Lewis – Brit Dent J 2008
- Penicillin resistance within the microflora of acute dental infections
- 5% of abscesses in 1998 → 55% in 2008
- Hospital admissions for severe dental infections in the UK
- 800 patients in 1998 → 1,600 in 2008
- At least one patient per month in the UK dies from the unsuccessful management of dental infection
Gomes et al – J Endod 2011
- Studied antibiotic resistance of bacteria from root canal infections from 2000 – 2008
- Resistance increased for all AB’s tested
- Penicillin V, amoxicillin, clindamycin
- Erythromycin – 100% of organisms were resistant!
Resistance: A Problem for Everyone[^16]
NPS News - No. 77; 2012
- Australia - taking penicillin within 2 months made patients twice as likely to carry penicillin resistant strains
- UK - transferable gene isolated from children after taking a beta-lactam AB
- UK - children with otitis media or a respiratory infection:
- After two weeks of AB’s - 67% had resistance genes and fourfold increase in MIC
- No AB’s - no change in resistance!
- Widespread use of AB’s promotes resistance
- Standard AB treatments become ineffective
Example
For example, the standard adult dose for many penicillins has increased from 250mg to 500mg over the years.
Reversing Resistance: The Norway Example
AAE Colleagues for Excellence - Winter 2012
- Norway - report strongly suggests that bacterial resistance can be reversed
- Norway does not have the “killer superbug” (i.e. staphylococcus) infections
- The reason?
- A “simple solution” -
- Norway stopped doctors from using AB’s when they were not indicated
- Treat fever with paracetamol and “wait and see” (e.g. common cold)
- A “simple solution” -
Effect of Antibiotics on Normal Flora[^20][^21]
*Rupnik et al. Nat Rev Microbiol 2009; 7: 526-36.
- Antibiotics are not targeted; they disrupt the body's entire normal flora, particularly in the gastrointestinal tract.
- ==This can allow opportunistic pathogens like Clostridium difficile to overgrow, causing severe and difficult-to-treat infections.==
- ==It can take several months for the gut flora to return to normal after a course of antibiotics, leaving the patient vulnerable during that time. Severe cases of C. difficile may require a fecal transplant.==
3 - 6 months…