Hospitals & Asylums
Over-the-counter
Antimicrobial Agent Course for the FDA: A Trade for Organic Antibiotics by the
Holidays HA-20-11-10
By Anthony J.
Sanders
Let the land produce vegetation: seed bearing plants
and trees on the land that bear fruit with seed in it (Genesis 1:11)
1.
The
90 Day Pertussis of 2010
2.
The Antimicrobial Spectrum of Oral Medication
Table 1: Bacterial Infections 2006
Table 2: Mechanisms of Action of Resistance to Major Classes of
Antibacterial Agents
The
Bordetalla pertussis epidemic unleashed by the Patient Protection
and Affordable Care Act of July 2010 P.L.
111-148 has
heightened sensitivity to the compelling need for the Food and Drug
Administration (FDA) to ensure the Commissioner appoints an advisory review
panel to establish an Over-the-counter monograph under 21CFR§330.10
to ensure Americans have safe, effective, adequate and affordable stockpiles of
oral antimicrobial agents, both organic antibiotics and synthetics, as well as
appropriately labeled antimicrobial cleaning supplies and detergent. Only then will the people and primary care
physicians stop calling the Act the “Patient Pertussis and Affordable Rheum
Attack of 2010” and call it the “Productive Patient and Affordable Home”. Pertussis, is a highly contagious respiratory infection, with
a distinctive phlegm producing cough, known as whooping cough, that lasts six
weeks with associated rheumatic pains throughout the body. Primary Care Physicians have dubbed this
whooping cough epidemic the “90 day Pertussis” because many cases drag on as
long as three months, probably as the result of re-exposure because one does
not become immune to pertussis without a DTaP (Diptheria and Pertussis) vaccine. Smoke-stopping is recommended by physicians,
but the most important thing, is to avoid being coughed on, fast to avoid all
proteins and get lots of aerobic exercise especially jogging and hiking, bathe
and wash all fabrics and surfaces frequently to disinfect the cloud of
infectious material spread by respiratory phlegm droplets as cloy as tobacco
smoke (Samoss ’10).
To the layman antibiotic consumer Pertussis is discernable from a viral
cold because the Public Health Service has declared a whooping cough
epidemic. Pertussis does not respond to
antibiotics after it has descended to the lungs from the extremely runny nose
of the first week. Unvaccinated persons
who succumb to whooping cough can sterilize Pertussis
against other opportunistic infections and reduce their contagiousness with
a full course of antibiotics.
Vaccination and antibiotics have been effective at controlling the
incidence of pertussis for the past century.
Between 1922-1925 the average annual number of reported cases of Bordetella pertussis was 147,271, by 2001 incidence
of whooping cough had decreased 95 percent to 7,580 (Fisher ’06: 7). Whooping cough kindly does not attack the
heart like the common rheumatic Streptococcus, Pertussis
however increases vulnerability to pneumonia
and can be deadly in infants and small children who are not up to date in their
DTaP vaccination.
All infants and children with a family income of less than 100% poverty
are insured by Medicaid for office visits and DTaP
vaccinations under the Omnibus Budget Reconciliation Act
of 1990 P.L.101-508 (Morone & Jacobs ’05:
277-278).
Having been educated in Western medicine’s Sreptococcus pyrogenes (Group A) by an insured high school junior whose mother abandoned us a month
before I too relocated from Washington State. Physicians prescribing
antibiotics for juveniles for Streptococcus
should issue a refillable script for antibiotics to sterilize their household
against prolonged exposure to Group A or Pertussis. Th that time as
much as $6.66 billion, may have been extorted by Washington State Medicaid
contractors with disputed contracts under color of Doe v. Reed, ultra vires
Washington election law, and the PPC Act, that paid the grossly overfunded
health care system more money without any promise of universal coverage or
primary care reimbursements, in June/July 2010 - $3 billion from Washington
State, $3 billion from the Center for Medicaid, Medicare and SCHIP (CMS) and
$600 million for the border police. To restore efficiency a Medicaid Integrity
Program must be instituted to return Washington Medicaid spending to its
previous low levels of toxicity by protecting patient complaints for the
sovereign immunity of the State budget.
Subsequently the nation has suffered an epidemic of whooping cough. In the
State of Washington, so recently treated its methicillin resistant staphylococcus aureus
(MRSA) with Nafcillin and/or vancomycin (Fisher ’06: 334) the bacteriological
warfare, has become so irritable many college students were hospitalized from a
party and alcoholic, energy drinks have been banned and the FDA has brought
manufacturers to consider a revision of their recipe (Sanders ’10).
One wedding guest returned home to Oregon
after a weekend in Washington to have an extortionate emergency appendectomy of
what was probably a Clostridium
species treatable with penicillin.
Pathology reports were inconclusive.
At only a 4 on the pain scale they should have gone to a family
physician for more than 24 hours before being coerced into surgery as the
result of the paucity of research of the past 100 years. Being one of the only surgeries with no
greater than the 0.1% risk of dying from general anesthetic, and with no known
complications, emergency appendectomies have cost 10% of the population large
sums of money over the past 100 years.
The literature omits prescribing an experimental bacterial sterilization
course of Antibiotics before the Appendectomy, or potentially deadly ruptured
appendix, also treatable with antibiotics.
Appendicitis researchers, suddenly more afraid of mortality than morbidity,
must be given a chance to experiment with Over-the-counter antimicrobial agents
for themselves (Scelza ’10).
Antibiotic resistance amongst physicians is
simply outrageous. One frustrated
caregiver complained to an ethicist, “My mother’s doctor is refusing to give
her antibiotics. He says that she’s
ninety-two and an infection will kill her sooner or later, so it might as well
be this infection” (Smith ’00: 1). If doctors
are going to cause scarcity in the supply of antibiotics and immunizations to
perform extraordinarily expensive and unnecessary procedures and CMS
contractors are going to wage bacteriologic warfare when it’s not flu season,
millions of uninsured, non-immunized Americans must be allowed to purchase
safe, effective, understandable and affordable courses of organic antibiotics
over-the-counter, to avoid re-exposure to Western military medicine. To be a member of the Hospitals & Asylums
revolution, it has been dissembled that one may not pay any health insurance
premiums because only the sick are due any credit for acts of healing (Sanders
’10).
2.
The
Antimicrobial Spectrum of Oral Medication
Bacterial
cells are prokaryotes, which lack nuclei and endoplasmic reticulum. Their cell walls are relatively rigid,
composed either of two phospholipid bilayers with a peptidoglycan layer
sandwiched in between (gram-negative species) or of a single bilayer covered by
peptidoglycan (gram positive bacteria).
Bacteria synthesize their own DNA, RNA and proteins but depend on their
host for favorable growth conditions. (Cotran et al
’94: 306). There are 10 times more microbes than human
cells in our bodies (Zimmer ‘08).
Humans live in symbiosis with an estimated 1014.001 bacteria. Normal persons carry 1012 bacteria
on the skin, including the Staphylococcus, we do most of our hand-washing to protect
against, epidermidis
and Propionibacterium
acnes, the agent responsible for
adolescent pimples. Normally, 1014 bacteria
reside inside the gastrointestinal tract, 99.9% of which are anaerobic, including
Bacteroides
species (Cotran et al ’94: 306). Without these symbiotic gut flora humans
would not gain any nutrition from their food and die. Other bacteria are necessary for the proper
functioning of certain joints.
There is
an international effort to catalogue thousands of new microbe species by
gathering their DNA sequences. They’re finding
that the micro-biome does a lot to keep us in good health. Micro-biome first came to
light in the mid-1600s, when the Dutch lens-grinder Antonie
van Leeuwenhoek scraped the scum off his teeth, placed it under a microscope
and discovered that it contained swimming creatures. A number of teams are working together to tackle this problem in a
systematic way. The biggest of these initiatives is known as the Human Microbiome Project. The $150 million initiative was started
in 2007 by the National Institutes of Health. The project team
is gathering samples from 18 different sites on the bodies of 300 volunteers
and are sequencing the entire genomes of some 900 species that have been
cultivated in the lab. Before the project, scientists had only sequenced about
20 species in the microbiome. The scientists
published details on the first 178 genomes. They discovered 29,693 genes that
are unlike any known genes. The entire human genome contains only around 20,000
protein-coding genes. In the mouth alone, there are between 500 and 1,000
species (Zimmer ’08).
Next to viruses, bacteria are the most frequent and diverse class of naturally
occurring human pathogens (Cotran et al ’94: 306) but
this may not hold true as our understanding of the microbiome
increases.
The
development of drugs able to prevent and cure bacterial infections is one of
the twentieth century’s major contributions to human longevity and quality of
life. The term antibiotics literally
means “against life” in this case against microbes. There are many types of antibiotics, antibacterials, antivirals, antifungals and antiparasitics. Some
drugs are effective against many organisms, these are
called broad-specturm antibiotics. Others are effective against just a few
organisms and are called narrow-spectrum antibiotics. The most commonly used antibiotics are antibacterials (Fisher ’06: 136). In 1920, British scientist Alexander Fleming
was working in his laboratory at St. Mary’s Hospital in London when almost by accident, he discovered a naturally growing substance that
could attack certain bacteria. In one of
his experiments Fleming observed colonies of the common staphylococcus aureaus bacteria that had
been worn down or killed by mold growing on the same plate or petrie dish. He determined that the mold made a substance
that could dissolve the bacteria. He
called this substance penicillin,
after the Penicillium mold that made it, by 1941 they
recognized even small doses of penicillin
cured bacterial infections and Fleming was awarded the
Nobel Prize in Physiology and Medicine. During World War II antibiotics came
into use curing battlefield wound infections and pneumonia. By the mid-to
late 1940s it became widely accessible for the general public. Before antibiotics 90% of children with
bacterial meningitis died, strep throat was at times a fatal disease (fisher
’06: 139).
Antibacterial
agents are among the most commonly prescribed drugs of any kind worldwide. At least 150 million antibiotic prescriptions
are written in the United States each year, many of them for chidren. Use of
antibacterial agents in hospitals in the United States accounts for 20 to 50
percent of all drug costs and represents the largest expenditure for any
pharmacologic class. In the outpatient
setting, the costs of antibacterial drugs are second only to those of
cardiovascular agents. A survey of
office-based physician found that between 1980 and 1992 there was a marked
increase in the use of expensive broad spectrum antimicrobials. It is not unusual for the purchase cost in
1995 of a newer parenteral antibiotic to be $1,000 to $2,000 for a 10 to 14 day
course of treatment. Therapy with a new
oral antibiotic can easily cost $50 to $60.
The cost of an office visit to get a prescription, administrative costs,
monitoring costs and pharmacy charges must be added to these figures for a
start-up fee for an as needed refillable prescription of around $150 dollars (Fauci et al ’98: 869).
Table
1: Bacterial Infections 2006
|
Bacteria |
Infections |
Usual
Antibiotic |
Comments |
|
Actinomyces israelii |
Actinomycosis, lumpy jaw
disease, abscesses |
Penicillin |
An anaerobic infection |
|
Arcanobacterium haemolyticum |
Pharyngitis |
Erythromycin |
Rash similar to scarlet fever |
|
Bacillus anthracis |
Anthrax |
Penicillin, ciprofloxacin, doxycycline |
Rate in nature; was used as a
bioterrorism weapon |
|
Bacillus cereus |
Diarrhea |
Supportive care |
Food borne |
|
Bacteroides species |
Abscesses |
Metronidazole |
Anaerobes; part of normal flora of the
bowel |
|
Bartonella henselae |
Cat-scratch disease |
None or azithromycin |
Kittens are the usual transmitters |
|
Bordetella pertussis |
Whooping cough |
Erythromycin, azithromycin |
Infection can be prevented by
immunization |
|
Borrelia burgdorferi |
Lyme disease |
Doxycycline, amoxicillin, ceftriaxone |
Transmitted by ticks |
|
Borrelia recurrentis |
Relapsing fever |
Penicillin |
Transmitted by body live and ticks |
|
Brucella species: abortus, melitensis, suis, canis |
Brucellosis: flu-like symptoms |
Doxycycline |
Rare in the United States; acquired by
animal contract or drinking unpasteurized milk |
|
Burkholderia cepacia |
Pneumonia |
Meropenem |
Causes illness in people with cystic
fibrosis or chronic granulomatous disease |
|
Campylobacter species: fetus, jejuni, coli |
Diarrhea |
Azithromycin |
Transmitted by food and animals |
|
Chlamydia psittaci |
Psittacocis (pneumonia) |
Doxycycline |
Acquired from birds |
|
Chlamydia trachomatis |
Genital tract infection, newborn
conjunctivitis, infant pneumonia, trachoma |
Erythromycin, doxycycline |
Sexually transmitted infection; newborns
are infected during birth; trachoma rare in the United States |
|
Clostridium botulinum |
Botulism |
Supportive care; antitoxin or antibody |
Food-borne and infant botulism |
|
Clostridium difficile |
Diarrhea |
Stop antibiotics, metronidazole |
Occurs in people who have been on
anti-biotics |
|
Clostridium perfringens |
Food poisoning, diarrhea |
Supportive care |
Food-borne infection |
|
Clostridium species: perfringens, sordellii, septicum, novyi |
Gas gangrene |
Surgery, penicillin |
Anaerobic bacteria; uncommon infection
of muscles |
|
Clostridium tetanus |
Lockjaw |
Antitoxin, metronidazole |
Rare in United States because of
immunization |
|
Corynebacterium diphtherieae |
Diptheria |
Antitoxin, erythromycin |
Rare in the United States because of
immunization |
|
Escherichia coli |
Sepsis, meningitis, urinary tract
infection, diarrhea, others |
Depends on the site of infection |
Can be part of normal flora of the
bowel |
|
Francisella tularensis |
Tularemia |
Streptomycin |
Transmitted by fleas or ticks or
contact with infected wild animals |
|
Haemophilus ducreyi |
Chancroid |
Azithromycin |
Sexually transmitted ulcer disease;
unusual in the United States |
|
Haemophilus influenza nontypeable |
Otitis media (ear infection) |
Amoxicillin clavulanate |
Not all ear infections require
antibacterial therapy |
|
Haemophilus influenza
type b |
Meningitis, epiglottis, arthritis,
pneumonia |
Ceftriaxone |
Now rare because of immunization |
|
Helicobacter pylori |
Ulcers |
Combinations: amoxicillin,
tetracycline, metronidazole, clarithromycin |
Persistent infection increase the risk
for cancer |
|
Kingella kingae |
Joint and bone infections |
Penicillin |
Not very common |
|
Legionella pneumophila |
Legionnaries disease
(pneumonia) |
Erythromycin |
Rare in children |
|
Leptospira species |
Leptospirosis: fever, rash, flu-like
illness, organs |
Penicillin, doxycycline |
Acquired through contact with dog or
wild animal urine |
|
Listeria monocytogenes |
Sepsis, meningitis |
Ampicillin |
Occurs in pregnant women, newborns,
and children with immune problems |
|
Moraxella catarrhalis |
Otitis media, sinusitis |
Ampicillin clavulanate |
Not all infections require
antibacterial therapy |
|
Mycobacterium leprae |
Leprosy |
Dapsone |
Rare in the United States |
|
Mycobacerium tuberculosis |
Tubercolosis |
Combinations: isoniazid, pyrazinamide,
rifampin ethambutol |
Most infected people have no symptoms;
one third of the world’ population is infected |
|
Mycoplasma pneumoniae |
Bronchitis, walking pneumonia |
Doxycycline, erythromycin |
Common cause of pneumonia in
school-aged children |
|
Neisseria gonorrhoeae |
Gonorrhea, newborn eye infection, join
infection |
Ceftriaxone, cefixime |
Sexually transmitted infection;
newborns can acquire it during birth |
|
Nocardia species |
Pneumonia, skin |
Trimethoprim sulfamethoxazole |
Serious infection; usually in children
with weakened immunity |
|
Nontuberculous mycobacteria:
Mycobacterium fortuitum, kansasii,
marinum, avium-intracellulare |
Lymph glands in the neck, pneumonia,
blood |
Surgery; antibiotic depends on the
organism and infection |
Lymph node infections in toddlers;
invasive infections in children with weakened immunity |
|
Pasteurella multocida |
Bite wound infection |
Penicillin |
Common in cats and dogs |
|
Prevotella species |
Abscesss (dental and
lung) |
Clindamycin |
Anaerobic; part of normal flora of the
mouth |
|
Salmonella species |
Diarrhea, bone, joint, kidney,
meningitis |
None for diarrhea; depends on site for
other infections |
Acquired by contact with animals or
contaminated foods |
|
Shigella species: sonnei, flexmero. Boydii. dysenteriae |
Diarrhea |
None, trimethoprim sulfamethoxazole,
others |
Food borne or contact with infected
person |
|
Staphylococcus aureus |
Diarrhea, skin, pneumonia, joint,
bone, heart |
Nafcillin, vancomycin; depends on susceptibilities |
Becoming more and more resistant to usual
antibiotics |
|
Steptobacillus agalactiae (group B streptococcus) |
Meningitis, sepsis, pneumonia, skin,
urinary tract infection |
Penicillin |
Serious in babies in pregnant women,
endocarditis in susceptible adults |
|
Streptococcus pneumoniae |
Pneumonia, otitis media (ear
infection), joint infection, meningitis |
Penicillin, ceftriaxone, cefotaxime |
Most serious infection (85%) prevented
by immunization |
|
Streptococcus pyrogenes
(group A streptococcus) |
Pharyngitis, skin, pneumonia, joint |
Penicillin |
Rheumatic fever, rheumatic heart
disease, and glomerulonephritis can follow an infection after a week |
|
Treponema pallidum |
Syphilis |
Penicillin |
Sexually transmitted disease; can
affect the fetus |
|
Ureaplasma urealyticum |
Urethritis |
Doxycycline |
Sexually transmitted disease |
|
Vibrio cholerae |
Diarrhea |
Fluids, doxycycline |
A risk for travelers |
|
Yersinia enterocolitica |
Diarrhea |
Trimethprim sulfamethoxazole |
Food borne from pork, especially
chitterlings |
|
Yersinia pestis |
Plague |
Streptomycin |
Rare in the United States; transmitted
by rodent fleas |
Source: Fisher ’06 Immunizations and Infectious
Diseases pgs. 330 - 334
Numerous
surveys have reported that approximately 50 percent of antibiotic use is in
some way “inappropriate”. Aside from the
monetary cost of unnecessary antibiotics, that would be much less if organic
broad spectrum antibiotics were sold Over-the-counter, there is the 1-4% risk
contracting recurrent Pseudo-membranous
colitis and the excess costs of treating more resistant organisms (Fauci et al ’98: 869).
In the 1970s the CDC’s extensive Study on the Efficacy of Nosocomial
Infection Control found that nosocomial infection rates fell by 32 percent in
hospitals that established programs with organized surveillance and control
activities, a trained, effectual infection-control physician, and one
infection-control practitioner per 250 beds.
In contrast, rates in hospitals without effective programs increased by
18 percent (Fauci et al ’98: 849). The most common
side effect of antibacterial agents are an increase in the prevalence of
naturally occurring antibiotic resistant C.
difficile, which can cause recurrent Pseudo-membranous colitis but is
reluctantly treatable with metronidazole (Fisher
’06: 328, Cotran et al ’94: 795). Nearly 4% of the population
were allergic to the original penicillin, but that rate has gone down to
1%.
Physicians
need to be generous with the refillable prescriptions of broad spectrum
antibiotics and antibacterial agents when treating infectious diseases so their
patients can give the effective antibacterial chemotherapy to the people they
infect, sparing them the cost of the doctor’s visit and incidental unnecessary
exposure to Western medicine. Antibacterial
agents, like all antimicrobial drugs are directed against unique targets not
present in mammalian cells. The goal is
to limit toxicity to the host and maximize chemotherapeutic activity affecting
invading microbes only. There are a
number of mechanisms of antimicrobial action – inhibition of cell-wall
synthesis, inhibition of protein synthesis, inhibition of bacterial metabolism,
inhibition of nucleic acid synthesis or activity and the alteration of
cell-membrane permeability. The term
antibacterial agent refers to all natural, synthetic and semi-synthetic
compounds that kill bacteria or inhibit their growth. The term antibiotic is reserved for those
compounds produced by living organisms (Fauci et al
’98: 856). Used appropriately these drugs
are lifesaving. However, their
indiscriminate use drives up the costs of health, leads to a plethora of side
effects and drug interactions, and fosters the emergence of bacterial
resistance, rendering previously valuable drugs useless. The rational use of antibacterial agents is
dependent on an understanding of their mechanisms of action, pharmacokinetics. Toxicities and interactions, bacterial strategies for resistance,
and bacterial susceptibility in-vitro.
In addition patient-associated parameters, such as the site of infection
and the immune and the excretory status of the host, are critically important
to appropriate therapeutic decisions (Fauci et al
’98: 856).
Antimicobial agents are able
to target bacterial cells but not human cells by a number of different
mechanisms. Some microbes are resistant
or have evolved resistance to all or specific antibiotics. One major difference between bacterial and
mammalian cells is the presence in bacterial cells of a rigid wall external to
the cell membrane. The structure
conferring cell-wall rigidity and resistance to osmnotic
lysis in both gram-positive and gram-negative
bacteria is peptidoglycan, a large, covalently linked sacculus
that surrounds the bacterium.
Chemotherapeutic agents directed at any stage of the synthesis, export,
assembly or cross-linking of peptidoglycan lead to inhibition of bacterial cell
growth and, in most case, to cell death. β-Lactam
antibiotics, penicillins, cephalosporins,
carbapenems and monobactams
are characterized by a four membered β-lactam ring, prevent the
cross-linking reaction called transpeptidation. The β-lactam ring of the antibiotic
forms an irreversible covalent acyl bond with the transpeptide,
known as the penicillin-binding-proteins, preventing the cross-linking
reaction. Virtually all the antibiotics
that inhibit bacterial cell-wall synthesis are bacteriocidal
and eventually result in the cell’s death (Fauci et
al ’98: 859). Bacitracin is a cyclic
peptide antibiotic that inhibits the conversion of the lipid carrier to its
active form that moves the water soluble cyto-plasmic
peptidoglycan subunits through the cell membrane to the cell exterior. Glycopeptides such
as vancomycin and teicoplanin,
are high molecular weight antibiotics that bind to the terminal
D-alanine-D-alanine component of the stem peptide while the subunits are
external to the cell membrane but still linked to the lipid carrier, thus
inhibiting peptidoglycan backbone (Fauci ’98:
856).
Table
2: Mechanisms of Action of Resistance to Major Classes of Antibacterial Agents
|
Antibacterial
Agent |
Major
Cellular Target |
Mechanisms
of Action |
Major
Mechanisms of Resistance |
|
Β-Lactams
(penicillins and cephalosporins) |
Cell
wall |
Inhibit
cell-wall cross-linking |
1.Drug
inactivation β-lactamase 2.
Insensitivity of target (altered penicillin-binding proteins) 3.Decreased
permeability (altered gram-negative out-membrane porins) |
|
Vancomycin |
Cell
wall |
Interferes
with the addition of new cell-wall subunits (muramyl
pentapeptides) |
Alteration
of target (substitution of terminal amino acid of peptidoglycan subunit) |
|
Bacitracin
|
Cell
wall |
Prevents
addition of cell-wall subunits by inhibiting recycling of membrane lipid
carrier |
Not
defined |
|
Macrolides
(erythromycin) |
Protein
synthesis |
Bind
to 50S ribosomal unit |
1.Alteration
of target (ribosomal methylation 2.Drug
interaction 3.Decreased
intracellular drug accumulation (active efflux) |
|
Lincosamides (clindamycin) |
Protein
synthesis |
Bind
to 50S ribosomal unit |
Alteration
of target (ribosomal methylation) |
|
Chloramphenicol |
Protein
synthesis |
Binds
to 50S ribosomal unit |
Drug
inactivation (chloramphenicol acetyltransferase) |
|
Tetracyclines |
Protein
synthesis |
Bind
to 30S ribosomal subunit |
1.Decreased
intracellular drug accumulation (active efflux) 2.Insensitivity
of target |
|
Aminoglycosides
(gentamicin) |
Protein
synthesis |
Bind
to 30S ribosomal subunit |
Drug
inactivation (aminoglycoside-modifying enzyme) |
|
Mupirocin |
Protein
synthesis |
Inhibits
isoleucine tRNA synthetase |
Insensitivity
of target (mutation of target gene or acquisition of gene for new, insensitive
enzyme) |
|
Sulfonamides
and trimethoprim |
Cell
metabolism |
Competitively
inhibit enzymes involved in two steps of folic acid biosynthesis |
Production
of insensitive targets (dihydropteroic acid
[sulfonamides] and dihydrofolic acid [trimethoprim]
that bypass metabolic block |
|
Rifampin |
DNA
synthesis |
Inhibits
DNA dependent RNA polymerase |
Insensitivity
of target (mutation of polymerase gene) |
|
Metronidazole |
DNA
synthesis |
Intracellularly generates
short-lived reactive intermediates by electron transfer system |
Not
defined |
|
Quinolones
(ciprofloxacin) |
DNA
synthesis |
Inhibit
DNA gyrase (A subunit) |
1.Insensitivity
of target (mutation of gyrase genes) 2.
Decreased intracellular drug accumulation (active efflux) |
|
Novobiocin |
DNA
synthesis |
Inhibits
DNA gyrase (B subunit) |
Not
defined |
|
Polymyxins |
Cell
membrane |
Disrupt
membrane permeability by charge alteration |
Not
defined |
|
Gramicidin |
Cell
membrane |
Forms
pores |
Not
defined |
Source: Fauci, et al.
Harrison’s Principles of Internal Medicine. 14th
Edition. 1998. Table 140-1. Pg. 857
Most
of the antibacterial agents that inhibit protein synthesis interact with the
bacterial ribosome. The difference
between the composition of bacterial and mammalian ribosomes gives these
compounds their selectivity.
Aminoglycosides, such as gentamicin, kanamycin, tobramycin,
streptomycin, netilmycin and amikacin,
are a group of structurally related compounds containing three linked hexose
sugars. They exert a bactericidal effect
by binding irreversibly to the 30S subunit of the bacterial ribosome and
blocking initiation of protein synthesis. Spectinosmycin
an aminocyclitol antibiotic, also acts on the 30S
ribosomal subunit but has a different mechanism of action from the
aminoglycosides and is bacteriostatic rather than bactericidal. Macrolides, such as erythromycin,
clarithromycin, and axithromycin, are antibiotics
that consist of a large lactone ring to which sugars are attacked. They bind specifically to the 50S portion of
the bacterial ribosome. After attachment
of mRNA to the initiation site of the 50S subunit becomes bound to the 30S
component to form the 70S ribosomal complex, and protein chain elongation
proceeds, thereby inhibiting protein chain elongation (Fauci
et al ’98: 859).
Lincosamides, such as
clindamycin and lincomycin, although structurally
unrelated to macrolides, bind to a site on the 50S ribosome nearly identical to
the binding site for macrolides, the number and types of bacteria against which
these two groups of agents are active differ.
Chloramphenicaol, a small antibiotic with a
single aromatic ring and short side chain, binds reversibly to the 50S portion
of bacterial ribosome at a site close to but not identical with that of
macrolides or lincosamides, and inhibits peptide bond
formation. Tetracycline, doxycycline and
minocycline, consist of four aromatic rings with various substituent groups,
which interact reversibly with the bacterial 30S ribosomal subunit, blocking
the binding of aminoacyl tRNA
to the mRNA-ribosome complex, but this mechanism is markedly different from
that of the aminoglycosides. Mupirocin, pseudomonic acid, is
produced by the bacterium Pseudomonas Fluorescens and its mechanism of action is unique in
that it inhibits the enzyme isoleucine tRNA synthetase by competing with bacterial isoleucine for its
binding site on the enzyme that is unique to bacteria (Fauci
et al ’98: 858).
The
inhibition of bacterial metabolism is caused by antimetabolites that are
synthetic compounds that interfere with the synthesis of folic acid. Products of the folic acid synthesis pathway
function as coenzymes for the one-carbon transfer reaction that are essential
for the synthesis of thymidine, all purines and several amino acids, inhibition
of folate synthesis leads to cessation of cell growth
and, in some case, bacterial death. The
principal antimetabolites are sulfonamides, such as sulfisoxazole,
sulfadiazine, and sulfamethoxazole, and
trimethoprim. Sulfonamides are
structural analogues of p-aminobenzoic acid (PABA),
one of the three structural components of folic acid, the other two being pteridine and glutamate, the sulfonamides compete with PABA
as substrates for the enzyme.
Trimethoprim is a diaminopyrimidine, a
structural analogue of the pteridine moiety of folic
acid. It is a competitive inhibitor of
the dihydrofolate reductase,
the enzyme responsible for reduction of dihydrofolic
acid to tetrahydrofolic acid.
4.
The Probiotic Microbiome
Anti-biotic
associated colitis, Pseudomembranous
colitis, is an acute colitis characterized by the formation of an adherent
inflammatory pseudomembrane overlying sites of
mucosal injury. It is usually caused by
toxins of Clostridium difficile,
a normal gut commensal. This disease
occurs most often in patients without a background of chronic enteric disease,
following a course of broad spectrum anti-biotic therapy. Nearly all bacterial agents have been
implicated. Presumably toxin-forming
strains flourish following alteration of the normal intestinal flora, the factors favoring the initiation of toxin
production are not understood. The
condition may rarely appear in the absence of antibiotic therapy, typically
after surgery of superimposed on a chronic debilitating illness. Infrequently the small intestine is involved.
Antibiotic associated colitis occurs primarily in adults as an acute of chronic
diarrheal illness, although it has been recorded as a spontaneous infection in young
adults without predisposing influences.
Diagnosis is confirmed by the detection of the C. difficile cytotoxin
in stool. Response to treatment is
usually prompt, but relapse occurs in up to 25% of patients (Cotran et al ’94: 795)
The
morphology of the pseudomembranous colitis derives its name from the
plaque-like adhesion of fibrinopurulent-necrotic
debris and mucus to damaged colonic mucosa, these are not true “membranes”
because the coagulum is not an epithelial layer. Pseudomembrance
formation is not restricted to C. difficile induced colitis, it also may occur following
any severe mucosal injury, as in ischemic colitis, volvulus, and with
necrotizing infections (staphylococci, shigella,
candida, necrotizing enterocolitis). What is striking about C. difficile
toxin induced colitis is the microscopic lesion. The surface epithelium is denuded, and the
superficial lamina propria contains a dense
infiltrate of neturophilis and occasional capillary
fibrin thrombi. Superficially damaged
crypts are distended by a mucopurulent exudate, which
erupts out of the crypt to form a mushrooming cloud that adheres to the damaged
surface, the coalescence of this cloud forms the pseudomembrane
(Cotran et al ’94: 795).
One common sense procedure that many people with
auto-immune disorders of the gut, particularly antibiotic associated colitis that is not treatable by antibiotics,
might benefit from is fecal transplant, otherwise known as bacteriotherapy. More than 15 fecal transplants have been
performed, 13 of which cured their patients.
It is a harmless procedure that one might be able to perform at home
with a healthy loved one, but neither modern or
traditional medicine perform it. In
2008, Khoruts, a gastroenterologist at the University
of Minnesota, took on a patient suffering from a vicious gut infection of Clostridium difficile.
She was crippled by constant diarrhea, which had left her in a wheelchair
wearing diapers. Khoruts treated her with an
assortment of antibiotics, but nothing could stop the bacteria. His patient was
wasting away, losing 60 pounds over the course of eight months. Khoruts decided his patient needed a transplant. But he
didn’t give her a piece of someone else’s intestines, or a stomach, or any
other organ. Instead, he gave her some of her husband’s bacteria. Khoruts mixed a small sample of her husband’s stool with
saline solution and delivered it into her colon. Writing in the ‘Journal of
Clinical Gastroenterology’, Khoruts and his
colleagues reported that her diarrhea vanished in a day. Her Clostridium difficile
infection disappeared as well and has not returned since. The procedure, known as bacteriotherapy
or fecal transplantation, had been carried out a few times over the past few
decades.
Assisted by information and technology of the
Human Genome Project Khoruts and his colleagues were
able to do something previous doctors could not: They took a genetic survey of
the bacteria in her intestines before and after the transplant. Before the
transplant, they found, her gut flora was in a desperate state. “The normal
bacteria just didn’t exist in her,” said Khoruts.
“She was colonised by all sorts of misfits.” Two
weeks after the transplant, the scientists analysed
the microbes again. Her husband’s microbes had taken over. “That community was
able to function and cure her disease in a matter of days,” said Janet Jansson, a microbial ecologist at Lawrence Berkeley
National Laboratory and a co-author of the paper. “I didn’t expect it to work.
The project blew me away” (Zimmer ’08).
The human microbiome has not yet been fully
surveyed, let alone incorporated into standard medical practice, but the Human Microbiome Project holds far greater potential for curing
diseases than the Human Genome Project, whereas 75% of the immune system occurs
in the gut and micriobiomes help to digest all
nutrients so they may be absorbed into the body. The Human Microbiome
Project is even more laborious than the Human Genome Project. After studying 178 distinct genome sequences
29,693 genes that are unlike any of the 20,000 human protein-coding genes
identified in the Human Microbiome Project that faces
complications extracting unmutated bacteria from all
locations deep within its living hosts (Zimmer ’08). The Microbiome
Project already offers a promising
and harmless bacteriotherapy of fecal transplant that
might cure even antibiotic resistant auto-immune diseases at little or no cost
(Cotran et al ’94: 306). The digestive system is reputed to be 75% of
the immune system.
For
bacterial infections originating in the gut garlic is a natural antibiotic,
while live culture acidophilus yoghurt is a natural pro-biotic. Proteins, such as milk, meat, beans and
chilies are however likely to foster enterococcal infections in endocarditis and should be avoided.
Bacterial infections of the lung, such as Steptococcus pyrogenes and Bordetella pertussis are highly contagious, spread by cough droplets, and can
live in fabrics for lengthy periods of time, and spread from a shirt to couch,
but can be washed in hot water or with antimicrobial detergent, unlike plaque causing chemical dyes. The sometimes undetectable infection of the
lung often triggers rheumatic pains in other parts of the body. Protein, inactivity, and sedentary employment
aggravate rheumatic conditions greatly.
Vigorous sustained exercise is needed.
All day hiking and camping in a tent, with clean clothes and sleeping
bag, tends to eliminate Streptococcus but
not Pertussis. If Pertussis is not
treated with antibiotics while a runny nose, barely distinguishable from a
common viral cold, descends into the lungs as a whooping cough for six weeks,
and is possibly deadly to newborns and small children unvaccinated with routine
DTaP (Diptheria and
Pertussis) vaccine routinely administered at the ages of 2, 4 and 6 months
again at 15 to 18 months, 4 to 6 years and at specified intervals for DTP, DTaP and tdap generations of
vaccines, thereafter (Fisher ’06:24).
Both
Group A and B Streptococcus cause rheumatic heart disease in auto-immune
heart patients, Group A that causes strep throat in young adults, waits a week
after all nasal symptoms stop, while Group B that is dangerous to children and
pregnant mothers causes a more instant rheumatic infection. Both interact with a resurgence of the
underlying enterococcal
infections that cause endocarditis. Toxic
shock syndrome may result from the mixture of Staphylococcus aureau, a leading cause of
food poisoning that occurs in the skin, and Streptococcus pyogenes
(Group A), so shower frequently, wash your hands and your vegetables
carefully and exercise. Garlic is a
natural antibiotic, avoid protein, beans, chilies,
milk and meats that take from 1 to 3 weeks to digest while vegan fare is
excreted in one day and fish in 3. Antibiotics have greatly helped to bring the
mortality rate of rheumatic heart disease
down in to the United States from 20.6 per 100,000 in 1940 to 2.2 in 1982 (Cotran et al ’94: 547).
Auto-immune heart patients are susceptible to bacterial infections that
leave residue called “vegetations”. They must be kept on a strictly vegan diet,
with lots of exercise and no beans, potatoes or chilies, until the “vegetation”
undergoes cellular death, decomposes and is washed away. All auto-immune patients should possess a
refillable prescription for a low cost course of broad spectrum antibiotic like
penicillin, ampicillin or erythromycin or
metronidazole for bacterial
infections complicated by antibiotic
associated colitis (Fisher ’06:
328-329). If there is any good reason
that these antibiotics should not be sold Over-the-counter let them be
explained on the package for the consumer to make an educated purchase, wait at
least a week between courses if there is recurrent bacterial infection and stop
if they develop a rash, fever, colitis, or sense a pseudomembrane
in their colon (Cotran et al ’94: 795).
This
course on antibiotics has challenged no less than 15 hours of vestigial
post-Internet medical transcription from pathology, internal and family medicine
textbooks, gained a better understanding of the
microbial spectrum and is fair trade for a refillable prescription for a low
cost generic refillable prescription for any organic broad spectrum penicillin or analogue in stock. I pray this petition is as inspiring of your
respect of Western medicine as it was for mine.
Maybe the Primary Care Physicians of the Community Health Center will
accept this copyright in trade for a prescription for penicillin. Hospitals &
Asylums is down to two erythromycin, recommended for pertussis. My Streptococci and Enterococci demand for penicillin
is nearly as urgent and more easily fulfilled than Haiti’s Vibrio cholerae is for doxycycline (Fisher ’06: 364). My aim is true and the Community Health
Center might not only have a responsibility to supply the family members of
their vaccinated and highly exposed workers with antibiotics but might purchase
this copyright in trade for a prescription for penicillin to allow their ad
hoc ethical review board (ERB) to petition the FDA for Over-the-counter
antibiotics for everyone. No Hospital
can suffer a bacterial infection to live or the healing environment would be
ruined for everyone. Nor, as this viability study has proven, is it acceptable
for a West Coast health institution to pose as an Ethics Committee when an
Ethical Review Board (ERB) better describes the politics. Please restock
Hospitals & Asylums with safe, low cost, highly effective, generic broad
spectrum organic antibiotics, to cure a vegan.
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