Drug Resistance, What is It and What Does The WHO Have To Do With It?

Perhaps it would be easier to start with exactly what the WHO is and what it does. It's a given Roger Daltrey will NOT be part of the hub mob this week, perhaps next week? The World Health Organization, (WHO), was founded in April of 1948. The WHO mission is as follows: "is the attainment by all peoples of the highest possible level of health" but its main mission in life is the combat against diseases. It as the Who that announced that after two years of studying smallpox they had successfully eradicated that disease. Unfortunately, this specific disease was saved, frozen and now this disease it is rearing its head again. Anyone who received the smallpox vaccine over 30 years ago has been advised to retake this vaccine, as it may no longer be of any use. The Who also states polio in third world countries will be eradicated within the next few years. Perhaps the best-known work from the WHO is with HIV. The HIV has developed a standard for Zimbabwe in 2006.

Perhaps one of the least known facts about what the WHO does concerns the standardization of results for anyone who takes the prescription drug Coumadin for any multitude of problems. Before the WHO, anyone who traveled to another country would have to get lab work taken due to the anticoagulant drug, Coumadin and what one physician feels is appropriate for that disease process may not be what another physician wants. This standard test is known as the international normalized ratio (INR).If a person is taking Coumadin for a history of a stroke, their INR will be different from a person who is taking Coumadin for a carotid stent or a pacemaker. However, regardless of that, if you take warfarin (Coumadin) and travel outside of your own country, you do not have to worry that your INR will not be regulated according to the way your physician wishes and that should be very reassuring.

The Who is always on the frontline with any outbreak of major infectious diseases such as malaria, tuberculosis and Sars however they also work with making sure children in poverty-ridden countries get the fresh fruits and vegetables they need to prevent malnutrition. Until 2009, the Who also felt they had the influenza vaccines under control. The WHO is even working on research concerning whether cell phones are dangerous for our health.

The important thing to remember about drug resistance is that it started with bacteria. In addition, the fight against bacteria, although it has been ongoing from the first time a human being got an infected cut, really took off with the work of the Pasteur's and their discovery of Penicillin. Then along comes World WAR II and that is the beginning of drug resistance. Admittedly, it is a couple of decades before it is tracked back to WWII and penicillin, but that is where it begins.

Interested? Skeptical? Lost? :) Don't worry, so were many, many nurses and other healthcare professionals including; dare I say it????

Oh, why not go for broke. YES!!!!!!!! EVEN DOCS!!!!

That is funny. (All nurses snicker.....)

At first the bacteria that everyone focused on was staphylococcus aureus. It's so pretty, too, and such a beautiful name. Reminds one of Egon, from The Ghostbuster's, doesn't it? Because only a researcher who truly LOVED his work would name the most common, most deadly, most readily changeable, hardest to eradicate bacteria "The Golden Seed".

Nonetheless, we cannot live without staph, either. Nor streptococcus, E. Coli, psuedomonas, Klebsiella (don't you just dig that name?) Kelbsiella pneumonii. Too Cool.

Switch gears here; pretend you are a gorgeous golden seed, looking for a new home. You have grown bored living in, on and around all objects, innate and organic (I didn't tell you that? Oh yea, Dude, virus' they die, bacteria? They are indestructible!) It takes a long time, eons, in fact, but that is OK, staph are patient, they wait. Then oh joy! Here comes a war!!! Always a wonderful opportunity for anyone or anything who are not adverse to making a profit off of death, infection, famine, destruction....stop it Bethard...this is not about that topic!

Sorry.

The physicians and the nurses are working tirelessly; saving lives that otherwise would never have survived. They deserve our heartfelt thanks and nothing we, as humans, can ever say or do will ever express our gratitude.

However, switch your head back to being 'staph.' See, along with open wounds of any kind come the high risk of infection. Most of the time Staph and its buddies do the job they are intended to do, keep us alive. Weird, I know. But given the correct scenario, bacteria of any kind, and in this case, staph in particular, becomes our enemy and cause severe infections.

With the discovery of penicillin, staphylococcus aureus was stymied!

"What is this stuff? We've never had our territory threatened! What do we do? Boss? Boss? Where did Boss go?"

Boss was laying low, trying to figure out what to do next. It did not take long. Gotta hand it to those bacteria, dude they are smart little buggies! Ha a pun…

Staphylococcus Aureus learns how to build a wall to stop penicillin from getting inside and killing them. Then, staph, being the generous boss that he is teaches all the other bacteria how and what to do to stop any and all antibiotics from causing any of them any problems.

Now, just before all you physicians and new nurses file for libel, please remember I am taking a huge poetic license here just to make my point OK? I’m on our side here.

Guess what the researchers, the physicians, and the nurses do then? Rally around? Work as a team? At least call up the infection control nurses and pick their brains?

Uh, nope.

We decide the CAUSE of this entire drug resistant phenomenon,” now called MRSA (methicillin resistant staphylococcus aureus)   has to be all of those nurses in the nursing homes because anyone who is anyone knows they are like some of the worst nurses in the world! Then, when that tactic failed, they decided it was the cause of all of the home health nurses out there because let’s admit it all they do is ride around all day and like do nothing but eat and drink and talk on their cell phones all day! Then, when they were mobbed and beheaded by the nurses who have certifications in geriatrics and home health from the American Nurses Credentialing Centers…. OK OK No, we didn’t behead anyone………yet...  J   Then finally, the infection control physicians really began to study the problem.

Come to find out this is how it goes:

·         Bacteria do their normal thing

·         Infection occurs, infections starts with air hitting blood and guts

·         Physicians and nurses do their thing, keep it clean and dry, cut away the necrotic parts, start the antibiotic of choice (PCN, only one at the time)

·         Bacteria scratch their respective heads for a bit, light bulb goes off and they develop RESISTANCE!

·         Physicians and nurse get really down, man, penicillin no longer working; but their scratch their respective heads and Voila! They find a newer and better antibiotic!

·         Bacteria are killed.

·         Bacteria don’t even have to scratch their respective heads this time; they are older, smarter and they far outnumber humans! They develop a resistance to the new antibiotic!

·          Physicians and researchers keep it up and man do they come up with some fantastic antibiotics! Some so strong you’d think we’d all of us would have to be living in bubbles by now! They should have killed off every single naturally occurring bacteria in the world!

·         Unfortunately, this is not to be.

·         So acronyms are the only thing left to do right? Hence MRSA (mur-sa or ma-riss-ah) however you like to pronounce it or just shout out the letters.

·         Of course not. Once the researchers, the physicians, and the nurses are educated, in serviced, and made aware we begin to fight back.

·         Want to know how? Ah, come on! Take a wild guess!  Bet you already know!

·         Yes! I knew you could do it! What else is ther to do but go to the sink, grab the soap and water and wash our hands!

·         “I’m gonna wash that [germ] right outta my [life]!” I apologize South Pacific fans J

It isn't just drug resistance or MRSA, it's the fact that all of us have helped create the mess we are in now. I know, I didn't tell you guys that either. Well, it is hard you know, I mean, there are probably some of you that have been so lucky you have never had to take an antibiotic of any kind in your life! Nevertheless, it doesnt matter, you are just as culpable. Because the bacteria are smart. They know if they don’t find a way to stop us from killing them, its lights out for the germy world, as they know it. Can’t you see them now, in their little forums, typing away about how best to eradicate the human race?

"We have to get them all as a group man or else there will always be some too strong (immunologically speaking)for us to kill off"!

"Calm down over there E Coli! You always were the first one of us to run off!"

(HAHAHA to any of you who caught that)

Because bacteria of all kinds are in us, around us, on us...everywhere!!!! There's the rub. It helped that people like myself, small, sensitive digestive system, doesn’t eat like I should, gets sick as a dog on those horse pills they call antibiotics and take as many as I can choke down then stop. It really doesn’t help that there are some who take them without any problems then start to feel great and stop taking the antibiotics. And it really doesn’t help that there are little old people on fixed incomes who know they will get the same stupid infection in a few months so when they feel just a little bit better they hoard their antibiotics for "just in case"

Sounds familiar doesn't it?

Don't give me that look! I know man, I have been there, seen and heard this and so many other excuses for not taking every last single stupid antibiotic that I wouldn’t even have to win the lottery if only I had a half penny for every excuse I have ever heard for not taking antibiotics and all of my loved ones would be set for life!

That has to be a record for the longest sentence yet...can we get a hubmob on that? :)

Sorry...I am car lagged I think. Plus the fact that Dog, the cat, is finally crashed after five days...but I will write that for you guys later; much.

Finally, the researchers and the infection control physicians come up with one wonderful antibiotic. That one antibiotic is specifically set to stop MRSA in its tracks.

Vancomycin (derived from the name 'vanquished" (Americans are anything if not optimistic, eh?) and metronidazole are the same drug. It has it's pros and it has it's cons. Red Man Syndrome is one "con" every nurse became extremely familiar with when this antibiotic was first introduced! In addition, regardless of the amount of fluid in the intravenous bag, if you are a home health nurse, it cannot be given in LESS THAN sixty minutes! Add to that if it is given through an ordinary peripherally inserted IV needle, it is so caustic it can cause the tissue around the vein to die if the IV becomes dislodged. That is why if you are going to receive Vancomycin, it will probably be given through a PICC (peripherally inserted Central Catheter) or a Groshong (Central Line IV).

Enough of all of this...I can hear you guys gagging  :)

The best part of being part of healthcare in any form is knowing that everyone is striving for the number one axiom:

"FIRST, DO NO HARM!"

In 2004, the WHO brought together the Health alliances of Great Britain and the United States to join forces and prevent adverse reactions from drugs among patents under the direction of healthcare at any time. A huge undertaking for anyone or any one organization, to be sure and yet, they were then and they are continuing to perform an excellent job. It is because of these persons and the alliance that more antibiotics for other resistant bacteria have been developed.

Unfortunately, the world of the GERM is also a great adversary and more work is ahead. Besides MRSA. There are resistant forms of tuberculosis, pneumonia, otitis media, and gonorrhea, just to name a few.

The most recent and the most important all to us, which the World Health Organization has done, is help to eradicate the amount of antibiotics given to animals used in the production of our food.

Moreover, of all of those, the poultry industry is he best known of these changes. Cipro (Ciprofloxacin) was widely used as an antibiotic in the poultry industry until it developed a resistance to y bacteria, especially those of lung infections. Because of this type of early study, not only did the WHO have to focus its attention on the human use of antibiotics and drug resistant antibiotics they have had to turn their attention to the animal use of antibiotics as our food chain! You see, the animals grown for food took the antibiotics, the bacteria get smart, we ate the animals that took the now smart antibiotic, we got sick, and the bacteria sat back and grinned the entire time!

Complicated isn’t it?

What is the point of this long drawn out lecture/nurses teaching/ugh-y better never to have known information?

Glad you asked   :) 

1.     Antibiotics will NOT do anything for a virus. A cold is a virus, so do NOT ask your Doctor for an antibiotic! What cures the common cold? Seven to ten days. I know, a bad joke, nonetheless…

2.     Antibiotics work BEST after a culture and sensitivity are performed. That means the nurse, on the physicians orders, takes a swab, gets a piece of the pus or junk out of your whatever is infected part, sends it to the lab, they spread it on a Petri dish, stick it in the warm, dark micro box and wait.

3.     Tick Tock Tick Tock.

4.     Three days later the microbiologists takes out your Petri dish, now looking ever so nice, sorta like that  “Saturday Night Live “ segment
“:What’s this in the fridge?”    “What’s it look like?”    “Oh, I don’t know, kinda green and fuzzy”   “Leave it in there!”

5.     The Microbiologists takes a specimen, spreads it onto a micro slide, put it under a microscope and voila, there you see the specific bacteria from your infected area! Then the microbiologist goes one-step further and isolates exactly which antibiotic will do the best job of “Vanquishing”) loved that segue didn’t you?) your specific infection!

6.     Only one problem….it takes three days and during that time what do you get? Chicken soup and lots of fluids and bed rest.

7.     Well, that is the IDEAL way to diagnose and prescribe the best antibiotic, I didn’t say it’s the way it’s always done

Therefore, now what is our and everyone’s answer to “first, do no harm?” Wash your hands frequently and often, use good hygiene and excellent housekeeping skills, see your doctor regularly and use your own good common sense. If you are sick, stay home. If you get an obvious infection from a cut, a sore that won’t heal, continued fever or cough, continued gastric distress like diarrhea, that never goes away or goes away but comes right back….what do you do?

Right-On!

Go see your physician!

You guys are so smart!