Bacteria, resistant strains

Aminosalicylic acid is a structural analog of pava-aminobenzoic acid, and has the same mechanism of action as the sulfonamides fsee Chapter 43). Nonetheless, the sulfonamides are ineffective against M. tuberculosis, and aminosalicylic acid is inactive against sulfonamide-susceptible bacteria. Resistant strains of tubercle bacilli emerge slowly in patients treated with aminosalicylic acid. 

Development of Resistance. One of the principal disadvantages of sulfonamide therapy is the emergence of dmg-resistant strains of bacteria. Resistance develops by several mechanisms overproduction of PABA (38) altered permeabiUty of the organisms to sulfonamides (39) and reduced affinity of dihydropteroate synthetase for sulfonamides while the affinity for PABA is retained (40). Sulfonamides also show cross-resistance to other sulfonamides but not to other antibacterials. In plasmodia, resistance may occur by means of a bypass mechanism in which the organisms can use preformed foHc acid (41). 

Resistance to Tetracyclines. The tetracyclines stiU provide inexpensive and effective treatment for several microbial infections, but the emergence of acquired resistance to this class of antibiotic has limited their clinical usehilness. Studies to define the molecular basis of resistance are underway so that derivatives having improved antibacterial spectra and less susceptibiUty to bacterial resistance may be developed. Tetracyclines are antibiotics of choice for relatively few human infections encountered in daily clinical practice (104), largely as a result of the emergence of acquired tetracycline-resistance among clinically important bacteria (88,105,106). Acquired resistance occurs when resistant strains emerge from previously sensitive bacterial populations by acquisition of resistance genes which usually reside in plasmids and/or transposons (88,106,107). Furthermore, resistance deterrninants contained in transposons spread to, and become estabUshed in, diverse bacterial species (106). 

Bactericides are substances that destroy bacteria, and they can be used in various ways. They may be incorporated into the soluble-oil concentrate, either at concentrations suitable to protect the oil in storage, or at levels sufficient to provide a persistent bactericidal effect on the emulsion in service. The cost of providing sufficient bactericide to cover the use of the soluble oil at a high dilution might prove prohibitive. Continued use of the same bactericide may produce resistant strains of bacteria. 

Closely related to the penicillins are the cephalosporins, a group of /3-lactam antibiotics that contain an unsaturated six-membered, sulfur-containing ring. Cephalexin, marketed under the trade name Keflex, is an example. Cephalosporins generally have much greater antibacterial activity than penicillins, particularly against resistant strains of bacteria. 

Because the natural penicillins have been used for many years, drug-resistant strains of microorganisms have developed, making the natural penicillins less effective than some of the newer antibiotics in treating a broad range of infections. Bacterial resistance has occurred within tire penicillins. Bacterial resistance is the ability of bacteria to produce substances that inactivate or destroy the penicillin. One example of bacterial resistance is tiie ability of certain bacteria to produce penicillinase, an enzyme that inactivates penicillin. The penicillinase-resistant penicillins were developed to combat this problem. 

Promoting Optimal Response to Therapy The results of a culture and sensitivity test take several days because time must be allowed for the bacteria to grow on the culture media However, infections are treated as soon as possible In a few instances, the primary health care provider may determine that a penicillin is the treatment of choice until the results of the culture and sensitivity tests are known. In many instances, the primary health care provider selects a broad-spectrum antibiotic (ie, an antibiotic that is effective against many types or strains of bacteria) for initial treatment because of the many penicillin-resistant strains of microorganisms. 

In the recently released book on worldwide compliance issues (Adherence to Long-term Therapies, Evidence for Action),7 published by the World Health Organization, researchers indicate that the problem of noncompliance is worse in countries in the developing world than in countries in the industrialized world. Many parts of the United States have similar morbidity and mortality rates as countries in the Third World.8 Specific disease states may have significant additional noncompliance ramifications due to the development of drug-resistant strains of bacteria.9 Many times what is necessary is referral to specific clinicians for individualized treatment and monitoring to enhance compliance. The case histories provided in this text will allow you to follow what others have done in similar situations to optimally help patients succeed in improving compliance rates and subsequent positive health outcomes. 

Nevertheless, a rapid disappearance of resistant bacteria was observed after stopping the antibiotic treatment (fig. 5). Different kinetics of disappearance were, however, observed. The aerobic species showed a more rapid return to the baseline sensitive status whereas the anaerobic bacteria, especially the Gram-negative rods, regained sensitivity to rifaximin more slowly. In any case, 3 months after the end of treatment resistant strains were no longer detectable in the feces [82], These results support the cyclic use of rifaximin that has been adopted by the investigators in the treatment of hepatic encephalopathy [77] and colonic diverticular disease [79]. 

Antibiotics are routinely added to animal feed in conventional agriculture. This can have various effects on humans. Direct transmission of antibiotic residues in animal products to people may cause direct toxicity, i.e. allergies, or lead to the emergence of resistant strains of bacteria. Another threat is antibiotic-resistant forms of bacteria harmful to mankind that might appear in animals and pass from them to humans (Smith 1974), or may impart resistance to other bacteria by plasmid or transposon interchange (Franco et al. 1990). The resulting dmg-resistant and harmful micro-organisms can then not be treated successfully (Silverstone 1993). 

An additional disadvantage with many penicillin and cephalosporin antibiotics is that bacteria have developed resistance to the drugs by producing enzymes capable of hydrolysing the P-lactam ring these enzymes are called P-lactamases. This type of resistance still poses serious problems. Indeed, methicillin is no longer used, and antibiotic-resistant strains of the most common infective bacterium Staphylococcus aureus are commonly referred to as MRSA (methicillin-resistant Staphylococcus aureus). The action of P-lactamase enzymes resembles simple base hydrolysis of an amide. 

Tomato canker caused by Xanthomonas can be controlled by the application of tetracycline(52-53). Streptomycin resistant strains of bacteria have Been found on peach, tomato and peppers(54), and the mixture of two antibiotics has helped to stop tHe build-up of resistance in the patho -gens in some cases(55-56). The silvery disease of sugar-beet caused by Coryn 5actferium is insufficiently controlled by mercurial compounds, but is completely eliminated when seeds are dipped for several hours in a solution of streptomycin. 

Since 1977, the Food and Drug Adminstration (FDA) has been considering a ban on the subtherapeutic use of procaine penicillin and tetracyclines in animal feeds. These antibiotics are used in both humans and animals, and any use of an antibiotic that is prescribed for humans presents some risk to human health, whether the use is for humans, animals, or other purposes. The risk is that pathogenic or disease-causing bacteria may develop a strain that resists that antibiotic. The resistant strain of the pathogen then may cause human disease that cannot be treated by this antibiotic. 

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