How can I prevent MRSA?

At present, we have no magic bullet to rid of MRSA. All the novel antibiotics available to fight off this organism are designed only for hospital use. However, one can fight and control this infection by adopting the following defense methods:

 -          washing your hands is the best defense against not only MRSA but all germs

-          Do not share personal items with anyone. MRSA can rapidly spread from contaminated clothing and equipments well as through direct contact

-          If you have a wound, keep it clean and covered. If you are active in sports and have a wound, take a break and let the wound heal

-          regularly wash your linen, esp. gym clothes

-          when you are prescribed antibiotics, finish the course and do not stop half way and share your antibiotics with other people

For the moment, there is no need to get one’s self tested for MRSA. The most cost effective way to control the spread MRSA is washing hands. If these basic hygiene precautions are undertaken, the risks of developing an infection and/or transmission of MRSA are significantly minimized.

Does everyone who gets MRSA become sick?

No,  many healthy individuals have been found to carry staphylococcus in their nose or skin at any given time. While the bacteria do not cause infections, it does become colonized. Once colonized, these bacteria only cause an infection if the individual becomes sick, cuts himself or is involved in a traumatic incident. The majority of healthy individuals who are colonized with MRSA do not become sick but are quite capable of transferring the organism to others by sharing personal care items or by coming in close contact.

Even though several newer antibiotics have been developed to fight off MRSA, experts believe that it is only a matter of time before the staphylococcus develops resistance to these new drugs.

While the vast majority of MRSA are found in the hospital, the community based MRSA has been found in clusters among athletes, law enforcement and military personnel, children and many minority ethnic groups.

Can you tell me what is MRSA?

In the last decade, there has been almost daily news about MRSA or methicillin resistant Staphylococcus aureus outbreaks all over the country. The media hype about this infection has created hysteria among both health care professionals and the public. There have been reports that his bug has caused deaths in other wise healthy individuals and many hospitals have had to close down operating rooms. If so, what is this Superbug; is it that bad and how does one acquire it?

MRSA is caused by the bacteria, staphylococcus or sometimes called staph. About 2 decades ago, a strain of staphylococcus surfaced in hospitals that was very resistant to many antibiotics that were designed to kill it. This led to its name- methicillin resistant staphylococcus or MRSA. MRSA is generally a harmless organism but can also cause serious infections in individuals who are hospitalized. It is also very resistant to most antibiotics, except vancomycin. In the last 7 years, many strains of staphylococcus have also started to show resistance to vancomycin.

For the better part of the past two decades, MRSA was predominantly a hospital based organism; this is not true anymore. MRSA is now widely found in the community. These community associated MRSA do differ slightly from the hospitals strains but can also cause serious skin, soft tissue infections and pneumonias. Most patients who do acquire MRSA in the community have no idea how they acquired the organism.

A new drug for head lice

Head lice are a very common problem in North America and affect many children each year. For years, toxic prescription drugs have been available but now there is a study showing that benzyl alcohol lotion (BAL 5%) is non toxic to the human and can kill lice by suffocating them. This formula may be excellent for use in babies as young as 6 months.

To date lindane has been used but the drug is very toxic and there are always problems with potential brain side effects. Moreover, lice have developed resistance to many other permethrin related compounds.

Other alternatives for head lice which are widely used include mayonnaise, olive oil or petroleum jelly. These homemade remedies all act by suffocating the lice but do not always work as lice are hardy and go into hibernation. As soon as these oils are rinsed, the lice come alive.

In the latest study, BAL 5% applied twice a day for 10 minutes, was well tolerated and without toxicity. The only side effects were mild skin and eye irritation. This is marked contrast to drugs like lindane which cause stinging on skin areas which have been scratched.

So far all experts agree that BAL 5% is a great alternative. The only problem is how much to apply on the head and at what frequency. Researchers say the chemical should be used twice as some eggs may still be viable after the first application.

BAL 5% is only available with a prescription and may not be covered by health insurance or Medicare.

Zanamivir (Relenza) for HINI flu!

Zanamivir (Relenza) is an antiviral drug which is available an inhaler. The product is used with a device called a diskhaler. Relenza is also used to treat swine flu. Like Tamiflu is it only effective when given in the first 48 hours after the symptoms occur. At this time the virus is multiplying fast and once the drug is taken within the first 48 hours, the virus growth can be controlled. For the acute infection, Relenza should be taken for 5 days.

In North America the majority of people who have been infected with HINI have been treated with Tamiflu. However, few individuals with kidney disease and women who are pregnant have been treated with Relenza.

So far the data on the effectiveness of Relenza are lacking. From the few studies that have looked at the effects on Relenza on seasonal flu, it appears that the drug is working fine.

Relenza does not cure HNI but helps to:

- Reduce the intensity of the illness
- Decrease the number of sick days by about 1 day
- May reduce chances of developing complications

In children the benefits of Relenza have not been established. One study did show that Relenza did not prevent children from getting complications like ear infections nor did it reduce the duration of infection.

Zanamivir does have a few side effects, the most common is diarrhea. Moreover, Relenza can also worsen wheezing in asthmatics and should be used with great caution in smokers and people with COPD. Other reported side effects of Relenza include mental confusion, lack of concentration or unusual behavior. It appears that these behavior problems disappear once the drug has been discontinued.

Does Oseltamivir (Tamiflu) work for HINI?

There is some evidence that Tamiflu reduces the chances of acquiring swine flu. However, to prevent swine flu one needs to take the drug for 10 days. The drug is available both as a capsule and a liquid. However, oseltamivir is not frequently used to prevent flu in healthy individuals. The drug is only used to prevent swine flu in high risk individuals who may be at risk for developing complications from the infection after being exposed to someone who definitely has been diagnosed with swine flu. There are some individuals like asthmatics or those with AIDS who can develop serious complications after acquiring swine flu and in only these individuals is Tamiflu given for prevention.

To date, there is no good evidence to show that anti viral drugs like Tamiflu can prevent the infection in the long run. For example, if you take Tamiflu for 10 days, no one knows how long its protective effects last. Unlike a vaccine, these drugs are prohibitively expensive and one needs to take repeated courses to prevent the virus from causing an infection.

Moreover, there is always the possibility that the virus may mutate and change its shape and no longer be sensitive to the drug. Already cases of the mutated swine flu virus have been reported and these strains are resistant to Tamiflu.

Like all drugs, developing resistance to Tamiflu is a major concern.

Finally, Tamiflu also has side effects like nausea, vomiting and diarrhea. Thus, long term use may make the individual more prone to drug induced complications.

End point: Tamiflu is not 100 percent effective in prevention of the swine flu. From the few studies published the drug may reduce your chances of acquiring swine flu by 50-70 percent. One should also remember that many studies on Tamiflu are being conducted by people who are being paid by the makers of the drug- so there is always a bias in reporting.

What is best treatment for my warts? part 2

Over the last few years, several clinical trials have been done comparing salicylic acid, a sugar pill and cryotherapy. Surprisingly, application of salicylic acid was much better than a sugar pill and even better than cryotherapy.

Several studies showed that cryotherapy was crap- it did nothing. Two studies showed that duct tape with cryotherapy was no good either. So for anyone with warts, at least you know what to avoid.

What is also surprising that when the wart was left alone or treated with a sugar pill, the results were comparable to duct tape and cryotherapy. This means that anyone who pays for cryotherapy is a fool.

Even though many new compounds have been released into the market to treat warts, the evidence for 5 fluorouracil, bleomycin, interferon, photodynamic therapy or dinitrochlorobenzene is still not available. In addition, these treatments are also expensive. Just because a drug is new does not mean it will work. Health care workers who always write the latest prescriptions generally do not think logically when it comes to effectiveness. Some health care workers simply write prescriptions for new drugs because they get a paid holidays/gifts by the drug companies.

So what should a consumer do?

There is ample evidence that topical use of salicylic acid is better than most treatments. The warts do take time to disappear, but treatment is readily available and cheap. When it comes to use of cryotherapy, one should rethink about going for more treatment. Evidence currently shows that it does not work, is expensive, and painful. And what about duct tape? – well, use it to seal air leaks in your home.

http://www.cochrane.org/reviews/en/ab001781.html