indispensable to prevent diseases and hygiene problems of various kinds, to avoid promoting bacterial resistance in enclosed environments, researchers suggest alternating the cleaning substances used (so that bacteria cannot habituate) and reserving overtly antibacterial products for circumscribed places deserving of increased disinfection (bathrooms, kitchen countertop, garbage compartment, etc.).

Other useful measures include using steam to sanitize surfaces that can tolerate high temperatures, putting plants in rooms (avoiding those most at risk of allergies), and increasing indoor-outdoor exchanges (for example, opening windows often).

Source

Mahnert A et al. Man-made microbial resistances in built environments.

Nature Communications 2019;10:968. doi:10.1038/s41467-019-08864-0 (https://www.nature.com/articles/s41467-019-08864-0)

Cranberry: an aid against antibiotic resistance?

15 February 20246 January 2024 by rosanna.feroldi

Antibiotic resistance continues to grow globally, and in Italy, the situation is among the most severe in Europe, with many fearsome bacteria now unassailable by most available antibiotics. According to data from theEuropean Center for Diseases Prevention and Control (ECDC), our country accounts for 1/3 of all deaths (10,000 deaths/year) related to antibiotic resistance on the European territory: in the EU/EAA area, a situation of similar severity affects only Greece, Croatia, Bulgaria and Hungary.

In addition to recommending that fewer and better antibiotics be used on the market to preserve their effectiveness and trying to identify new drugs that are more active against bacteria (long, complex, and rarely successful work), researchers are testing the possibility of enhancing the action of current antibiotics or restore their bacteriostatic/bactericidal activity by combining them with other compounds.

Among such strategies that could help overcome the problem is one based on a protein found in the inviting red berries of the cranberry: plant also known as “American cranberry” or “American oxycock” and has long been exploited for its favorable action against inflammation of the female lower urinary tract (in addition to any specific therapy indicated by the doctor).

In particular, a study published in Advance Science indicates that the pro-anthocyanidin protein (c-PAC) contained in cranberry is able to interfere with two important resistance mechanisms developed by pathogenic microorganisms: selective membrane permeability, which allows bacteria to not absorb or to absorb in minimal amounts the antibiotic that should kill them; and active “pumping” outward from the bacterial cell of antibiotic molecules that have already been absorbed, before they can do damage. By reducing the effectiveness of these two defensive mechanisms, c-PAC would have the effect of increasing the response to antibiotics by pathogenic microorganisms.

L’protective effect of c-PAC has been shown in in vitro and in vivo tests on some of the bacteria most dangerous to human health in case of infection and most frequently resistant to available drugs, such as Escherichia coli (mainly responsible for severe and life-threatening gastrointestinal infections, especially in children, the elderly, and people with reduced immune defenses), Pseudomonas aeruginosa (the cause of difficult-to-fight airway, urinary, and eye infections, severe otitis, endocarditis, and often fatal septicemia); and Proteus mirabilis (mainly at the origin of severe urinary tract infections).

In the case of E. coli and P. aeruginosa, c-PAC has been shown not only to prevent the development of tetracycline resistance, but also to reduce the tendency of these bacteria to form biofilms on the surface of target organs. The formation of biofilms, i.e., dense and compact patches of bacteria tightly adhered to mucous membranes and interacting with each other, is a colonization mechanism that microorganisms use to increase their ability to survive, reducing the ability of drugs to attack and kill them. Hindering biofilm formation, therefore, amounts to making bacteria more isolated and fragile.

Whether this initial evidence can be converted into a combination drug containing an antibiotic and the cranberry protein remains to be evaluated, but the avenue opened is certainly interesting and gives cause for hope.

Source

Maisuria VB et al. Proanthocyanidin Interferes with Intrinsic Antibiotic Resistance Mechanisms of Gram-Negative Bacteria. Advance Science 2019; doi:10.1002/advs.201802333 (https://onlinelibrary.wiley.com/doi/epdf/10.1002/advs.201802333)

The disastrous invasion of antibiotics, in the US they even prescribe them with virtual visits

8 February 20246 January 2024 by Redazione My Special Doctor

The disastrous invasion of antibiotics around the world is taking on even more worrisome contours: in the U.S. they even prescribe them with virtual visits. Better not to import this phenomenon to Italy, we say: but why do we need to be so careful?

Overuse and inappropriate use of antibiotics have contributed to the emergence of increasingly resistant bacteria. Exaggerated prescribing by physicians and the use of products on livestock farms are among the major culprits for this phenomenon. And in the United States the situation is getting worse, because of doctors who are prescribing antibiotics to children through visits made with smartphones, all online and probably all at random.

A study published in the journal ‘Pediatrics‘ and funded by the NIH (National Health Institute)National Institute of Health described the phenomenon alarmingly. More than half of the children seeking care online for acute respiratory infections (sinusitis, bronchiolitis) received antibiotics, a solution less used by children visited in person. Telemedicine and its flaws are blatantly visible in this case.

In fact, it is often difficult for doctors to distinguish between a bacterial and a viral infection, with the latter not requiring the use of antibiotics; one can only imagine how it is possible to zero in on the right treatment with an online ‘visit’. As many as 2 million people in the United States have been affected by antibiotic-resistant bacteria in the past year, a symptom of overuse of these drugs.

The researchers examined in the study as many as 4604 telemedicine visits, 38408 emergency room visits and 485201 pediatric visits, excluding all cases limit such as urinary tract infections and other non-bacterial disorders or viral. This is a broad spectrum of cases.

While in Italy personal contact with the doctor is a basic prerogative, thanks in part to an accessible health care system, in the United States the medical field is often a matter of saving money. Virtual visits, or telemedicine, represent a business with ample room to maneuver. Leading Teladoc, which opened the MinuteClinic site in August, allows patients over two years old to see the doctor with an app on their smartphone, for only $60. Other companies are following suit.

Why do American citizens love this kind of business? For laziness: telemedicine advertisements sell the time and effort saved in moving to see the doctor in person. But all associations, particularly pediatric associations, are trying to discourage parents from using this type of treatment, particularly when children suffer acute symptoms

Beware of the antibiotic (especially if prescribed online)!

In the United States, a study published in the journal ‘Pediatrics’ and funded by the NIH (National Health Institute) examined a Very high number of pediatric visits (specifically 485201 visits outpatient, 38408 ER visits, 4604 visits made online) to verify The percentage of antibiotic prescriptions for acute respiratory infections (such as sinusitis and bronchiolitis). Well: it turned out that, unlike the other two groups, more than half of the children visited online were given prescribed antibiotics.

This opens to two considerations:

The first, already well known but unfortunately rehashed, related to the inappropriate and excessive use of antibiotics (both through exaggerated prescribing by doctors and their use in livestock farms), which has contributed to the emergence of increasingly resistant bacteria (it is estimated that as many as two million people in the United States alone have been affected by resistant bacteria in the past year)
The second refers to the practice of online visits, via smartphones, which make it even more difficult for physicians to distinguish between a bacterial or viral infection, precisely because all those complex elements fundamental to clinical observation are missed

Certainly an online visit is cheaper and more convenient, but fortunately our health care system still has population health as its goal. and not solely and exclusively savings and convenience.