• Are there really no new antibiotics?

    By Guy Tsafnat - August 24, 2015, 4 PM


    Global health organisations such as the Centers for Disease Control and Prevention (CDC) and the World Health Organisation (WHO) often broadcast  that antibiotics are losing efficacy because bacteria grow resistant to them and there are no new antibiotics. However, this list shows that new antibiotics are steadily being released even today. So are there really no new antibiotics?


  • Mitigation Strategies for Antibiotic Resistance

    By Guy Tsafnat - June 15, 2015, 4 PM


    The World Health Organisation warnsthat we are facing a post-antibiotics era in which diseases commonly and effectively treated by antibiotics could become untreatable and deadly. Common conditions such as urinary tract infections and infected wounds (from accidents or surgery) will become risky. There are already 9 known superbug strains and more are emerging. Elective surgery and cancer treatments will become too risky to perform. In order to understand what we can do to delay or even avoid this future, we first need to look at what forces are driving it.


  • Antibiotic Cycling Regimens

    By Guy Tsafnat - April 20, 2015, 4 PM


    Antibiotic cycling regimens are prescription policies that suspend the use of a particular antibiotic for a period (“cycle”) to allow resistances levels to subside. This should prevent resistance from building up in the microbial ecosystem. Antibiotic cycling regimens are typically employed in intensive care units where resistance is often rampant.
    While antibiotic cycling may yet be proven to be a good idea, only some weak evidence shows that it has any effect. Several studies found that the effect of cycling can range from moderately slowing the rate at which resistance builds up to having detrimental effects.1 It becomes obvious that the same policy may not work for all antibiotics, that cycle parameters need further investigation to find effective combinations and that the potential adverse effects of cycling are relatively unknown.
    The microbial ecosystems that cycling aims to disrupt, are rarely known or understood and no real-time feedback mechanisms exist for appropriate adjustments to be made to regimens. Antibiotic resistance stems from specific genes that bacteria carry that can travel (“horizontally”) between organisms and between patients in complex ecosystems that are highly localised. To be more effective, cycling policies need to be guided by the real-time monitoring of the genetics of the local bacterial ecosystem.
    Simultaneous resistance to multiple antibiotic therapies (as is often observed in intensive care) is proof that the invisible microbial ecosystems are important for the design of effective cycling regimens. It is well established that effective cycling can reduce antibiotic resistance load and improve patient safety and lead to responsible stewardship of antibiotics.
    1.    Bal A, Kumar A, Gould I. Antibiotic heterogeneity: from concept to practice. Annals of the New York Academy of Sciences 2010;1213:81-91.


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