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(1) LOCAL APPROACHES TO COMBATING ANTIBIOTIC
RESISTANCE ARE DOOMED TO FAILURE
(2) FAMILY MEMBERS AND KISSING CONTACTS
AT
GREATER RISK OF MENINGITIS
(3) UNDERSTANDING WHY ANTIBIOTICS MAY
BE
OVER-PRESCRIBED FOR PATIENTS WITH SORE
THROATS
(4) VETS DEFEND THE USE OF ANTIBIOTICS
IN
ANIMAL HUSBANDRY
(5) THE USE OF ANTIMICROBIAL DRUGS IN
DEVELOPING
COUNTRIES MUST BE LIMITED TO AVOID
PRODUCING
UNTREATABLE DISEASES
(6) INJURY PREVENTION
RISKS OF USING WATER SLIDES "QUESTIONABLY
HIGH"
(1) LOCAL APPROACHES TO COMBATING
ANTIBIOTIC RESISTANCE ARE DOOMED TO
FAILURE
(Antimicrobial resistance: a major threat to public health)
http://www.bmj.com/cgi/content/full/317/7159/620
The Chief Medical Officers of the European Union are meeting in
Copenhagen next week to assess the strategies needed to prevent
and control the emergence and spread of anti-microbial resistant
micro-organisms. This week�s BMJ has a collection of
papers on
antibiotic resistance which explain how resistance develops, discuss
ways of reducing inappropriate prescribing and assess the changes
in practice and the surveillance systems needed to contain thismajor
and global threat to public health.
Richard Wise, professor of medical microbiology at Birmingham,
and colleagues say that the past decade has seen the progressive
intercontinental spread of methicillin resistant staphylococcus
aureus
and penicillin resistant Streptococcus pneumoniae with concerns
about increasing resistance of Salmonella typhi. Bacteria respect
no borders and concerted international action is needed.
The authors say that veterinary practice must change, that patients
must be educated not to expect antibiotics for every infection, that
clinical guidelines will be needed to control antibiotic prescribing
and
that more fundamental research will be required to understand the
levers that control antibiotic resistance.
Contact :
Professor Richard Wise, Professor in Clinical Microbiology,
Department of Microbiology, City Hospital Trust, Birmingham
Fax: +44 121 551 7763
r.wise{at}bham.ac.uk
(2) FAMILY MEMBERS AND KISSING CONTACTS
AT GREATER RISK OF MENINGITIS
(Which contacts of patients with meningococcal disease carry
the pathogenic strain of Neisseria meningitidis?
A population based study)
http://www.bmj.com/cgi/content/full/317/7159/621
Family members and kissing contacts of patients with meningococcal
disease (a form of meningitis) have a marked increased risk of carrying
the disease-causing organism and this justifies using chemoprophylaxis
(antibiotics to prevent the disease developing). But a study from
Norway in this week�s BMJ does not support the use of
chemoprophylaxis for less close contacts of the sick person.
Professor Bjorn-Erik Kristiansen from the University of Tromso and
colleagues studied the prevalence of virulent bacteria strains in 1535
primary contacts of 48 patients with meningococcal disease in Norway.
They found that family members and kissing contacts have a 12.4% risk
of carrying the organism compared to much lower levels of under 2%
in
less close contacts. The prevalence in the general population is 0.7%
where there is no disease outbreak.
To prevent the spread of meningococal infection, many countries give
antibiotics to "close contacts" to eradicate the disease causing strain
of
bacteria. This means chemoprophylaxis is often given to more contacts
than is needed, say the authors. They conclude that the benefits of
giving
chermoprophylaxis to less close contacts than family members and kissing
contacts may be marginal.
Contact:
Prof. Bjorn-Erik Kristiansen, Dept. Medical Microbiology, University
of
Tromso, Norway
Fax: +47 35 505 701
bjorneri{at}online.no
(3) UNDERSTANDING WHY ANTIBIOTICS MAY BE
OVER-PRESCRIBED FOR PATIENTS WITH SORE THROATS
(Understanding the culture of prescribing: qualitative
study of general practitioners� and patients� perceptions of
antibiotics for sore throats)
http://www.bmj.com/cgi/content/full/317/7159/637
General practitioners are increasingly prescribing antibiotics for patients
with sore throats in spite of growing clinical evidence that these
drugs
alleviate symptoms only slightly, if at all. The choice of treatment
is affected
by both the patient�s expectations and what the doctor perceives the
patient expects. Over-prescription of antibiotics is a major concern
as it has been correlated with the increasing prevalence of antibiotic-resistant
bacteria.
In this week�s BMJ, Dr Christopher Butler and colleagues
from the
University of Wales College of Medicine report the findings of a survey
which illustrates some of the cultural reasons why doctors prescribe
antibiotics or non-antibiotics, based on interviews with GPs and patients
in South Wales.
Dr Butler et al report that the prescribing decision is very much influenced
by the doctor-patient relationship, but that patient satisfaction was
not
necessarily related to receiving a prescription for antibiotics. Both
doctors
and patients emphasised the importance of educating patients about
the
appropriate use of antibiotics, and two thirds of patients gained satisfaction
from receiving information and reassurance from their GPs. Doctors
were
divided about the possible benefits of a national campaign to educate
the
public, but saw the value of educating patients individually.
Contact:
Dr Stephen Rollnick, Senior Lecturer in General Practice,
Department of General Practice, University of Wales College of Medicine,
Llanedeyrn Health Centre, Maelfa, Cardiff
fax : +44 1222 540129
genpract{at}cf.ac.uk
(4) VETS DEFEND THE USE OF ANTIBIOTICS IN ANIMAL
HUSBANDRY
(Anti-microbial resistance : a veterinary perspective)
http://www.bmj.com/cgi/content/full/317/7159/665
The use of antibiotics in the livestock industry is controversial. However,
in an
editorial in this week�s BMJ, the Director of the Moredun
Research Institute,
Dr Quentin McKellar argues that antimicrobials are an extremely valuable
resource in livestock production and their prudent use is beneficial.
Dr McKellar indicates that when antimicrobials are used to enhance performance
in food producing animals, they are administered at low, subtherapeutic
concentrations which are only minimally absorbed. Different antimicrobials
are used for humans and animals but there can be a risk of common resistance.
Prophylactic use of antibiotics is common in intensive farming to control
the
spread of infection. As these antibiotics are being used at higher,
therapeutic
dosages, Dr McKellar argues that prophylactic use is normally only
justified
if the spread of infection cannot be contained by vaccination, changes
in
management, or better hygiene.
Contact:
Dr Quentin McKellar, Moredun Research Institute, International Research
Centre, Pencuik, Midlothian
Fax : +44 131 445 6111
mckeq{at}mri.sari.ac.uk
(5) THE USE OF ANTIMICROBIAL DRUGS IN DEVELOPING
COUNTRIES MUST BE LIMITED TO AVOID PRODUCING
UNTREATABLE DISEASES
(Antimicrobial resistance in developing countries)
http://www.bmj.com/cgi/content/full/317/7159/647
Antibiotics are an important resource for the treatment of infectious
diseases, which cause 98% of child fatalities and the majority of overall
deaths in the developing world. As the most effective and newly-developed
drugs are expensive, many people turn to less expensive sources
of treatment, such as pharmacies or markets for prescriptions.
This overuse of unregulated antimicrobial drugs greatly contributes
to
the increase in antibiotic-resistant bacterial diseases.
In this week�s BMJ, Professor Hart from the University
of Liverpool
and Dr Kariuki of the Kenya Medical Research Institute review the
progress of antibacterial resistance in diseases including pneumococcal
meningitis, tuberculosis and typhoid fever. They conclude that there
must be improved surveillance of resistance, better regulation of
antimicrobial drugs to increase their usefulness, and better education
of medical personnel, veterinarians and the public to encourage more
appropriate use of these drugs. The authors also suggest that improving
laboratory infrastructure would be a long-term solution to facilitate
surveillance of resistance trends as an early-warning system for public
health.
Contact:
Professor Hart, Department of Medical Microbiology and Genitourinary
Medicine, University of Liverpool, Liverpool
fax:+44 151-706-5805
cahmm{at}liv.ac.uk
Risks of using water slides �questionably high�
[Some observations on waterside injuries]
http://www.bmj.com/cgi/content/full/317/7159/617
Despite a battery of safety features, water slides which rely on traffic
light
systems can be �inherently unsafe,� suggests a study in Injury Prevention.
There are around 300 such facilities at swimming pools and leisure
complexes in the UK.
An investigation was prompted by an incident in which an adult collided
with a teenager while descending a waterside flume at a community
swimming pool. The teenager sustained bruising and a broken arm.
Ten other actual or near collisions had been reported in the preceding
three months at the same pool, a figure the author suspects to be an
underestimate of the true numbers.
The author assessed the descent of 250 people down the flume during
relatively busy periods. All of them followed instructions. He
found
that anyone taking 15 to 20 seconds plus to descend would be at
risk of being struck from behind, despite the inbuilt safety system
of the traffic light. Slow descents might very well be engineered
by
the less able and timid, says the author. On the basis of his
observations
about 1 per cent of descents fall into this category.
This level of risk far surpasses even the accident rate from contact
sports,
says the author. The design does not take into account that the
flumes are
used by the general public, some of whom might not be the most
fit
and resilient, and leaves the operators vulnerable to legal accusations
of
failure in their duty of care, he concludes.
Discussions with poolside attendants showed that they preferred to rely
on the closed circuit TV system rather than the traffic lights.
Senior management firmly believed in the safety of the design and that
any
accidents were attributable to failure to follow instructions.
A statement from the manufacturer indicated that the system was entirely
safe and could never lead to collisions.
Contact: Professor David Ball, School of Health, Biological and
Environmental Sciences, Middlesex University, London.
david.ball{at}paston.co.uk
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Please remember to credit the BMJ as source when publicising an article
and to inform your readers that they can read its full text on the
journal's web site (http://www.bmj.com).