From: firstname.lastname@example.org(Steven B. Harris)
Subject: The *Really* Dangerous Drugs in Mexico: OTC Antibiotics (was:
Date: 29 May 1997
In <email@example.com> firstname.lastname@example.org
(Jonathan Fox) writes:
>Brother John (email@example.com) wrote:
>>But take heart. As the United States continues its slide toward a Third
>>World economy and culture, doctors will eventually be parted from their
>>most precious power: the power to prescribe. We won't be able to afford
>>a doctor visit for every ache and sniffle. And pharmacists will once
>>again be the first resort of sick people.
>Great. Then we can revert to the system Mexico has, where you can call up
>your friendly neighborhood pharmacist, say you have had a cough for a few
>months, and he will be happy to give you one antituberculous drug. Since
>the standard of care for active tuberculosis is to start on at least FOUR
>antituberculous drugs, they are just doing their part to help breed as
>much antibiotic resistance as they can, while, naturally, many of their
>immigrants bring it up to the U.S. where our Centers for Disease Control
>can have a ball trying to track and quell the resistance.
>Jonathan R. Fox School of Medicine
>firstname.lastname@example.org University of California, Davis
Yep. The legal drugs in Mexico are by far a greater threat to the
U.S. and its way of life than the illegal ones. Our brilliant congress
has yet to figure this out. Are we pressuring Mexico about OTC
antibiotics? Dream on. Does our surgeon general say anything about
this? Are you kidding?
The truth is, however, that it's a hellavalot easier for your kids
to just say "no" to cocaine, than it will be for them to just say no to
multidrug resistant Pneumococcus, Staph aureus and T.B. Unfortunately,
by the time this becomes apparent, it will largely be too late.
Steve Harris, M.D.
From: email@example.com (Jonathan R. Fox)
Subject: Re: question about antibiotic resistance
Date: Tue, 20 Oct 1998 23:16:45 GMT
On Tue, 20 Oct 1998 18:00:02 GMT, firstname.lastname@example.org wrote:
>I recently took my son to the doctor and listened to the doctor's
>now-standard spiel about how he doesn't like to prescribe antibiotics, but in
>this case... The implication was that he was being browbeaten into doing it,
>though I had not in fact said a word.
>Is it true, as we hear on the news, that overprescription of antibiotics to
>pushy and insistent patients is the cause of the emergence of
>antibiotic-resistant strains? I read a book a while back that described how
>antiobiotics are available without prescription in other parts of the world,
>which sounds like a more significant factor to me.
As far as I know, no one has really proven who is to blame, if anyone
in particular. We like to point fingers at community practitioners
who prescribe useless antibiotics for viral infections, veterinarians
who supplement animals' food with antibiotics, and hospitalists who
overdo broad-spectrum coverage for immunocompromised patients. All of
them may have their part.
Differences in resistance patterns of Streptococcus pneumoniae, a
common cause of ear infections, sinusitis, and pneumonia, in the
United States compared to certain Scandinavian countries is quite
profound, being much higher in the U.S. In some of these Scandinavian
countries, routine care for ear infections is pain medications and
decongestants, withholding antibiotics at first. Over 50% of ear
infections will indeed spontaneously resolve without antibiotics,
although the discomfort is prolonged and the risk of complications is
greater. The difference in resistance patterns, though, would imply
that outpatient use of antibiotics has something to do with S.
pneumoniae resistance patterns. The Scandinavians may be on to
something here, although in the United States few physicians would
risk the lawsuit that would arise should he or she withhold
antibiotics and the patient suffer a suppurative complication of an
It seems that methicillin-resistant Staphylococcus aureus (MRSA) and
vancomycin-resistant Enterococcus (VRE) were bred in hospitals. This
is not to imply negligence on the part of hospitalists -- one has to
balance the risk of emerging antibiotic resistance with the benefit of
properly treating bacterial infections. Since bacterial infections
will always happen, resistance will eventually arise even with the
most prudent use of antibiotics. The problem is now that MRSA and VRE
have spread into the community. I have seen several cases of
previously healthy children who have never been hospitalized before
come down with MRSA pneumonia. This is quite frightening, because we
have essentially one drug to treat MRSA infection, which is
vancomycin. Even more frightening is that strains of
vancomycin-resistant Staph. aureus have been discovered.
What can we do? Efforts are widespread to combat emerging resistance
in both the outpatient and inpatient settings. Education is the key
to controlling overuse of antibiotics in the outpatient setting.
There are still some old-timers who give antibiotics for colds and
poorly educated practitioners who doubt their ability to differentiate
viral from bacterial infections, erring on the side of giving rather
than withholding antibiotics. Furthermore, patients need to be aware
of this problem and not expect antibiotics for any febrile illness.
In the inpatient setting, some hospitals have developed or are
developing committees that oversee the use of antibiotics, restricting
certain ones unless approval is obtained.
Hopefully infection control practices and the development of new
antibiotics will keep us one step ahead of returning to the
pre-antibiotic era. But we need a unified concerted effort.
Jonathan R. Fox, M.D.
From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Subject: Re: MMR--Panorama Tv transcript
Date: Wed, 13 Mar 2002 16:30:15 -0700
"Carol T" <email@example.com> wrote in message
> > So you end up with less than 1/1000th of the concentration.
> It doesn't matter to a few feverously multiplying bacteria cells how
> much is going in, as long as they are getting the information they need
> to become stronger.
A common misconception. Antibiotic-resistant bacteria aren't "stronger".
They're just resistant to that particular antibiotic. In all other respects
they're weaker, because they're partly expending energy on whatever it is
they need to do to protect themselves from the antibiotic (there are a whole
raft of mechanisms, but they all take energy).
Left to themselves with no antibiotic around, resistant bacteria lose their
resistance over time. Why? It's adaptive. If it wasn't so, all bacteria
would have long ago become resistant to all natural antibiotics, long before
humans discovered how to use any of them.
> It's also enticing bacteria that it would normally kill to utilise its
> defence information so that they can wreak havoc at a later time, and it's
> doing this at the time a child is also given major live viruses to fight.
Wreaking hovoc? Sorry, the worst neomycin is going to do (even in much
larger doses than this, and for much longer) is breed neomycin-resistant
bacteria. Which would mean the child might be resistant to one of the three
antibiotics in triple antibiotic salve, when next he cuts his widdle pinkie.
Which is the only place he'll ever see that antibiotic again. I doubt that
havoc will ensue.
From: firstname.lastname@example.org (Steve Harris sbharris@ROMAN9.netcom.com)
Subject: Re: Social and Medicinal Parallelz...
Date: 10 Dec 2003 14:38:51 -0800
email@example.com wrote in message
> *********************** exzerpt ***********************************
> Overuse of antibiotics during the past half-century has allowed
> mutant germs to survive and thrive, giving rise to increasingly
> virulent and pathogenic bacteria that no longer respond to traditional
> antibiotic therapy.
Use of antibiotics results in more antibiotic resistant strains of
bacteria, true enough, but it's a complete myth that these are any
more intrinsically virulent or pathogenic than the non-resistant
bacteria, in a non-antibiotic containing environment. If anything,
they are intrinsically weaker, since they spend time and energy on
matters having to do with antibiotic defense, which non-resistant bugs
don't. That's WHY all bacteria aren't resistant to all natural
The worst that happens if bacteria become resistant to all antibiotics
is that you're back to square one-- the kind of world which you'd have
if antibiotics had never been invented. Or maybe it would be a little
better than that, for reasons mentioned above. The idea that
antibiotics create stronger or nastier bugs is nonsense.
From: David Rind <firstname.lastname@example.org>
Subject: Re: Antibiotics
Date: Mon, 26 May 2003 15:52:07 -0400
> Why are doctors so strict about making you finish the course of antibiotics
> he puts you on even if your symptoms are gone within a couple of days and
> the course is for say.. 2 weeks?
Probably for no very good reason most of the time.
My impression is that this is a carry over from one of the few
early studies of duration of antibiotics that, as best I recall,
really did show that 10 days of penicillin for strep throat is needed
to prevent the development of rheumatic fever. (I say "as best I
recall" because this study predates Medline, and when I tried to
track down the original article a number of years ago, I was unable
to find it.)
Although there is a potential concern about undertreating a serious
infection and thus breeding resistance, this has little to do
with, say, telling someone to take 2 full weeks of antibiotics for
a superficial skin infection, rather than letting them stop a couple
of days after the infection appears completely gone.
I think if you pushed on the issue in most individual circumstances,
people would be hard-pressed to come up with any actual data that
a specific duration of antibiotic therapy is needed to treat a
given minor infection without causing the development of