[Medicine-for-people] MRSA -- The Latest Health Scare and What You
Can Do About It
Douwe Rienstra
medical at olympus.net
Thu Feb 5 08:48:31 PST 2009
MSRA -- The Latest Health Scare and What You Can Do About It
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Medicine for People!
February, 2009
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Contents
- How deadly is MRSA?
- How to make a bad germ worse
- Good germs
- Bad germs
- The germs strike back!
- The hidden cost of cheap hamburger
- The hidden cost of that unnecessary antibiotic prescription
- What to do
- Don't be frightened
- Do be careful
- Help your doctor help you
- Hot soaks for superficial skin and soft-tissue infections
- Live long and prosper
- For further reading
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==== MRSA -- The Latest Health Scare and What You Can Do About It ====
You've probably read about MRSA, the so-called "super-bug" which has
been on the rise over the past five years. MRSA, or
Methicillin-Resistant Staphylococcus aureus (
http://en.wikipedia.org/wiki/Mrsa ) is a kind of Staphylococcus
aureus, a fairly common type of bacteria that has been causing skin
and soft tissue infections for millennia. I see a lot of people with
MRSA. It shows up in abscesses (we lance them and they go away),
folliculitis (tiny pimples in the hair follicles, often resolved with
hot soaks and antibacterial soap), or the skin infection known as
impetigo (oral generic sulfamethoxazole is effective). As the Centers
for Disease Control says:
"Almost all MRSA skin infections can be effectively treated by
drainage of pus with or without antibiotics. More serious infections,
such as pneumonia, bloodstream infections, or bone infections, are
very rare in healthy people who get MRSA skin
infections." http://cdc.gov/features/mrsainschools/
=== How deadly is MRSA? ===
I have never seen anyone die from MRSA. However, statisticians tell
us that MRSA kills about 18,000 or 19,000 people a year in the United
States (the figures are from 2005, see
http://webmd.com/news/20071016/more-us-deaths-from-mrsa-than-aids ).
How do we interpret this statistic? It's more than the 16,000 dead
from AIDS that year, but less than 41,000 from automobile accidents,
and far less than the 866,030 deaths from major cardiac disease (for
more details of what carries us away, check out
http://cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf pages 31-34). Put
another way, about .006 percent of the US population died of MRSA in 2005.
As a physician who has seen it and treated it, MRSA does not scare
me. The most frightening thing about this bug is that we ourselves
created it. With indiscriminate use of antibiotics, we encouraged the
development and spread of these bacteria.
=== How to make a bad germ worse ===
== Good germs ==
In last month's newsletter ( http://rienstraclinic.com/news/2009/01 )
we talked about our intimate connection with the bacteria that live
inside and around us. Just as the bacteria in our intestine depend
upon us for life, so do we depend upon them (
http://en.wikipedia.org/wiki/Intestinal_bacteria ). Here are just a
few examples of what intestinal bacteria do for us. They synthesize
biotin, a vitamin important for our hair and nails, and for proper
regulation of blood sugar. They synthesize vitamin K, required for
blood clotting. Bacteria enable us to obtain more energy from the
food we eat by fermenting foods we cannot digest, then sharing the
surplus with us. Our own resident bacteria protect us from harmful
bacteria by crowding them out.
We humans have benefited from our coexistence with certain bacteria
for millennia.
== Bad germs ==
Of course, like any intimate relationship, this one can go bad. Not
all bacteria are our friends. Some can cause infectious illness, have
long ended human lives, and continue to do so. Before the discovery
of antibiotics, diseases such as meningitis and tuberculosis were
fatal. The discovery of antibiotics was a great breakthrough in
medicine. Over the past fifty years, we've had antibiotics to fight
infection. Now we hear that "Superbugs" such as MRSA foil these efforts.
== The germs strike back! ==
Just when we thought we had infections licked, some bacteria
developed resistance to antibiotics that once killed them. We really
shouldn't have been surprised. Bacteria fight one another, like all
organisms, forever competing for resources and space on the planet.
One method they use is chemical warfare. Bacteria synthesize
compounds toxic to their enemies but not to themselves. For example,
the Streptomyces genus of bacteria protect themselves using
streptomycin, tetracyclines, neomycin, and many other compounds that
we've copied for medical purposes. Fungi take part in this
microscopic battle as well. Penicillin, for example, was first found
in a bread mold, and used by that bread mold to stake out its
territory. Antibiotic cephalosporins (Keflex) were discovered in a
sewer, the product of another fungus fighting for its life in a rough
neighborhood.
Every war has offense and defense. Bacteria can synthesize and
secrete compounds that destroy antibiotics, or they can make tiny
"bilge pumps" in their cell membrane, and pump the antibiotics out
before they do harm. Further, bacteria are promiscuous. They don't
need to have a lasting relationship with individuals of the same
species to mix and match DNA. They pass it around casually, even
between different species.
== The hidden cost of cheap hamburger ==
Here's the problem. When animals are raised on antibiotics, the
usually harmless bacteria in and on that animal tend to become
resistant, even though the bacteria don't make the animal ill.
Whatever bacteria are left when that animal gets to our table will
travel through our intestine, gaily passing out DNA packets (called
plasmids) to the bacteria in our own ecosystem, giving them the
blueprints to resist those antibiotics. Now our own bacteria have the
means to destroy penicillin, or to pump out methicillin before it
harms them. So if our usually benign bowel bacteria get into our
tissues from diverticulitis, a urinary infection, surgery or trauma,
the standard antibiotics are not going to work. This is just one way
that careless use of antibiotics harms us.
== The hidden cost of that unnecessary antibiotic prescription ==
A frequent error in medical practice is the over-prescription of
broad-spectrum drugs such as cephalexin (Keflex). A couple of decades
ago, this drug was a good choice. It killed both staph and strep, and
these are the common offenders in skin and soft tissue infections.
Nowadays, though, cephalexin will not kill MRSA, so it is a lousy
choice. It is also much more likely to disrupt the ecosystem in the
intestines, leading to overgrowth of usually innocuous bacteria
called Clostridium difficile. These bacteria, nicknamed "C diff", can
cause diarrhea that can last for years, or in someone weakened by
other illness, can kill.
=== What to do ===
== Don't be frightened ==
Your chances of succumbing to MRSA are miniscule. We all have to go
sometime, but it probably won't be by MRSA. If you discover symptoms
of MRSA, such as a skin infection or fever, call your doctor. This is
almost always a treatable, curable disease.
== Do be careful ==
In every medical clinic, we use standard precautions, such as
hand-washing and proper sterile procedures, as preventive measures.
These are equivalent to the rules you have for fire in your home. You
make sure that the candle is not sitting next to drapery, and you
extinguish it before leaving the house.
The Standard Precautions:
1. Wash your hands often, especially before preparing food and after
using the lavatory.
2. Cover your mouth when you cough.
3. Shower daily.
4. Keep skin infections covered.
Some people are colonized with MRSA, meaning they do not have an
infection, but the bacterial lives quietly in their nose. If you
carry MRSA in this way, or have an active infection, follow these
guidelines to prevent spread to your loved ones:
http://tpchd.org/files/library/72640dd923f76e37.pdf
== Help your doctor help you ==
Avoid unnecessary prescription antibiotics. If you have a bacterial
infection, don't hesitate to accept an antibiotic. But if your doc
says it's probably a virus, try not to tell her your friend had the
same thing and her doctor gave her an antibiotic and the friend
promptly improved. Your doctor may prescribe an antibiotic just to
show she cares, but all you are doing is disturbing your own
bacterial community.
If you do need antibiotic treatment for skin and soft tissue
infections, the current reasonable, initial choice of antibiotics to
cover MRSA would be trimethoprim/sulfamethoxazole (Septra, Bactrim),
combined with penicillin to treat strep if present. Your doctor may
also collect some material for culture, so that if the initial
treatment isn't effective, he'll know what is.
== Hot soaks for superficial skin and soft-tissue infections ==
I recommend hot soaks for skin infections. The heat increases blood
flow and oxygen and speeds healing. For instructions, go to
http://rienstraclinic.com/health_info/hot_soaks.html .
== Live long and prosper ==
The good news is you've got a smart immune system. It is used to a
bacterial environment and has learned to take advantage of it (
http://rienstraclinic.com/news/2009/01 ). Our immune system does not
just blindly attack whatever it sees. Like an intelligent policeman,
it evaluates risk. Some bacteria, as they pass down the
gastrointestinal tract, are actively tolerated. Others do not arouse
our immune system to inappropriate action, but do get the immune
equivalent of a "keep moving" message*. If we don't throw off our
bacterial ecosystem by overuse of antibiotics, it should keep traffic
moving along safely for the rest of our lives.
* This "keep moving" analogy comes from Good Germs, Bad Germs by
Jessica Snyder Sachs.
=== For further reading ===
Good Germs, Bad Germs: Health and Survival in a Bacterial World. By
Jessica Synder Sachs. Hill & Wang, 2007.
Why Dirt is Good: Five Ways to Make Germs Your Friends. By Mary
Ruebush, Kaplan, 2009. Reviewed in the New York Times by Jane Brody
on January 26, 2009 http://www.nytimes.com/2009/01/27/health/27brod.html
==========================================
=== Recent issues of Medicine for People! ===
January 2009 Good Germs, Bad Germs http://rienstraclinic.com/news/2009/01/
December 2008 The Woman with a Hole in her Heart
http://rienstraclinic.com/news/2008/12/
November 2008 Women's Health: Osteoporosis, Hormones
http://rienstraclinic.com/news/2008/11/
October 2008 Medical fads and fantasies, Flu Vaccine, Hepatitis
http://rienstraclinic.com/news/2008/10/
September 2008 Managing Your Medications
http://rienstraclinic.com/news/2008/09/
August 2008 Deodorant and Sprains and Strains
http://rienstraclinic.com/news/2008/08/
July 2008 What About Hope? http://rienstraclinic.com/news/2008/07/
June 2008 The Heart Detective at Work http://rienstraclinic.com/news/2008/06/
May 2008 Alternative Medicine Hall of Shame
http://rienstraclinic.com/news/2008/05/
April 2008 Integrating Western and Alternative Medicine
http://rienstraclinic.com/news/2008/04/
March 2008 Evolution of a Doctor http://rienstraclinic.com/news/2008/03/
February 2008 Diagnostic Testing; Healthy Lifestyle Support Group
http://rienstraclinic.com/news/2008/02/
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Medicine for People! is written by Douwe Rienstra MD, edited by
Carolyn Latteier, and published in Port Townsend, Washington.
Copyright January, 2009.
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