- Jun 27, 2018
Barbara Rutkowski, EdD, MSN, CCM - Vice President, Clinical Operations, Advanced Plan for Health
A lot has happened since Alexander Fleming accidentally discovered Penicillin in 1928 after a chance exposure of staphylococcus to penicillin mold. For his discovery, he won the Nobel Prize after penicillin was commercialized in 1945, used successfully for war wounds and surgery in World War II and hailed as the “miracle drug”. In his acceptance speech, Fleming admonished the world to beware that bacteria would become resistant in time.
Fast forward to today where there are several classes of antibiotics including: Penicillins, Tetracyclines, Cephalosporins, Quinolones, Lincomycins, Macrolides, Sulfonamides, Lipopeptides, Aminoglycosides and Carbapenems. While infectious disease specialists worry about continued efficacy in all categories, they are particularly concerned about Clostridium Difficile infections, carbapenem-resistant Enterobacteriaceae (CRE), and neisseria gonorrhoeae. Carbapenem resistance is particularly troubling as this class offers wide spectrum protection for moderate to extreme life-threatening infections, especially for those who have failed other treatment or become resistant to multiple other antibiotics.
Bacteria become drug resistant when their DNA or genes adjust to the antibiotic and send instructions to other bacteria to block the effectiveness of the drug. The challenges are to: Develop drugs that can overcome these genetic changes in bacteria; Diagnose and address outbreaks more readily; Develop novel treatment mechanisms; Improve reimbursement that encourages the costly research and development required to create innovative solutions to fight our creeping world-wide scourge.
Imagine the horror of taking your child to the doctor for strep throat only to discover that he has a drug-resistant bacterial infection for which no antibiotic is effective – or discovering that after a successful surgery, you have an infection which is resistant to the only drug available to treat it. That day is quickly approaching. According to FDA Commissioner Scott Gottlieb, M.D. and the Centers for Disease Control and Prevention, 2 million people in the USA are infected with bacteria resistant to antibiotics, and 23,000 die because of these infections.
Health Plans, health care providers and facilities all need to know that adverse responses to antibiotics are responsible for one in five emergency department (ED) visits, according to a CDC study, and constitute the most common cause for emergency room use, especially in children who are younger than 18. Nausea, vomiting, diarrhea, overdose, inappropriate access by young children and stomach pain are some antibiotic-related reasons for which people seek ED care. By far, allergic reactions are the most common reason, accounting for 78% of those seen in the ED. Most adverse rashes or anaphylactic reactions are caused by the penicillins and sulfonamides. The report continues, “more than one-half of the estimated 100 million antibiotic prescriptions written in the community each year for respiratory tract infections may be unnecessary.”
Common Drug Interactions
Ensuring members and patients read medication inserts is important in their understanding of the directions for taking antibiotics as well as potential interactions with food or other medications. Some of the most common adverse antibiotic interactions are as follows:
Grapefruit juice may reduce absorption of penicillin and ampicillin.
Minerals in dairy products may bind with tetracylines to prevent absorption and reduce their efficacy.
Tetracyclines interact with anti-coagulants to alter their effect on blood clotting, which can be dangerous, especially when used with Warfarin.
Erythromycin interacts with theophylline, an asthma drug, increasing levels of the asthma drug.
Erythromycin interacts with statin drugs, designed to reduce cholesterol levels, resulting in a greater risk of muscle aches and soreness.
Erythromycin interacts with carbamazepine, an anticonvulsant, thereby magnifying the effect of the seizure medication.
Taking mineral supplements like calcium and magnesium with antibiotics like Cipro, a fluoroquinolone, reduces the effectiveness of the antibiotic.