Completely Cured

My friend's father recently was hospitalized with pneumonia. After five days he was out of the hospital, and two days after that, he assumed that he was better and returned to work. He felt good, his symptoms had abated. But then, within a few weeks, the pneumonia reappeared and he was back in the hospital. Although it might have been easy for my friend to blame her father for returning to work too soon, often our bodies tell us we feel fine and so we listen to them. The question then becomes: How do you know when you are actually well?

To get answers to this question, I called internist Alan Inglis, MD, who practices integrative medicine and is editor of American Country Doctor, a monthly magazine on health topics. As you may have guessed, it isn't a simple issue. He says there are a number of reasons why your illness might linger or return, depending on the nature of the illness itself, the health and age of the patient and how the patient behaves.

Repeat Offenders

Certain illnesses tend to reappear -- and pneumonia is one of them. There are several reasons why this happens. One is that patients often don't complete the series of antibiotics that were prescribed to treat the illness. Classically, this is because the patient begins to feel better and decides not to bother with the balance of the pills. Consequently, only the weakest strain of bacteria is killed off, opening the way for the stronger ones to reassert themselves -- and causing you to have a relapse. Daily Health News contributing editor Andrew L. Rubman, ND, adds that, in the case of pneumonia, often yeast or mold organisms are at the root of the disease and simply are not treated by the physician. Suppressing the bacteria may only temporarily mask the problem rather than really cure it.

Recurrence also can signal that another disease is present. Recurring pneumonia, he says, can be a sign of lung cancer, especially in a smoker, and if it happens often, the patient should be tested for cancer. Or, as stated above, he/she should be tested for yeast strain antibodies. In my friend's case, the second round was actually a different strain of pneumonia than the first time around. The second one was the pneumonia bacteria that is usually picked up in the hospital. He had the same diagnosis twice -- but it was really two sicknesses. The second was actually a result of the hospital stay!

Patients' individual profiles obviously can affect the duration and recurrence of illness, especially for older patients who are not in good health. People of any age who have a chronic disease, such as diabetes or lung disease (chronic obstructive pulmonary disease is common, a result of long-term smoking), are prone to recurrence of other illnesses, including pneumonia.

Another good example of a recurring illness is urinary tract infection (UTI). Women tend to get it repeatedly because of gender-specific anatomy -- their urethra is shorter than usual and so more vulnerable to the entry of bacteria. Dr. Inglis adds that sinus infections are another common recurring illness. Although they are almost always viral, many people take antibiotics to treat them, and antibiotics don't cure viral infections. The natural pattern of the viral infection, however, has what's called "double sickening" -- symptoms start to decrease but then suddenly reappear. Patients on antibiotics assume that they are getting well, but when the symptoms take a turn for the worse, it feels like a relapse, although it's just the viral infection doing what it does. Patients can use immune-boosting supplements but mostly have to wait it out, making themselves as comfortable as possible in the process.

Again, the UTI in women is often precipitated by underlying yeast [or e.coli]. When we see recurring bacterial infections, it is convenient to blame the underlying problem on viruses. This unfortunately is conjecture, not science.

Antibiotic Users Beware

It has become common knowledge that many bacteria are becoming resistant to certain antibiotics. Dr. Inglis reports that resistance to certain antibiotics can actually be geographic, existing in pockets around the country and rendering them useless to many people who live in the area. It's important for doctors to be aware of any resistance problem in their area so they know to prescribe a different antibiotic.

What You Can Do

In spite of the complicating factors, Dr. Inglis offers a set of guidelines that, if followed, will help anyone get completely well -- or at least substantially improve their chances for it. They are...

Take the complete prescribed course of medication. Don't decide for yourself when you no longer need your drugs. If you are taking something other than antibiotics and think that you may not need to continue, talk to your doctor before making a change. Do not do it on your own.

Consider taking probiotics, capsules of friendly intestinal bacteria. While there are many available at health-food stores, it is best to speak to a professional for his/her recommendation on the best product for your situation -- they're not all alike. Dr. Inglis says that probiotics are especially crucial for anyone on antibiotics to prevent the medication from promoting secondary problems, such as yeast infections or gastrointestinal complaints. However, probiotics can also help keep the GI system working well generally.

Be well, 
Carole Jackson, Bottom Line's Daily Health News, August 29, 2005

Sources:

Completely Cured: Alan Inglis, MD, internist, who practices integrative medicine and is editor of American Country Doctor, a monthly magazine on health topics.

Good Marketing or Good Product?    Udo Erasmus, PhD, research scientist specializing in the effects of fats and oils, and author of Fats that Heal Fats that Kill (Alive). www.udoerasmus.com

Quebec strain of C. difficile in 7 provinces

Jan 26, 2006:-  The same strain of Clostridium difficile that has caused close to 1400 deaths in Quebec since 2003 is present in 7 provinces, the Public Health Agency of Canada is reporting.

The NAP 1 strain of C. difficile was found in hospitals in Ontario, Quebec, Nova Scotia, Newfoundland and Labrador, Alberta, Saskatchewan and British Columbia. The Canadian Nosocomial Surveillance Program participated in a 6-month study conducted by the Canadian Hospital Epidemiology Association and the Public Health Agency, and involving 34 hospitals that belong to the program.

From Nov. 1, 2004, to Apr. 30, 2005, the National Microbiology Laboratory in Winnipeg collected more than 2000 stool samples and epidemiological data from patients at these institutions. The Public Health Agency has so far analyzed 615 of those samples and identified 1847 cases of NAP 1. Although they have not yet found the strain in New Brunswick and Manitoba, that may be because they still have more samples to investigate, says Denise Gravel, manager of the Nosocomial and Occupational Infections section of the Public Health Agency.

Compared to Agency data from a similar 1997 study, the incidence rate of C. difficile is essentially unchanged; 5.8% per 1000 hospital admissions in 1997, and 6% in the new study. But the mortality rate has jumped by 400%. In 1997, C. difficile contributed, either directly or indirectly, to the deaths of 1.5% of patients with the infection; the new study indicates the mortality rate is 5.8%, “which of course is highly significant,�?Gravel says.

She says morbidity has also jumped. “We did find that those who had the NAP 1 strain are 2.3 times more likely to have a serious outcome.�?The study defined “serious outcome�?as death, colectomy or ICU admission.

Quebec has the highest incidence rate, 13 per 1000 admissions compared with 7 per 1000 in Ontario, 3 per 1000 in Western Canada and 6 per 1000 in Atlantic Canada. There are no baseline data to allow a comparison with provincial rates in each province.

In separate data released by the Quebec government in December 2005, C. difficile is listed as the direct cause of death for 354 people in 2003 and 686 in 2004, for a total of 1040 deaths.

These official figures appear to support the estimates of Dr. Jacques Pépin, an infectious disease specialist in Sherbrooke, Que. Pépin published a paper last year (CMAJ 2005;173:1037-42) estimating that as many as 2000 people died, directly and indirectly, from C. difficile in 2003�?004.

C. difficile directly caused another 341 deaths in the first 6 months of 2005, according to the province. In total, Quebec has attributed 1381 deaths directly to C. difficile from 2003 through the first half of 2005. �?Laura Eggertson, CMAJ

 
http://www.cmaj.ca/news/26_01_06.shtml

Deadly intestinal bacteria on the rise

Infection most often strikes older hospital patients who took antibiotics

Feb. 1, 2006:-   TRENTON, N.J. - New Jersey is among the states seeing an increase in deaths from an intestinal bacterial infection

http://www.msnbc.msn.com/id/11134749/

Drug-Resistant Staph Tops Group's 'Hit List'
Common Bacterial Infection Has Mutated to Become Resistant to Most Antibiotics

March 1, 2006 �?- David Jackson still can't believe his ex-wife, Kimberly, is gone -- the victim of a deadly infection she contracted from an unsanitary pedicure.

"Something so stupid like a pedicure took her life," Jackson said. "She couldn't get it healed. No matter what she was doing, and the antibiotics just wasn't, wouldn't stop it."

Kimberly Jackson had contracted a staph infection -- a bacterial infection that can strike anywhere in the body, from the blood to the skin. Many of these bacteria are becoming resistant to antibiotics, and that has many doctors worried.

The Infectious Diseases Society of America today released a "hit list" of six drug-resistant "superbugs." No. 1 on that list is a potentially deadly strain of staph called MRSA (methicillin-resistant Staphylococcus aureus).

Dr. Tim Johnson, ABC News' medical editor, said that overuse of antibiotics had contributed to the growing number of infections that are resistant to drugs.

"We're seeing this drug-resistant strain now partly because of the use of antibiotics," Johnson said. "These bugs have a remarkable ability to mutate and develop resistance to whatever we throw at them."

Need More Treatments, Doctors Say
Once confined to hospitals, dangerous staph infections are cropping up in many other places where people interact in close quarters -- schools, prisons and sports teams.

"It is definitely a growing problem," said Dr. John Francis of the Johns Hopkins University School of Medicine. "There's a risk of this bacteria that's commonly found in your skin to then be passed from one individual to another."

What's most alarming to health professionals is that as the bug mutates, it grows more resistant to the few antibiotics left that can still treat it.

"We desperately need more tools, because that's how we're going to stay ahead of this," said Dr. Victor Nizet of the University of California, San Diego School of Medicine.

Johnson said that some experts believe drug companies aren't devoting enough resources to research new antibiotics.

"Why? Perhaps it's because these companies are focusing more on drugs that will be immediately profitable," Johnson said.

Another challenge in treating drug-resistant strains of staph infection is that they are everywhere, Johnson said.

"About one in three of us harbor some kind of staph bug in our respiratory system or on our skin, without symptoms," he said.

Fortunately, preventing a staph infection is relatively easy. The Centers for Disease Control and Prevention recommends the following:

 Keep your hands clean by washing thoroughly with soap and water, or using an alcohol-based hand sanitizer.
 Keep cuts and scrapes clean and covered with a bandage until healed.
 Avoid contact with other people's wounds or bandages.
 Avoid sharing personal items such as towels or razors.

From:   http://abcnews.go.com/GMA/OnCall/story?id=1672872&page=1

Antibiotic resistant bugs found after use: study

Canadian Press, Feb. 9 2007

TORONTO -- Taking a single course of a certain type of antibiotics gives rise to high levels of antibiotic resistant bacteria in the mouth, an effect that lasts for at least half a year, a new study has found.

The extraordinary persistence of the effect startled the scientists who discovered it and others in the field as well - and underscores the need for judicious use of these precious drugs, experts said.

Senior author Dr. Herman Goossens said he and his co-authors assumed that if they followed the subjects in their study for six months they would see the rates of resistant bacteria in their mouths return to normal levels. But that didn't happen.

"We were pretty staggered by these data," said Goossens, a microbiologist at the University of Antwerp, in Belgium. "We never expected this."

Goossens said the findings suggest that even after a single - and short - course of antibiotics, a person could spread resistant strains of bacteria to close contacts within a household or a hospital for months.

The findings, reported Thursday in the journal The Lancet, are a sharp reminder of the power of antibiotics, suggested Eric Brown, a biochemist at McMaster University in Hamilton.

"So a quick course of antibiotics and a half a year later, you're still carrying resistant organisms. That's a little bit terrifying," said Brown, whose laboratory is working on alternative ways to kill bacteria, because of the rising problem of antibiotic resistance.

It also suggests doctors treating patients for bacterial infections should carefully consider which antibiotics they prescribe if those patients have taken antibiotics within the past year - the period Goossens thinks it might take for resistance levels to subside to normal after antibiotic use.

"If you're a doc who's about to treat a patient who has been treated before, it should have an impact on the decisions you make about what to give that patient," Brown said.

The study, which was partially funded by drug maker Abbott Laboratories, is the first to definitively show that antibiotic use is the major factor in the emergence of antibiotic resistance, Goossens said.

It seems a bit like proving the known.

Plenty of research has shown that as antibiotic use rises in a population, the rate of antibiotic-resistant infections rises as well. Based on those findings, infection control experts have been campaigning for years to get doctors to cut back on antibiotic use out of a fear that resistance is threatening the continued efficacy of these important drugs.

But because those studies looked across populations, they couldn't rule out other factors that might have been involved and therefore could only draw a link between antibiotics and antibiotic resistance.

Proving antibiotic use causes antibiotic resistance requires studying individuals - and that's what Goossens and his colleagues did.

A group of 224 healthy volunteers were randomly selected to receive either azithromycin or clarithromycin - both drugs from the macrolides class of antibiotics - or a fake treatment. Neither the volunteers nor the researchers knew who received which.

The back of the mouth of each participant was swabbed at the start of the study and then at regular intervals after the subject had completed the course of antibiotics. The swabs were tested to determine whether the streptococci in the mouths were susceptible or resistant to the antibiotics.

Surprisingly, the researchers found that roughly 28 per cent of the streptococci in the mouths of all subjects were resistant from the start. But whereas that level didn't change for participants who received a placebo, the proportion of antibiotic-resistant bacteria in the mouths of treated participants spiked to about 90 per cent shortly after treatment.

At six weeks out, the resistant bugs still made up about 60 per cent of streptococci and at six months, 50 per cent.

Should people in this position become infected with streptococci - which cause respiratory and other ailments - those infections might not respond to antibiotics. Furthermore it's known that bacteria can pass along resistance to other types of bacteria, again making affected people more vulnerable to resistant infections.

"It . . . should serve as a wake-up call for individual prescribing physicians, nurse practitioners, midwives, dentists and others that inappropriate use of antibiotics does have consequences," said Dr. John Conly, former chair of the Canadian Committee on Antibiotic Resistance and head of the department of medicine at Foothills Medical Centre in Calgary.

And those consequences are felt at a variety of levels, said a commentary that accompanied the research.

"The key message is that antibiotic prescribing affects the patient, their environment and all the people that come into contact with that patient or with their environment," wrote Stephanie Dancer, of the department of microbiology at Glasgow's Southern General Hospital.

"Clearly we're overusing antibiotics," said Goossens. "We've done this for decades."

From:   ctv.ca/servlet/ArticleNews/story/CTVNews/20070209/antibiotic_resistant_070209/20070209?hub=Health

Antibiotics Can Cause Blood Sugar Swings

Infections are an ongoing risk for those with diabetes, bearing with it serious or life-threatening complications. Antibiotics, of course, have been the standard pharmacologic treatment for infections. So it was disconcerting when a recent Canadian study showed that one antibiotic, gatifloxacin (Tequin), has significant risk of hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) in both diabetics and non-diabetics.

Even before the study results were published in the March 30, 2006, issue of The New England Journal of Medicine, the Canadian government issued a warning to consumers that stated that people with diabetes should not use Tequin. Since then, the drug maker Bristol-Myers Squibb has returned the rights of the drug to a Japanese drug company, and Bristol-Myers Squibb stopped selling and manufacturing Tequin as of June of this year. I checked with my local pharmacy (CVS) and although the pharmacist there told me that he had received a bulletin about Tequin, it has not, as of this writing, been removed from the shelves... although, he said that apparently doctors had gotten the message and stopped writing prescriptions for Tequin because he could not remember the last time he filled a prescription.

WHAT ABOUT OTHER ANTIBIOTICS?

The good news is that very few antibiotics carry the same risk, due to differences in how they work, said David N. Juurlink, MD, PhD, one of the study's authors from the University of Toronto. His study did reveal that there was a slightly increased risk of hypoglycemia with levofloxacin (Levaquin), but no such risk was seen with moxifloxacin (Avelox), ciprofloxacin (Cipro) or certain cephalosporin antibiotics (such as cefuroxime).

Dr. Juurlink pointed out, though, that it's important to remember that infections themselves can cause swings in blood sugar, especially for diabetics. It's not always exclusively the drug.

John Mohr, PharmD, at the University of Texas Health Science Center at Houston Medical School, agrees. His own research suggests that the class of antibiotics known as fluoroquinolones (of which Tequin is one and Cipro, Levaquin and Avelox are others) have been more associated with glucose abnormalities than other classes of antibiotics.

DOSING AND KIDNEYS

Another aspect to be aware of in all of this, said Dr. Mohr, is the dosing issue as it relates to kidney function. For fluoroquinolones that are excreted through the kidneys, attention should be paid to the dose, especially for those patients that have impaired kidney function. Diabetics can have impaired kidney function... they may not be able to eliminate the drug properly... and they can be retaining too much of the drug, unless proper dosage reductions are done. In effect, this can create an overdose situation, he said, which could certainly produce adverse events, such as sugar swings.

Diabetics are not the only ones who have impaired kidney function, Dr. Mohr pointed out. Renal function declines with age, so age is a risk factor for these events as well.

SAFETY STRATEGIES

Dr. Mohr suggests that diabetics taking antibiotics should monitor their blood sugar more frequently than usual and be especially aware of symptoms indicating dysglycemia (a blood sugar imbalance). Diabetics are well aware of these, but since sugar imbalance can affect non-diabetics as well, I asked him to enumerate the symptoms.

What to watch for: Increased perspiration... heart palpitations... increased hunger and/or thirst... confusion.

If you experience these symptoms while on a fluoroquinolone, whether you have diabetes or not, you should seek medical care. If you experience sudden changes in mental status or confusion, you should go to an emergency room. However, increased thirst or hunger may not necessarily be due to the fluoroquinolone, and a follow up in your physician's office should suffice.

Be well, Carole Jackson Bottom Line's Daily Health News;  http: //www .bottomlinesecrets.com

Sources:

Relief at Your Fingertips;  Joan-Ellen Macredis, ND, LAc, MAc, uses acupressure in her practice in Stamford, Connecticut.
Antibiotics Can Cause Blood Sugar Swings:  David N. Juurlink, MD, PhD, assistant professor in the department of medicine at the University of Toronto.
John Mohr, PharmD, assistant professor of medicine-research at the University of Texas Health Science Center at Houston.