Update on antibiotics (and a note on coffee)

In May of this year the CDC announced the first US isolation of a so-called “super bug,” meaning a bacteria resistant to all available antibiotics. The E. coli bacterium was cultured from the urinary tract of a Pennsylvania woman with no history of foreign travel. According to the US Department of Health and Human Services, the bacteria contain the mcr-1 gene conferring resistance to even extremely potent drugs like carbapenum. This marks the first US isolation of the gene from a human specimen (previously found in Europe and Canada). The gene was located on a plasmid, a bit of DNA capable of being transferred from one bacterium to another. E. coli, a regular inhabitant of intestinal flora, is not transmitted through aerosol (coughing/sneezing) or skin contact, and the gene does not yet pose a general threat to the public, but serves to highlight the need for ongoing vigilance when it comes to antibiotic stewardship.

 

Screen shot 2016-06-23 at 11.18.16 AM

 

Bacteria preceded us and they will outlive us. Resistance is part of the natural selection process inherent to life on this planet and will never be eliminated. The biggest threat to humans, however, comes from the overuse of antibiotics that accelerate this process. Thirty million pounds of antibiotics are fed to livestock annually in the US to promote growth (rather than to treat disease). This remains the largest source of antibiotics in the environment, constituting 80% of all antibiotic use. Those same antibiotics end up in animal feces, eventually draining into waterways, finding their way into marine animals and drinking water.

Despite these concerns, the use of antibiotics continues to increase. In April of this year, the FDA released guidelines calling for pork, poultry, and beef producers to voluntarily reduce the amount of antibiotics fed to livestock. The new guidelines, however well intended, have no bite. A proposal to actually ban the use of certain antibiotics in livestock, first proposed by the FDA in 1977 remains in perpetual stalemate. But even a ban of antibiotic use for growth might not reduce their use by a significant amount. When a Dutch law banning the use of antibiotics to promote livestock growth went into effect in 2006, producers continued using them at roughly the same rate as before, simply changing the indication from “growth” to “treatment” (even when there wasn’t any actual disease present). Dirty tricks to keep the price of hamburgers low.

 

Screen shot 2016-06-23 at 11.19.29 AM

 

So what’s a person to do? It’s unrealistic to expect the nation to go vegan, but we can all support legislation limiting or banning the use of antibiotics in livestock for growth purposes. Know that this will likely increase the cost of your Chik-Fil-A sandwich by a dime and be willing to pay it. Better yet, cut down or eliminate the amount of meat you eat. Your arteries and pocketbook will thank you. Next, stop going to the doctor for coughs and colds. In a report released by the FDA earlier this year, 30% of all antibiotics continue to be prescribed for viral infections where they offer no benefit. Of course, doctors are largely to blame but, if patients stop asking, doctors will stop prescribing. Wash your hands, eat less meat, and when the next cold strikes, enjoy a hot toddy rather than a cold antibiotic. (For more on this topic, see my post from 2/19/16: “I’m skeptical about …antibiotics.”)

In an unrelated story, there’s more good news for coffee drinkers. On June 15, 2016, in a rare reversal, the World Health Organization dropped coffee from its list of potential carcinogens. Placement of coffee on the list dates back to 1991 after epidemiological studies linked the beverage to certain types of bladder cancer. Since then a great deal of new research has emerged, the bulk of it suggesting that coffee and caffeine offer protection against cancer, as well as a host of other diseases including heart disease, type 2 diabetes, and Parkinson’s. WHO didn’t go so far as to remove all caution, citing data linking the ingestion of “very hot” beverages to esophageal cancer (iced coffee drinkers can now exit the closet).

According to the report, published in Lancet Oncology, researchers concluded, after reviewing more than 1,000 studies, that coffee is unlikely linked to several types of cancer including breast, prostate, and pancreatic, while consumption is associated with a lower incidence of other cancers including uterine and liver. The data for an additional 20 types of cancer was considered inconclusive. In response, Geoffrey Kabat, a cancer epidemiologist from the Albert Einstein School of medicine, said, “What evidence shows over all is that coffee drinking is associated with either reduced risk of several cancers or certainly no clear increase in other cancers. There’s a strong signal that this is probably not something that we need to be worrying about.” Now where’s my French press? (For more on this topic, see my post from 5/29/16: “I’m optimistic about … coffee.”)

Dana Loomis et al., “Carcinogenicity of Drinking Coffee, Mate, and Very Hot Beverages,” Lancet Oncology 2016; 17 (7): 877-78.

 

One thought on “Update on antibiotics (and a note on coffee)

  1. What about all the STDs that people come in to be treated for simply because they think they could of been exposed, let alone actually truly being contaminated? Soon chlamydia, gonorrhea and all those other STDs are going to be resistant to antibiotics as well. Now wouldn’t that be a stinky situation!?! I guess some people would say it is a good incentive to practice abstinence…

Leave a Reply

Your email address will not be published. Required fields are marked *

*
*
Website