(Oliver van Hecke) GPs in the UK carry out over 300m patient consultations every year and at least a quarter of these deal with children. Almost two-thirds of such appointments are for coughs, sore throats, or earaches – illnesses which young children commonly get. Related Real, Safe, and Trusted Detox Products — Now That You’ve Seen the Bad, […]
(Lisa Egan) As public health organizations issue dire warnings about the rising threat of antibiotic-resistant superbugs, a surprising hero may rush in just in time to save the day. A new study has found that cannabidiol (commonly known as CBD) is remarkably effective at killing a wide range of Gram-positive bacteria.
Taking antibiotics for kidney stones is probably a bad idea. A review of almost 300,000 patient records from the United Kingdom (UK) revealed higher rates of kidney stones in people who took 5 categories of oral antibiotics, including broad-spectrum penicillins and fluoroquinolones, which include Cipro. 
Broad-spectrum penicillins are antibiotics containing both penicillin and another active ingredient.
The study doesn’t prove that antibiotics cause kidney stones, but that would be a logical assumption to make based on previously-published studies. The findings of the review were concerning enough that pediatric urologist Gregory E. Tasian said that he would consider looking for alternatives to the antibiotics shown to cause kidney stones whenever feasible.
“These findings just add weight to the large body of evidence that antibiotics should be prescribed for appropriate reasons and used judiciously.” 
In as many as one-third of cases, antibiotics are prescribed for conditions the drugs can’t treat, such as a virus. This, in addition to potentially upping the risk of kidney stones, is a known contributor to drug resistance and superbugs.
In the study, researchers reviewed the records of patients who developed kidney stones at least 3 months after taking antibiotics. Since stones can take weeks to months to develop, the researchers excluded any patients who might have developed them for other reasons.
The strongest link between antibiotics and kidney stones was found in sulfa drugs, including Bactrim. Patients who took sulfa antibiotics were more than twice as likely to develop kidney stones within 3-12 months after finishing a course of the drugs compared to people who hadn’t taken the medicines.
A slightly weaker link was found between kidney stones and 4 other categories of antibiotics:
Fluoroquinolones (Cipro, Flagyl)
Nitrofurantoin (sold as Macrobid)
The risks were especially high for children younger than 18. 
Patients who took broad-spectrum penicillins were found to be 30% more likely to develop kidney stones within 3-12 months of finishing the medicines than those who did not take the antibiotics. No link was found between regular penicillin and antibiotics. 
According to Joshua M. Stern, a New York urologist who was not part of the study, the relationship between the five categories of antibiotics and kidney stones is a complicated one; but it’s likely that antibiotics disrupt the microbiome in such a way that it creates an ideal environment for the formation of stones.
“This study really shows at a large scale that antibiotics are associated with increased kidney stone risk.” 
The findings remained consistent even when the study subjects were taking other medications or suffered from other conditions that might predispose them to kidney stones, according to Tasian.
Apart from the pain that kidney stones can cause, there are other risks involved with them, too, including a higher risk of high blood pressure, decreased bone density, and heart disease. Tasian called for more research to determine whether those disorders are also associated with antibiotic use.
Fortunately, the microbiome does a pretty good job of protecting and regenerating itself. In the study, the risk of kidney stones did decline somewhat over time, suggesting that the patients’ internal bacteria had started to recover.
Remember: Don’t take antibiotics for kidney stones!
A class of antibiotics called fluoroquinolones has been associated with numerous serious side effects over the years, so it’s not uncommon to see the U.S. Food and Drug Administration (FDA) issue new warnings about more complications of taking the medications. On December 20, the agency yet again warned about a new threat associated with fluoroquinolone antibiotics.
Fluoroquinolones – which includes the drugs ciprofloxacin (Cipro or Cipro XR), metronidazole (Flagyl, Flagyl ER), and levofloxacin (Levaquin) – increase the risk of heart vessel tears, according to the FDA. Often used to treat upper respiratory infections, fluoroquinolone antibiotics have been commonly prescribed for at least 30 years.
In a statement, the agency said:
“These tears, called aortic dissections, or ruptures of an aortic aneurysm, can lead to dangerous bleeding or death.”
The antibiotics pose a risk of aortic dissection whether given in injection or pillform and “should not be used in patients at increased risk unless there are no other treatment options available.”
Those at increased risk include people with a history of blockages or aneurysms of the aorta or other blood vessels, those with high blood pressure, patients with certain genetic disorders involving blood vessel changes, and the elderly, the FDA said.
Before taking an antibiotic, patients should notify their doctor if they’ve been diagnosed with:
Hardening of the arteries (atherosclerosis)
High blood pressure
Genetic conditions, such as Marfan syndrome and Ehlers-Danlos syndrome
People already taking fluoroquinolones shouldn’t stop taking the antibiotics without first talking to their doctor.
Dr. Satjit Bhusri, a cardiologist at Lenox Hill Hospital in New York City, said:
“Antibiotics, when used appropriately, save lives. With this new warning from the FDA regarding increased risk of aortic rupture, caution should be given to those at risk. Screening by a cardiologist prior to starting these antibiotics is the best prevention. An ultrasound of the heart and aorta is a simple, non-invasive, and life-saving tool.”
The FDA said that anyone who experiences the symptoms of an aortic aneurysm while taking fluoroquinolone antibiotics should seek immediate medical attention. Those symptoms may not appear until it’s almost too late, however.
“Patients should seek medical attention immediately by going to an emergency room or calling 911 if you experience sudden, severe, and constant pain in the stomach, chest, or back. Beware that symptoms of an aortic aneurysm often do not show up until the aneurysm becomes large or bursts, so report any unusual side effects from taking fluoroquinolones to your healthcare professional immediately.”
FDA Commissioner Scott Gottlieb said the risk ofaortic aneurysm or dissection is low, but the agency “observed” that people taking fluoroquinolones are twice as likely to experience either complication. 
“For patients who have aortic aneurysm or are known to be at risk of an aortic aneurysm, we do not believe the benefits outweigh this risk, and alternative treatment should be considered.”
The FDA said it has not identified the reason for this increased risk.
One of the top causes of antibiotic resistance is the use of the medicines in livestock. Many factory farms feed animals antibiotics to prevent disease and promote growth. Yet, despite countless warnings that the practice fuels drug-resistant superbugs, it continues to be a serious problem. Thankfully, establishments such as McDonald’s claims to finally be taking more action against widespread antibiotic use.
In December, McDonald’s took its efforts to reduce the use of medically-important antibiotics in livestock to the next level when the company announced plans to reduce the use of antibiotics in cows that are part of the fast-food company’s global beef supply.
Bruce Feinberg, a senior director at McDonald’s Corp., who oversees global quality systems for protein and dairy products, called the plan “probably the most ambitious project that McDonald’s has ever taken on.”
McDonald’s said it will measure antibiotic use in its top 10 beef markets, including the U.S., Brazil, and New Zealand. The company will then set targets for reduction by the end of 2020. It will start reporting its progress in meeting those targets in 2022.  
Environmentalists are more than happy to see McDonald’s taking action against the overuse of antibiotics in farm animals. 
In a statement, Lena Brook, interim director of food and agriculture at the Natural Resources Defense Council (NRDC), wrote:
“McDonald’s is the first major burger chain to announce a comprehensive antibiotic use reduction policy for all beef sold by its restaurants – and the largest, by far.”
According to the NRDC, some 40% of medically-important antibiotics sold in the livestock sector in the U.S. are used in the beef industry. By comparison, just 6% goes to the poultry industry. That, the NRDC says, is why “addressing overuse in beef production is critical to combat drug resistance.”
It’s tougher to remove medically-important antibiotics from livestock than it is to remove them from poultry because cattle live longer than chickens and have more chances to fall ill. 
Bob Smith, an Oklahoma-based cattle veterinarian for Veterinary Research and Consulting Services, explained that cattle farmers face unique challenges in reducing antibiotic use while also keeping their animals healthy, as there are few good alternatives to the medicines.
“We will need those medically important antibiotics in meat production for a long, long time. We want to use those wisely.”
But someone has to get the ball rolling, and it might as well be a monstrosity of a company like McDonald’s.
Keith Kenny, McDonald’s global vice president for sustainability, said in a statement: 
“McDonald’s believes antibiotic-resistance is a critical public health issue and we take seriously our unique position to use our scale for good to continue to address this challenge.”
In October, McDonald’s received a failing grade in the Chain Action Report. Produced by the Center for Food Safety (CFS), Consumer Reports (CR), Food Animal Concerns Trust (FACT), U.S. PIRG Education Fund (USPEF), Friends of the Earth (FOE), and NRDC. The report rated the top 25 fast-food chains’ antibiotic policies.
USPEF, who has been pressuring McDonald’s to phase routine antibiotic use out of its meat supply for more than 3 years, applauded the fast-food chain’s commitment.
Matthew Wellington, the consumer group’s antibiotics program director, remarked:
“The Golden Arches just raised the bar for responsible antibiotic use in meat production. McDonald’s new commitment is a promising step forward that will help preserve antibiotics for the future and that’s something we should all be happy about.”
As the biggest beef buyer to pledge to reduce antibiotic use in cattle, McDonald’s could set a new benchmark for livestock producers and other fast-food chains alike. 
David Wallinga, a senior health adviser for the NRDC, said:
“McDonald’s iconic position and the fact that they’re the largest single global purchaser of beef make it hugely important.”
While McDonald’s is in no way a healthy place to eat, the chain has been making strides in recent years to make their food a bit less … er, toxic? In addition to banning antibiotics in its chicken supply, the company said in 2014 that it would not be sourcing genetically modified (GM) Simplot potatoes, which are engineered to brown slower and bruise less easily than non-GMO potatoes.
Then, in 2015, McDonald’s said it would replace the high-fructose corn syrup in their hamburger buns with regular sugar, and ditch preservatives in its McNuggets, pork sausage patties, omelet-style eggs, and scrambled eggs.
In this age of antibiotic resistance, researchers and health experts are warning that doctors need to prescribe significantly fewer antibiotics to prevent an antimicrobial-resistance crisis that could plunge modern medicine back into the Dark Ages. But a new study shows that almost half of all antibiotics are prescribed without an infection-related diagnosis.
Researchers analyzed more than 500,000 antibiotic prescriptions and found that nearly half were written without an infection-related diagnosis, and 20% were given without an office visit – usually over the phone. The authors can’t be certain of how many of the medications were inappropriately prescribed, however.
In looking at patient records, Dr. Jeffrey Linder, of Northwestern University’s Feinberg School of Medicine in Chicago, and his team found that part of the problem could be a result of “bad coding,” referring to the system doctors use to record diagnoses.
Years ago, I worked in medical coding. There is not always a specific code to accompany a specific diagnosis, so doctors and coders alike often have to find a code that is most like a diagnosis. It’s possible, then, that the wrong codes are sometimes chosen.
But even if diagnostic codes are a part of the problem, Linder said the findings are still concerning. They suggest that many doctors prescribe antibiotics not to treat an established infection, but because they assume patients want them, he explained.
Antibiotic resistance commonly makes news headlines, yet many people still don’t understand that antibiotics are only effective at treating bacterial infections. They don’t work against the common cold and other viruses. When people use these medications inappropriately, bacteria are exposed to the antibiotics and it gives them a chance to mutate and become resistant.
Rampant Outpatient Overprescribing
Linder and his colleagues looked at 510,000 antibiotic prescriptions written at 514 medical clinics over 2 years. Prescribers included doctors, nurse practitioners, and physician assistants in primary care and specialties such as gastroenterology and dermatology.
Overall, no documented diagnosis of an infection accompanied 46% of the antibiotic prescriptions the team analyzed.
Another diagnosis, such as hypertension, was documented in 29% of cases.
17% of prescriptions lacked a diagnosis altogether.
Additionally, 1 in 5 prescriptions was made without an in-person visit.
Linder explained: 
“We found that nearly half the time, clinicians have either a bad reason for prescribing antibiotics or don’t provide a reason at all. When you consider about 80% of antibiotics are prescribed on an outpatient basis, that’s a concern.”
It is OK, sometimes, to prescribe an antibiotic by phone, Linder said. He gave the example of a woman with a history of recurrent urinary tract infections (UTI) who calls her physician to report that her symptoms have returned. In a case such as this, it may be “perfectly appropriate” to just call in an antibiotic without seeing the patient, according to Linder. 
It is also acceptable to prescribe antibiotic refills for someone with acne, but in most cases, the patient should be seen by his or her physician in the office before a prescription is given, Linder advised.
Dr. Ebbing Lautenbach, chief of the infectious diseases division at the University of Pennsylvania, said that patients should feel free to ask questions when they are prescribed an antibiotic.
“Sometimes an antibiotic is an appropriate choice, and sometimes it’s not. Providers should explain, ‘Here’s why I think an antibiotic is necessary.’ And there should be a discussion of the pros and cons of taking one.”
Why are antibiotics doled out so often?
There are multiple reasons why a doctor might prescribe an antibiotic without a solid diagnosis of a bacterial infection. Pleasing the patient is one. Patients sometimes demand antibiotics. In other cases, a doctor might be strapped for time, so it’s easier to just hand out a script.
Linder said: 
“Despite 40 years of randomized controlled trials showing antibiotics don’t help for most coughs and sinus infections, many people are convinced they will not get better without an antibiotic and specifically call the doctor requesting one.
At busy clinics, sadly the most efficient thing to do is just call in an antibiotic prescription. We need to dig into the data more, but we believe there is a lot of antibiotic prescribing for colds, the flu, and non-specific symptoms such as just not feeling well, none of which are helped by antibiotics.”
But in most cases, according to the researcher, “the problem is the doctor’s perception that patients want antibiotics.” 
Linder said patients need to take a more proactive role when it comes to medications.
“You can tell your doctor that you only want an antibiotic if it’s really necessary. That will automatically shift the doctor’s default position on it.”
The study was presented at ID Week 2018 in San Francisco. The findings are considered preliminary until they are published in a peer-reviewed journal.
If you’ve ever been through the discomfort of having your appendix surgically removed, just think: It might have all been for naught. Finnish researchers involved in a new clinical trial report that antibiotics are plenty effective at treating acute appendicitis most of the time.
The overwhelming majority of appendicitis cases are cut-and-dry. The organ hasn’t ruptured and there is no risk of infection. These uncomplicated cases can be remedied with antibiotics, and patients need only go under the knife if it looks like the appendix is getting ready to burst, according to lead researcher Dr. Paulina Salminen, a surgeon at Turku University Hospital.
“There are no severe complications associated with the antibiotic therapy, so it’s a safe option.”
About 20-30% of people with appendicitis walk through the doors of the emergency room with an appendix that is about to burst, so that means 70-80% of appendicitis patients can be treated with antibiotics.
When an appendix is perforated, however, the contents can leak out into the stomach, causing a life-threatening blood infection.
For the research, Salminen and her colleagues compared 273 patients who had an appendectomy with 257 patients treated with antibiotics. The researchers found thatapproximately 60% of those treated with antibiotics didn’t need to have an appendectomy in the 5 years after treatment.
Just 100 of the 257 patients treated with antibiotics had to have an appendectomy over the 5-year study period, including 15 patients operated on during the initial hospitalization, the study found. Of those, 70 experienced their recurrent appendicitis within 1 year of the first episode.  
The study only looked at open appendectomy, not the less invasive laparoscopic procedure. Laparoscopic appendectomy is associated with a faster recovery time and fewer complications.
Certain subgroups of patients may fare better having surgery than being treated with antibiotics, such as patients with appendicolith, in which the appendix is obstructed with calcified deposits. However, these patients were excluded from the study. 
The authors wrote: 
“Nearly 2/3 of all patients who initially presented with uncomplicated appendicitis were successfully treated with antibiotics alone and those who ultimately developed recurrent disease did not experience any adverse outcomes related to the delay in appendectomy.
These findings demonstrate the feasibility of treating appendicitis with antibiotics and without surgery.”
By comparison, 1 in 4 of those who underwent surgery experienced complications, including infections around the incision, and abdominal pain and hernias. Just 7% of patients treated with antibiotics had complications. 
“It’s a feasible, viable, and safe option.”
An editorial accompanying the study in JAMA proclaims that “it’s a new era of appendicitis treatment.”
Appendicitis patients treated with antibiotics face about a 40% chance of needing surgery anyway. But the idea of avoiding pain, anesthesia, scars, and all of the other unpleasantries associated with going under the knife could, for many people, make it a risk worth taking.
After all, if the worst case is ending up back in the hospital, why not try a simpler solution first?
The term “superbug” refers to bacteria that have become resistant to the antibiotics normally used to get rid of them. Now, a new study suggests that the term is more fitting than scientists previously realized. It turns out that these infectious bacteria stealthily “hibernate” during antibiotic treatment, which further prevents the medications from killing the bugs. 
Almost all infectious bacteria develop some antibiotic-resistant traits, so a substantial fraction of bacteria survive a course of antibiotics. But a small number of bacteria, including some of the world’s most dangerous pathogens, can resist antibiotics without needing these traits.
A small portion of pathogenic bacteria can survive a course of antibiotics by lying dormant until the danger passes. They simply hibernate, according to researchers from the University of Copenhagen. Once a person finishes taking their medication, these bacteria “wake up” and go back to being nasty, disease-causing bugs.
Professor Kenn Gerdes of the University of Copenhagen’s Department of Biology said:
“We studied E. coli bacteria from urinary tract infections that had been treated with antibiotics and were supposedly under control. In time, the bacteria re-awoke and began to spread once again.”
Antibiotics typically work by targeting a bacteria cell’s ability to grow, which means that a hibernating bacterium remains untouched by the drugs. It is not technically resistant.
“It is temporarily tolerant because it stops growing, which allows it to survive the effects of an antibiotic.”
It’s still a mystery why some bacteria go into a dormant stage while others don’t, considering hibernating bacteria share the same genetic characteristics as other bacteria in a given population.
“Antibiotics are usually directed at the bacterial growth processes. Genetically, these bacteria have all the same features of the other bacteria in the population. It is rare and affects only 1 in 10,000 to 1 million cells. That makes it hard to investigate.” 
The researchers found that an enzyme in dormant bacteria is responsible for putting bacteria into a dormant state, which allows them to avoid being attacked. But right now it’s anyone’s guess as to why this enzyme gets triggered in the rare bacterium. 
“The discovery of this enzyme is a good foundation for the future development of a substance capable of combatting dormant bacteria cells.”
Much more research – and funding – is needed to understand why some bacteria become dormant, but it will hopefully lead to more effective antibiotics in the future.
“The enzyme triggers a ‘survival program’ that almost all disease-causing bacteria deploy to survive in the wild and resist antibiotics in the body. Developing an antibiotic that targets this general program would be a major advance.”
The U.S. Centers for Disease Control (CDC) said earlier this year that more than 200 rare “nightmare” antibiotic-resistant genes were found during testing in 2017.
Dr. Anne Schuchat, principal deputy director of the CDC, expressed shock at the findings, saying:
“I was surprised by the numbers we found. Two million Americans get infections from antibiotic resistance, and 23,000 die from those infections each year.”
The authors write in the report that the bacteria haven’t spread widely, but they found a variety of resistant germs in every state.
The agency tested for 2 of the most well-known superbugs: carbapenem-resistant Enterobacteriaceae (CRE), and carbapenem-resistant Pseudomonas aeruginosa (CRPA) bacteria. 
What the CDC Testing Found
The CDC tested 5,776 isolates of antibiotic-resistant germs from hospitals and nursing homes and discovered that about 1 in 4 had a gene that helped spread its resistance, while 221 bacteria contained “an especially rare resistance gene,” according to Schuchat.
Follow-up screening revealed that nearly 1 in every 10 contacts also tested positive. Those individuals had “silent” infections. Schuchat explained this means that “the unusual resistance has spread to other patients and could have continued spreading if left undetected.” It’s anyone’s guess as to how frequently asymptomatic patients spread the disease to uninfected people.  
The rare genes were discovered in isolates gathered in 27 states from infection samples, including pneumonia, bloodstream infections, and urinary tract infections (UTIs). 
Doctors and scientists are working to halt the spread of antibiotic-resistant superbugs before they even start, comparing them to a rapidly-consuming wildfire that’s difficult to bring under control. 
As part of the effort, the CDC recently established the Antibiotic Resistance Laboratory Network (ARLN), which consists of labs across the country that test patients’ samples for highly resistant-bacteria and track antibiotic-resistant bugs as they pop up.
Fortunately, Schuchat said, the CDC’s aggressive strategy to identify, track, and contain the germs has been largely successful and appears to have stopped their spread.
The agency’s strategy involves rapidly identifying superbugs at facilities, assessing those facilities for gaps in infection control, screening other patients to identify any “silent” carriers, and continuing these steps until they can put on lock on further transmission of the germs.
A mathematical model utilized by the scientists shows that implementing this strategy could prevent as many as 1,600 new CRE infections in 3 years. That’s a 76% drop in cases.
“We need to do more, and we need to do it faster and earlier with each new antibiotic-resistance threat.”