Socio of Sci/Bio-Philoso English
Using Antibiotics Judiciously amid Superbug Threats
2017-12-24 00:00:00
Cedric Dent

The proliferation of sexually transmitted diseases (STDs) might finally be coming to drastic decline via mass instruction to take antibiotics within 24 hours of having had unprotected sex according to a new study. As much of a milestone as this may be for the fight against STDs, though, increased use of antibiotics for any new purposes is highly controversial now that scientists are repeatedly warning the public about the global threat of high antibiotic resistance, which only threatens to get worse in the near future anyway. This comes just a month after the World Health Organization published guidelines for livestock industries, instructing them to desist antimicrobial use for both disease prevention and production enhancement of livestock.

The strategy sounds simple enough. If you have unprotected sex, which could be for any of several reasons (i.e. whether by mistake or deliberately), the new study advises you to take antibiotics within 24 hours. Its results came from testing this strategy on a sizable number of men who had frequent, unprotected sex with male sex partners. “My message with that study would be that we need to do more research to prevent [sexually transmitted infections]—because that’s a concern,” says Dr. Jean-Michel Molina, St. Louis Hospital’s head of infectious diseases in Paris and lead author on the published paper. “And this strategy […] could potentially be used.”

Molina insists that he isn’t in favor of long-term antibiotics use to stave off STIs; rather, he advocates using this method as a stopgap solution in tandem with other control approaches. For instance, he also recommends more frequent STI testing in the first place, particularly among high-risk populations like that of homosexual men. “I don’t want this strategy to be used widely in any person, clearly,” Molina clarifies. “But if you can select a group with a high incidence rate of syphilis or chlamydia, and you want to try to reduce the rate of syphilis quite quickly in this group of people, you may think that this strategy could be used for a couple of months.”

Syphilis, mind you, has been especially observed for its uptick in recent years. In 2015 and 2016, the infection averaged 8.7 cases per 100,000 people, which is a higher rate than has been seen since 1993 according to the U.S. Centers for Disease Control and Prevention. That indicates that prevention as of late has been waning in its efficacy, and the infection incidence has gone up in every age group for both men and women over age 15 across all ethnicities according to the same report from the CDC. The French study was published in Lancet Infectious Diseases and funded by American medical research funding giant, The Bill and Melinda Gates Foundation.

Global health authorities, though, are presently discouraging any and all use of antimicrobials in food-producing animals who aren’t infected with anything specifically because authorities recognize that human beings need to cut back on antibiotic use in every area possible. The WHO proposes that antimicrobial administration for livestock be reduced across the board, and the organization is being particularly insistent with regard to drugs for that serve as staples in human medicine; all of which is detailed in a 90-page document.

Dr. Marc Sprenger directs the WHO antimicrobial resistance secretariat, and he said in a recent press conference that untreatable infections are manifesting as a result of antimicrobial resistance and thereby posing a significant threat to public health worldwide. He added that misuse and overuse of antimicrobials in both animals and humans have proven to be major contributors to increased resistance. The WHO’s director of food safety and zoonoses, Dr. Kazuaki Miyagishima, has publicly stated that antimicrobial resistance is also increasing as a result of routine or prolonged antimicrobial use in general, adding that reduction of that overuse in animal production is paramount for safeguarding public health.

Miyagishima claimed antimicrobials shouldn’t be involved in livestock production or be used for preventive measures anymore. The only exceptions he made were for veterinarian-supervised prevention methods. Chavonda Jacobs Young, Ph.D., chief researcher at the U.S. Department of Agriculture, announced in contradiction, however, that the WHO guidelines lack support from “sound science.” She said they conflate growth promotion and disease prevention, which would mean the guidelines are based on “low quality evidence.”

The guidelines read, nevertheless, “It is not practical, and in some cases not ethical, to conduct randomized clinical trials to investigate the impact of restricting antimicrobial use in food-producing animals on the prevalence of antimicrobial resistance.” Opposing pundits classify these guidelines as a “strong recommendation [based on] low-quality evidence.” Even if this is the case, it remains a common viewpoint among experts that there are no areas where antibiotic use should be increased.

A new study in Cambodia, in fact, suggests that antibiotic resistance in the country is already dangerously high. Published by the Pasteur Institute, the study shows shockingly high and steadily increasing levels of antibiotic resistance kingdom-wide and attributes this to overprescribing medication. “In Cambodia, the misuse of antibiotics is a known phenomenon, but there is little data on microbial resistance,” according to the press release that accompanied publication of the study. This is in a country wherein Amoxicillin resistance jumped from 50 to 70 percent between 2010 and 2014 according to Eng Lengsea who was head of the microbiology lab at Phnom Penh’s Calmette Hospital in 2015—compared to 18 percent resistance in the U.S.

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