Overuse of antibiotics harming India's fight against TB: The Lancet

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India, which is facing the highest burden of tuberculosis (TB) in the world, is also the world's largest consumer of antibiotics, say researchers of Indian-origin in a study, conducted to determine whether pharmacies have contributed to the inappropriate use of antibiotics.

TB is a potentially serious infectious bacterial disease that mainly affects the lungs.

Excess usage of antibiotics has lead to significant antimicrobial resistance that threatens the effective prevention and treatment of TB, as resistant microorganisms (including bacteria, fungi, viruses and parasites) are able to withstand attack by the antimicrobial drugs.

The findings showed that pharmacies frequently dispensed antibiotics to simulated patients who presented with typical TB symptoms.

However, none of the pharmacies dispensed first-line anti-tuberculosis drugs without prescriptions.

Antibiotics and steroids (which can be harmful to individuals who actually have TB), were dispensed only when the patient presented with a lab test confirming TB, thus making the diagnosis apparent to the pharmacist, the study said.

"Our study clearly showed that not a single pharmacy gave away first line anti-TB drugs (isoniazid, rifampicin, ethambutol, pyrazinamide and streptomycin) without prescriptions," said Madhukar Pai, Canada Research Chair at McGill University, in Quebec, Canada.

"However, pharmacists gave away other antibiotics and rarely referred patients with typical TB symptoms, and that means they are contributing to delays in TB diagnosis," Pai added.

This can increase transmission of the infection in the community. So, there is great potential to harness pharmacists to identify those who need TB testing in India, the researchers said.

For the study, the team used two standardised patient cases, one with a patient presenting with two to three weeks of pulmonary TB symptoms and a second with a patient with microbiologically confirmed pulmonary TB.


These trained patients then visited 622 pharmacies in three Indian cities (Delhi, Mumbai, and Patna), completing 1200 interactions with pharmacists

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Source: India Times
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Antibiotics may increase diabetes risk in kids by gmpviolations.com

Parents, take note! Giving antibiotics to children may change the composition of gut microbes and dramatically increase their risk of developing Type 1 diabetes, a new study has warned.

The research focused on the microbiome, the bacterial species in our guts that co-evolved with humans to play roles in digestion, metabolism and immunity, researchers from New York University (NYU) in the US said. As children’s exposure to microbe-killing antibiotics has increased in recent decades, the incidence of autoimmune diseases like Type 1 diabetes has more than doubled. The study found that short pulses of antibiotics cause mice that are susceptible to Type 1 diabetes to develop the disease more quickly and more often. “Our study begins to clarify the mechanisms by which antibiotic-driven changes in gut microbiomes may increase risk for type 1 diabetes,” said Martin Blaser from NYU.

“This work uses non-obese diabetic (NOD) mice, the best model of type 1 diabetes to date, and doses of antibiotics like those received by most children to treat common infections,” said Blaser.

This is the first study of its kind suggesting that antibiotic use can alter the microbiota and have lasting effects on immunological and metabolic development, resulting in autoimmunity, said Jessica Dunne from NYU. Researchers assessed the effects of antibiotic treatment on the development of microbiomes in NOD mice, which are known to be more susceptible to Type 1 diabetes.

They examined the effects of exposure to either continuous low-dose antibiotics or pulsed antibiotic therapy (PAT), which mimics the doses used to treat many infections in children. Specifically, male NOD mice exposed to PAT were found to have twice (53 per cent) the incidence of Type 1 diabetes as control NOD mice (26 per cent incidence) that received no antibiotics, researchers said.

To determine the effects of antibiotics, researchers collected samples of gut bacteria from all study mice. They used genomic and statistical techniques to analyse the millions of pieces of bacterial DNA in the samples. Three-week-old PAT males, for instance, had a nearly complete loss in their intestines of certain bacteria shown in past studies to normally train the immune system.

At all time points in all samples, species diversity in PAT-treated microbiomes was lower than in control mice, and the composition of the bacterial communities differed greatly. The results, which produced immunological changes resembling those seen in the microbe donors, showed that a perturbed microbial population by itself was sufficient to alter the recipient’s immune system. The findings were published in the journal Nature Microbiology.

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Source: indianexpress

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