The good, the bad, the ugly and alternatives to antibiotics

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Thomas RileyThe Good, the Bad, the Ugly and Alternatives to Antibiotics--8.6.2011, Maribor

Transcript of The good, the bad, the ugly and alternatives to antibiotics

  • 1. & The Alternatives Microbiology & ImmunologyThe University of Western Australia PathWest Laboratory Medicine Thomas V Riley
  • 2. The Good - normal human microbial flora Bacteria perform physiological, nutritional and protective functions in the human body. Maintaining a balance is crucial. Antibiotics, tissue damage, medical procedures, changes in diet, and the introduction of new pathogens are examples of changes that can affect your normal flora. We are only beginning to appreciate the complexity and function of normal flora in the human body.
  • 3. The Good - Probiotics Uses supposedly non- Probiotics are: Live pathogens microorganisms which when Both bacteria and administered in yeasts have been used adequate amounts confer a health Useful for preventing: benefit on the host (WHO) vaginal infections urinary tract From Latin pro, for" infections and Greek bios, "life" diarrhoeal diseases
  • 4. How do probiotics work? Antagonism through production of inhibitory substances Competitive inhibition for sites/nutrients Inhibition of toxins Immunomodulation of the hostFilho-Lima et al. (2000) J Appl Microbiol 88: 365-370
  • 5. Lactobacillus Lactobacillus casei var rhamnosus Extensively studied Reduces travellers diarrhoea Reduces rotavirus diarrhoea Reduces the severity of diarrhoea in childcare centres Has lots of non-specific effects Available commercially
  • 6. Saccharomyces boulardii Same as S. cerevisiae,bakers/brewers yeast A non-pathogenic yeast that: Survives gastric acid Multiplies to high numbers Not inhibited by antibiotics Does not affect normal flora Prevents infection in animals
  • 7. The Bad - AntibioticsThe term "antibiotic" (from Ancient Greek anti, "against" and bios, "life").One of the greatest advances in medicine.Antibiotics are not really bad but they are over-used and abused.Antibiotics kill bad bacteria and good bacteria.Undesirable side-effects.Until recently, antibiotics were used asgrowth promotants for productionanimals.Resistance develops.
  • 8. Contributing factors Selective pressure Antibiotic overuse Human health Farming Agriculture Aquaculture Disinfectant use
  • 9. Increasing resistance means: Higher antibiotic doses are required More More side resistance effects More cost
  • 10. A lack of antibiotics
  • 11. The Ugly - Diarrhoea
  • 12. Not diarrhoea - hopefully!
  • 13. Bojesen AM, Olsen KE, Bertelsen MF. Fatal enterocolitis inAsian elephants (Elephas maximus) caused by Clostridium difficile. Vet Microbiol 2006 10;116:329-35.
  • 14. The Alternatives Probiotics Naturally-occurring antimicrobial agents Phytomedicines (plant-based remedies in the form of teas, extracts and oils) are a multimillion dollar industry worldwide. Medicinal plants Essential oils Garlic Honey Bacteriophage therapy Bacterial viruses are making a comeback.
  • 15. CDI in the United States is costing over US$ 3 billion per year (Clin. Infect. Dis. 46:497504.)
  • 16. Effect of LGG yoghurt on C. difficileinfection at SCGH mid-Nov to mid FebMonth Specimens No.positive % positiveNovember 77 10 12.9December 127 15 11.8*January 133 7 5.2*February 59 4 6.7*P < 0.05
  • 17. Experiences with S.boulardii So far weve treated 50 patients with recurrent CDI All elderly Given vancomycin for 7 days plus lyophilised S.boulardii (500 mg bd) concurrently and then continuing for another 3 weeks 49 or the 50 patients cured 1 patient non-compliant!
  • 18. Probiotics for CDIThere is insufficient evidence to recommend probiotic therapy as an adjunct to antibiotic therapy for C. difficile colitis. There is no evidence to support the use of probiotics alone in the treatment of C. difficile colitis. Pillai & Nelson. Cochrane Database of Systematic Reviews 2008, Issue 1.
  • 19. The ultimate probiotic faecal transplant Faecal replacement (enema) therapy Lots of anecdotes, little hard data Safety issues, ethical issues Equipment required: blender, naso-gastric tube Low numbers reported, many more undertaken success rate >90%
  • 20. Medicinal plants Antimicrobial activity of plant extracts many applications: raw and processed food preservation pharmaceuticals alternative medicines Over 2700 plants active against S. aureus and MRSA (Mahady GB Curr Pharm Design 2005; 11: 2405-27))
  • 21. Garlic
  • 22. Garlic (Allium sativum) First recorded use in 3000BC by the Sumerians widely cultivated then Used by Egyptian pyramid builders The Romans extolled the virtues of garlic as did the Greeks including Hippocrates 1st evidence as antimicrobial from plague in France in 1721 macerated garlic and wine Juice used by French and English in WW I to treat infected wounds (Harris et al. Appl Microbiol Biotech 2001; 57: 282-6)
  • 23. Garlic Antimicrobial properties attributed to allicin which is produced from alliin (alliinase) Di-allyl tri- & tetra-sulphides very potent and g amounts effective in vitro Active against many Gram +ve (incl. MRSA) & -ve bacteria, and fungi including dermatophytes Mode of action still being debated
  • 24. Garlic anti-MRSA activity in vivo (Tsao et al. J Antimicrob Chemother 2003; 52: 974-80) Previously shown anti-MRSA activity of serum from humans who had eaten garlic Infected BALB/cA mice with MRSA and treated with garlic extract, DAS & DADS p.o. (vanc) DAS & DADS at high conc. killed mice All 3 inhibited growth of MRSA in a dose dependant manner All 3 suppressed infection induced elevation of fibrinolectin and IL-6 Significant antioxidant protection
  • 25. Honey Long recorded history of use Antibacterial activity against a range of organisms: Staph aureus (incl. MRSA), E.coli, Pseudomonas, enterococci and H.pylori Activity attributed to high osmolarity, low pH, presence of H2O2 but there is something else (UMF) Renewed interest in wound care