Thursday, 12 August 2010

an end to an(tibiotic) era

i read quite a few blogs. and i always like it when people post stuff pertaining to their areas of expertise. kind of like someone with (debatable) authority posting an idiot's guide to something - simplified, general, practical. i wish the blogs i read would do more of this, but i dunno if this is just me and people dislike these types of posts. anyway. leading on to what i was going to post today, a few things about antibiotics (which most of you probably already know).

depending on where you're residing, different antibiotics may be over-the-counter or by prescription, and this has a fully justifiable reason. some of you may live in, say, malaysia, where antibiotics are like the cure-all and are ridiculously overprescribed. some of you may live in the uk where the proverbial sh*t has pretty much hit the fan and they're implementing stop-gap measures to control prescriptions. but, no matter where you live, it's a definite case that you probably don't need those pills you're so reliant on.

bacteria are smart. they wage the canonical 'biological arms race' against whatever crap we throw at them, which may be stuff we find naturally, or some nasty chemicals we conjure up in the lab. conjure here being an interesting choice of words, since, when you go down to the details, how scientists come up with their discoveries... is pretty much witchcraft and hoodoo anyway. so, for every bacterium that wages these battles, they're better equipping themselves for the greater war. here's some tips to help us out. it won't win the war for us but it'll probably give time for us to develop new and exciting weapons with which to prolong it. my metaphors are bad.

1. antibiotics kill living things, namely bacteria (but sometimes other stuff, but let's not go there). taking antibiotics when you have a flu will do nothing in the majority of cases, since it's probably caused by a virus. on which antibiotics have no effect. what's this you say, you already know this? and it's not a big deal? because it does no harm, you say? wrong. wrong. and wrong. taking 'unnecessary' antibiotics exposes your normal bacteria population (that resides on and in your bodies) to selective pressure. darwinian selection then weeds out the weak, leaving the (more) resistant ones, which, although may not effect you now, have a bigger implication when it comes to the population as a whole, especially, say, when you come into contact with the immunosuppressed, or become so yourself. e.g. if you have an operation, or get a bigger infection or just grow old and bitter.

basically, if you don't need it, don't take it. or for you doctors out there, stop prescribing unnecessarily. what? your patient's b*tching and you need to shut him up? tell the sucker to suck less and suck it up. heck, if you think you need it, but only as a means to reduce some minimally-impacting symptom, screw it - you're just quickening the bacterial-resistance clock. and time's ticking out.

2. if you're gonna kill 'em, kill 'em all. i'm sure the doctors out there are bored of this. and some of you have heard this a million times. if you're on a course of antibiotics, don't stop midway. don't skip out on your regimes. don't be bad and think that just because you feel better, it's all chocolate rainbows and liquid sunshine. it just means you're asymptomatic, but heck knows if you've gotten rid of the culprits (even if you finish your regime, there's no guarantee of this). and, again, leaving survivors is bad, because of that selection picture i put up above. here, you can read more if you like.

3. antibiotics target specific pathways or structures in a bacterium. once bacteria develop resistance towards this, the antibiotic is pretty much useless. and the same applies for most, if not all, antibiotics which work in the same way. to prevent this, especially in hospital settings, you want to get a combination of antibiotics, which do not work in the same way, so that there's less chance the bacteria will develop resistance (this is simple statistics, say the chance of spontaneously developing resistance to respective antibiotic classes are p and q, p < p.q, especially given p and q should be small numbers). obviously, this doesn't apply to your monthly visit to the gp for your antibiotic to treat a sore throat, but this point is more for the graduating doctors or fresh registrars who still prescribe 2 beta lactams because '2 is better than one'. this isn't boys like girls ft. taylor swift - stop being bad and do the right thing. try some aminoglycoseds or something to go with the beta lactams. or something.

4. antibiotic resistance differs according to your geographical location, and hence, so does your prescription regulations. ask your doctor for more information. so, when you're going on that cross-world journey, don't think you can self prescribe for your gangrenous leg or endocarditis just because you have something left over from last year. get a doctor's opinion. and make sure the doctor isn't the doctor. who?

5. there's more points i wanna make... but let's end it with this one: prevention is better than cure. if you have something, try not to get others infected. this includes making out with your girl just after getting out of the hospital, and running off to the local brothel 2 hours into pay-day. we don't need to give prophylactic and preventative antibiotics to random whores (not that i have anything against them), especially not when they could be better used to treat homeless degenerates... or third world baby machines... or serial puppy-killers with sprinkles on top.

this isn't to say you shouldn't visit grandma at hospital because she's on her deathbed with consumption or flesh-eating bacteria. but this is to say that just because you aren't feeling as horrible as you did when you got that strep throat 2 days ago, you're free to go coughing up in every tom, dick and harry's grills. and that's my convoluted and unnecessarily-long sentence for the week.

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