Antibiotic resistance is always a major problem.

You find a medicine that kills 99.9% of the germs. Eventually that one germ that didn’t die starts multiplying (usually in a patient whose own immune system can’t get rid of the last little germ) and soon you have a bacteria that the drug won’t kill.

Many of the germs that kill people become resistant, and so doctors have to scramble around a to find a new antibiotic.

One of the main ways these germs get resistant is giving antibiotics to minor infections, such as colds.

Such resistance has occured with a lot of “gram negative” organisms that cause infections to the urinary tract and in people whose immune systems are weakened (i.e. the old, diabetics, malnutrition, HIV, or who have other chronic diseases). And resistance to treatment also is a problem in the third world, with the dysentery/typhoid germs (Salmonella/Shigella), Tuberculosis, HIV, and Malaria germs needing newer and more expensive medicines.

The latest “scare” headline on this is the emergence of MRSA, the stapholococcus germ that usually causes boils, has become resistant, and headlines today note that 19,000 patients died last year from infections caused by that germ.

This isn’t the first time this germ has evolved to cause problems. When I began my medical training in the 1960’s, we had epidemics of penicillin resistant staph. Back then, people with such infections were isolated, and hand washing basins were placed in the hallways to stop the spread.

Then Methicillin and other antibiotics were invented that worked, and the problem went away…

But when I worked in Northern Minnesota in the late 1990’s, we started seeing it again.

Our patients came back from the Twin Cities after open heart or vascular surgery and the wounds would get infected. Usually we treated them with vigorous local cleaning and ointments, and changed antibiotics depending on our lab tests. These people weren’t that sick, so a two or three day wait for the lab to let us know what worked wasn’t critical.

But then we started seeing young people with boils or impetigo that wouldn’t go away with Cephalexin. They were all from a small isolated clinic run in an area with many Native American patients who often had extended families living in the same household. And indeed, when we checked, most of the patients were related to people who had had the heart surgery. We cleared up much of that problem by the local public health nurse making home visits and teaching family in wound care.

Then we got an influenza out break. A twelve year old was so sick with post influenza pneumonia that we shipped her to the Twin Cities…and it’s good we did, because although she survived, she had MRSA (resistant Staph germ) and needed to go on a respirator to save her life.

You see, although usually the Staph germ causes skin infections and abcesses, it can also cause pneumonia or spread all through the body (septicemia) in a sick person.

But in most people it sits on the skin, not causing problems, and when the “carrier” is a doctor or nurse, you can see the problem. Yes, cleaning your hands prevents the spread. But if you wash you hand 80 times a day, you end up with severe dry cracked skin on your hands (aka “dishpan hands”). Gloves help too. And the newer less drying “skin cleansers” which are alcohol based helps.

But the Staph germ also hides inside the tip of the nose. So if you have an outbreak, you need to check here. If you find it, you have to use a local ointment three times a day to get rid of it.

But MRSA is a problem, but there are still antibiotics that work..,for now.

Alas, lurking in the wings is a newer one: VRSA. Vancomycin resistant Staph, or multiple antibiotic resistant staph.

Vancomycin is the big gun for MRSA…if it stops working, you are in trouble…

But Staph is not the only germ developing resistance that we doctors worry about.

For years, the Strep Pneumonia germ, that causes pneumonia in all ages and ear infections in kids, has gotten more and more resistant to Penicillin.

This has been a problem for years in Africa, where penicillin shots were used to treat everything, and in some areas were so popular that even the traditional healers gave the shots along with their herbs

Then the problem spread to Europe. In the US, the problem was mild, and you could treat these infections by merely doubling the dosage of Amoxicillin or using another antibiotic.

But doctors were worried about what could happen, so they went back to the days before Penicillin, and revived the Pneumonia shot.

This is why your doctor told you to get that Pneumonia shot: the shot protects you against some of the stronger strains of this germ. But the original Pneumonia shot didn’t work in kids, but scientists figured a way to make it work, so now we give a different pneumonia shot to kids under age two.

In kids, for years we saw ear infections that went on to meningitis and destroyed middle ears. Well, between the “HIB” shot against Haemophilus Influenza germ, and the new Pneumonia shot, doctors stopped worrying about it. Whereas when I started medicine, most docs did spinal taps on kids. I used to do a lot, but nowadays I just call in the Pediatrician to do the procedure, since I don’t do enough to keep in practice.

But now there is a report about the Strep Pneumonia germ resistance causing problems with ear infections. The infections didn’t go away, so the docs went back to doing an old treatment that predates my time in medical school: cutting a tiny hole into the ear drum to let the pus out. This prevents the infection from eating inward to cause damage (mastoiditis, meningitis/brain fever) or having the infection make a big hole in the ear drum, meaning it has to be fixed with surgery.

The usual antibiotics, even in higher doses, don’t work, and for some of these kids, the only antibiotic that works are the “floxin” type antibiotics (quinolones) that are not supposed to be used in kids because the drug can cause an arthritis of the bone/cartilege of the large joints. But better a bad joint than being deaf or dead…
And what is more worrysome is that this Strep Pneumonia germ causes a very nasty pneumonia, one that killed young healthy people in the days before penicillin.

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Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket, and she writes essays on medicine to HeyDoc Xanga blog

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