A Fix for MRSA?

Bacteria, but not the good kind

Another tactic, if counter-intuitive (or maybe not), in the never-ending war on MRSA*: stop giving out so many damn antibiotics:

Norway’s model is surprisingly straightforward.

• Norwegian doctors prescribe fewer antibiotics than any other country, so people do not have a chance to develop resistance to them.

• Patients with MRSA are isolated and medical staff who test positive stay at home.

• Doctors track each case of MRSA by its individual strain, interviewing patients about where they’ve been and who they’ve been with, testing anyone who has been in contact with them.

Haug unlocks the dispensary, a small room lined with boxes of pills, bottles of syrups and tubes of ointment. What’s here? Medicines considered obsolete in many developed countries. What’s not? Some of the newest, most expensive antibiotics, which aren’t even registered for use in Norway, “because if we have them here, doctors will use them,” he says.

He points to an antibiotic. “If I treated someone with an infection in Spain with this penicillin I would probably be thrown in jail,” he says, “and rightly so because it’s useless there.”

[snip]

But can Norway’s program really work elsewhere?

The answer lies in the busy laboratory of an aging little public hospital about 100 miles outside of London. It’s here that microbiologist Dr. Lynne Liebowitz got tired of seeing the stunningly low Nordic MRSA rates while facing her own burgeoning cases.

So she turned Queen Elizabeth Hospital in Kings Lynn into a petri dish, asking doctors to almost completely stop using two antibiotics known for provoking MRSA infections.

One month later, the results were in: MRSA rates were tumbling. And they’ve continued to plummet. Five years ago, the hospital had 47 MRSA bloodstream infections. This year they’ve had one.

“I was shocked, shocked,” says Liebowitz, bouncing onto her toes and grinning as colleagues nearby drip blood onto slides and peer through microscopes in the hospital laboratory.

In Ontario, at least, provincial efforts to control the spread of MRSA focus on identifying and isolating patients with MRSA in health care facilities, and providing best practice guidelines for hospitals and health care professionals. Maybe a rethink of the paradigm is needed?

__________

*Methicillin-resistant Staphylococcus aureus. Particularly nasty and highly communicable. And kills lots of people — 2600 a year in Canada is one figure I’ve heard, but I can’t find any official figures, yet.

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  1. #1 by atyourcervix on Tuesday 19 January 2010 - 1808

    Oh man! You got my hopes up about treatment for MRSA. I read this article several days ago. Sounds great in theory – and it seems to be working well for them. It would take a huge paradigm and attitude shift of physicians, nurses, nurse practitioners and patients to stop with the over prescribing of antibiotics in the US.

    (side note: my boyfriend has a rather nasty MRSA infection that is unresponsive to Bactrim, which it was tested to be susceptible to. We’re looking at a much more expensive, extensive IV regimen of antibiotics to try to cure it. I really had hoped that you had more scientific evidence of good treatment of systemic cutaneous MRSA.)

    • #2 by torontoemerg on Wednesday 20 January 2010 - 2009

      Yikes! I’m sorry I don’t.. What do they want to give him, and for how long?

      Culture shift is right.

      • #3 by atyourcervix on Thursday 21 January 2010 - 1628

        His ID doc wants to start IV Daptomycin x 3 weeks. We’re doing another round of Bactrim p.o. x 2 weeks first. Along with meticulous skin decolonization with hibiclens.

  2. #4 by no on important on Wednesday 20 January 2010 - 0841

    Huh. So its the HUMANS that develop the resistance to the antibiotics? I had no idea.

    • #5 by Anonymous on Monday 24 January 2011 - 0922

      Well clearly. And here I was thiking it was the bacteria that are resistant. More fool me.

  3. #6 by torontoemerg on Thursday 21 January 2010 - 1743

    They aren’t using vanco? He’s resistant? Hopefully the much cheaper Bactrim will do the trick…

  4. #7 by atyourcervix on Friday 22 January 2010 - 1212

    argh, my response didn’t show!

    He has already been on bactrim x 2 weeks once before. I doubt it will work again. As for vanco, he has C&S studies done, so I will need to check with his ID doc if vanco is an option. Here is the breakdown of daily costs:

    Cost:

    ·UCSF acquisition cost: 500mg = $129.05/vial Typical cost for 70kg pt: $129.05/day (single-use vials)

    ·Cost of comparable agents

    Vancomycin 1g IV q12h = $11/day

    Linezolid 600mg IV q12h = $128/day Linezolid 600mg po BID = $96/day

    Synercid (quinupristin/dalfopristin) 7.5mg IV q8h (70kg patient) = $275/day

    • #8 by atyourcervix on Friday 22 January 2010 - 1215

      Daptomycin – $2700/3 weeks
      Vancomycin – $231/3 weeks

      Hmmm….I definitely need to talk to his ID doc!

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