Antibiotic resistant gonorrhea – another reason for antibiotic regulation

An excellent paper and accompanying editorial in the Canadian Medical Association Journal describes huge increases in fluoroquinolone antibiotic resistance in Ontario from 2002 to 2006. Similar changes have been described in many other parts of the world.

Fluoroquinolones have only been in existence since the 1980s and first licensed for sale in Canada in 1988. They were the first new class of antibiotic introduced for many years and were received with extreme expectations. They were widely touted as the solution to antibiotic resistance to penicillins, tetracyclines, sulfa antibiotics and others. Ciprofloxacin, the most successful of the class was brilliantly marketed to community-based physicians as having “IV power in an oral formulation”.

In 20 short years one might say “the arse has well and truly fallen out of ‘er”. Fluoroquinolones are all but useless for many clinical indications. 20 years! All over the world!

Another good reason to increase attention to antibiotic misuse and develop the regulatory structures needed to tackle this urgent and relentless problem.

What happened to phage type 80/81?

In the late 1950’s an epidemic of hospital – associated Staphylococcus aureus infections occurred in many parts of the world. The problem was most acute in England and was the impetus for an extensive report by a sub-committee of the standing Medical Advisory committee of the Central Health Services Council entitled Staphylococcal Infections in Hospitals

The recommendations proffered to address the epidemic were reasoned and practical. They are extraordinarily similar to the many recommendations made of late to fight the current epidemic of MRSA. They make me realize that we have known for a long time how to limit the spread of infections. We just don’t.

What goes around comes around

The recent explosion of so-called community-associated MRSA is associated with strains possessing a virulence factor referred to as Panton-Valentine leucocidin (PVL). While not well understood, PVL is associated with the ability to cause severe soft tissue infections.

Phage type 80/81 strains possessed PVL and recent modern genetic analysis of a community-acquired strain of MRSA prevalent in the South Pacific reveals that it is Phage type 80/81 that has acquired the gene that confers methicillin resistance. The exact organism responsible for large epidemics in the 1950s hospitals has evolved into a community-associated MRSA causing problems in the South Pacific in 2008. Do we really believe that identifying and decolonizing hospitalized individuals with MRSA is a practical solution to this problem?