Matthew Policy Paper

Matthew Trisler 2 October 2009
“Superbug Strikes in City” sounds like a horror movie title, but instead it is a headline printed in the October 26, 2007, edition of the New York Post. Twelve days earlier a 12-year-old Brooklyn boy, Omar Rivera, died after a wound he received on the basketball court became infected with methicillin-resistant Staphylococcus aureus (MRSA), a bacterium that has become resistant to one of the most potent drug classes in the current antibiotic arsenal (2).
Background:
A bacterial infection can occur almost anywhere, at anytime, in a variety of ways. The best protection anyone could have is simply an understanding of bacteria itself. However, the general population of the United States and the world has little to no knowledge of bacteria other than the fact that it co-exists with us (5). “The concept of antibiotic immunity is a misnomer that can lead people to believe that they may become "immune" or "resistant" to an antibiotic if they take it too frequently or inappropriately. This notion stems from a misunderstanding in the general public of the concept of antibiotic resistance (1).” It is not people who become resistant or immune to the antibiotics; but rather it is the bacteria responsible for the infections that become resistant. “The purpose of an antibiotic is to killor at least inhibit the growth ofbacteria to quell an infection (1).” Bacteria have been around for thousands of years and have had to survive in hostile environments. As a result, they have a number of mechanisms for survival that has allowed them to adapt, survive and thrive for as long as they have been in existence. One of which is the development of antibiotic resistance. If we don’t find a solution to antibiotic resistance soon were going to have several resistant strains of various types of bacterial infections giving us trouble. A great example of this is staphylococcus aureus which kills roughly 19,000 more people then HIV/AIDS a year (2). Then you've also got the overuse of germicides around the home. We've got so many disinfectant wipes and sprays that our immune systems practically never get any "target practice" so that when we go out into the real world, we get hammered by stuff that we should be able to deal with naturally (4).The problem of resistance actually has been discussed and raised probably for at least the past 30 to 40 years. In 1981, a meeting was held in Santa Domingo on resistance and as a result, an international organization was established: The Alliance for the Prudent Use of Antibiotics (3). The Alliance was formed with 93 other countries to combat the drug-resistant infectious diseases becoming prevalent in developing countries.

Policy:
To perform the increasingly arduous task of stopping antibiotic resistance dead in its tracks, a more aggressive protocol than what is currently in practice will be implemented. In order to get antibiotic resistance under control before it’s beyond measure, the following policy will be implemented:
• Rather than a single antibiotic being prescribed to subdue a bacterial infection, a cocktail of antibiotics will be utilized to wipe out the entire infection.
• The Alliance for the Prudent Use of Antibiotics will be placed in charge of a new effort that combines the knowledge and resources of participating nations to more effectively combat the wide range of antibiotic resistant strains currently present.
• Preventative measures should also be taken so that people aren’t unknowing causing more harm than what they mean to. Such measures would include classes being taught or instructional demonstrations being performed to inform people.
Rather than using monotherapy or synergistic combinations, which is much of what our current practices consist of, a cocktail of several antibiotics would be more effective in eliminating the resistant strains. Theoretically assuming that the frequency of mutation to a particular antibiotic is 10 power x, for a cocktail of few more antibiotics the sum effect would be 10 power x + 10 power y + 10 power z, or 10 power xyz which is greater than the individual parts. Thus proving that although a bacterial strain may be resistant to one or two of the antibiotics used, it is improbable that it will be resistant to all of them. The end result will be that the bacterial infection, although resistant to part of the cocktail but not all of it, will be killed.
The antibiotic cocktails will be prescribed just like any other antibiotic we currently have. To determine the proper composition and potency of the cocktail, lab tests will be performed on the bacterial infection and the doctor will make the call as he sees fit. Also the cost of the cocktails will be slightly more expensive than most of the antibiotics currently on the market, however they’ll be covered under health insurance just as the others are.

The Alliance for the Prudent Use of Antibiotics will be endowed with the task of developing and producing new antibiotics. With an open sharing of knowledge, time and resources with other nations, the researching and development of new antibiotics will drastically increase. Also, with some of the greatest minds from all over the world working together toward a common goal, new ideas are bound to arise. Secondly, The Alliance will be tasked with determining the proper mixture of the antibiotic cocktails. This is to ensure the cocktails are as safe as possible while still being effective.

Although The Alliance for the Prudent Use of Antibiotics is already in existence and staffed, the funding for the organization will need to be increased greatly. However the funding is shared amongst all nations participating in the organization and therefore it will not a huge financial burden on any one country. The additional funding will go toward research and development, as well as tools and utilities needed, and payment to the additional staff members that will be needed.

The classes taught and demonstrations performed will be free of charge for the public and will be put on by nurses and/or teachers without pay. They will include knowledge of bacteria and the current state of antibiotic resistance.

Finally, the national governments of the participating nations will be the ones who oversee the Alliance’s progression and performance. If it is found to not be operating properly, nations have full right to pull out of the Alliance whenever they deem necessary.

Conclusion:

If time has shown us anything it’s that a passive approach to solving the problem of antibiotic resistance isn’t working. Same with things like cleaning your hands, countertops, sinks and so on. A more aggressive approach is needed to get us moving on the right track. That is why an international organization must be made. One could argue that using a cocktail of antibiotics could be harmful to the user. However, there are always possible side effects and downsides to taking drugs, but that is why they are extensively researched and tested. Someone could also say the international organization will never work because that means countries have to work together which doesn’t usually work out. Well yes they are working together, we’ve seen it done before and we see it today with the United Nations and other international powers.

References:

1. How is antibiotic immunity acquired? May 10, 2004. Mazzulli, Tony. Page 1. http://www.scientificamerican.com/article.cfm?id=how-is-antibiotic-immunit
2. Squashing Superbugs—The Race for New Antibiotics, July 2009. Walsh, Christopher T. http://www.scientificamerican.com/article.cfm?id=squashing-superbugs
3. Antibiotics have been around for years, so why is it only recently that antibiotic-resistant bacteria have become the focus of attention and alarm? Also, why are resistant strains especially likely to arise if a patient doesn't complete a course of antibiotic therapy? It seems counterintuitive, 2009. Replied to by: Levy, Stuart B., Bittner, Marvin J., Salyers, Abigail. http://www.scientificamerican.com/article.cfm?id=antibiotics-have-been-aro
4. Journal of Clinical Microbiology. Role of Hands. J Clin Microbiol. Potential October; 29(10): 2115-2119
5. How do antibiotics kill bacterial cells but not human cells? March 13, 2006. Mobley, Harry. Page 1. http://www.scientificamerican.com/article.cfm?id=how-do-antibiotics-kill-b

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