Thursday, May 03, 2007

Notes from an Infectious Disease Symposium

At a Infectious Disease symposium today, a presenting doctor delivered a comprehensive and entertaining review of antimicrobial/antibiotic therapy. Reminding us of the overuse of antibiotics and the prevalence of antibiotic-resistant strains of previously treatable organisms, he admonished prescribers to refrain from giving into the demands of adults with bronchitis---and parents of febrile children---for antibiotics that have no proven efficacy against viral illnesses.

More often than not, a worried parent will fret over a child with a fever and adamantly demand antibiotics from a rushed doctor or nurse practitioner who, in the interest of efficiency and a waiting room filled with patients not yet seen, will give in and write that prescription, knowing full well that the patient would eventually improve on their own without the meds. However, the parent or patient leaves feeling that the doctor saw how sick he or she was, and is satisfied that something is being done to assuage the symptoms. Sounds like a lose-lose situation to me. The only winner is the bacteria that gains some resistance. All hail to the bug!

Further discussion ensued with a description of the many side effects of antibiotics. This esteemed Infectious Disease expert described how antibiotics are indiscriminate in their destructive rampages through the gut, assassinating not only the bacteria which is their intended target, but also the normal flora (friendly bacteria) of the intestine, thus the resultant antibiotic-induced diarrhea which so often results from these drugs which truly are wonders of 20th century medicine. What worries me (but failed to surprise me) is that this doctor so familiar with antibiotics and the ravages which they wreak on the intestinal flora said nothing about replacing those friendly bacteria through the subsequent ingesting of yogurt or probiotics. While antibiotics destroy bacteria and anything else in their way, probiotics (acidophilus, biphidus, and some friendly yeasts) aid in the rebuilding of the gut's normal and delicate balance. While some scientific evidence supports the notion that probiotics actually rebuild the intestinal flora, other evidence admits only that probiotics allow the gut time and opportunity to recover from the ravages of the antibiotics. Whatever the case, this issue deserves attention when discussing antimicrobial therapy, and the entire thing was simply glossed over. Needless to say, I did little to assist the situation, and failed to ask a question to provoke such a conversation. More fool me.

Next was a description of the new vaccine against Human Papilloma Virus (HPV). Several common strains of HPV have been proven to be direct implicated in causing cervical cancer, thus a new vaccine has been approved for sexually active young women and girls in order to prevent certain types of HPV and the potential for cervical cancer. Being the first vaccine to ostensibly prevent cancer, a major breakthrough in cancer prevention in women has been achieved. While many parents may worry about adding yet another vaccine to the arsenal already injected into their beloved children, potentially avoiding the risk of certain gynecological cancers is an enormous benefit not to be taken lightly. That said, the long-term efficacy of the vaccine has yet to be unequivocally proven, with no firm knowledge of the potential need for a booster later in life, as well as an admitted lack of firm evidence vis-a-vis long-term safety. Still, Gardisil will be added to vaccination schedules for young girls between 9 and 13 years of age, and most parents will most likely choose to vaccinate.

Finally, updates regarding HIV/AIDS and the continued development of new classes of medications to stop HIV replication in its tracks was a highlight of the day. More than thirty years since the identification of HIV and the first diagnoses, the scientific momentum has seen no abatement, with new drugs always in the pipeline. As the virus mutates and finds new ways to evade the drugs, scientists continue to find novel methods for insinuating molecules of medication into the HIV replication process, curtailing the virus' ability to copy itself and commandeer its host's immune system. I am continually amazed.

Even now, as the 21st century gets fully underway, infectious diseases seem to still be a great threat to survival and quality of life around the world. Coupled with the urgent challenge of climate change, major scientific breakthroughs will continue to be needed in order for humans to continue to survive natural threats (HIV, HPV) and human-made threats (climate change) which challenge our longevity as a species, and the life of the planet itself.
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