Start looking for another way to treat those pimples

Our love affair with antibiotics just keeps taking its toll.

A recent MSNBC piece, "Super acne? Drug-resistant zits on the rise," quotes several dermatologists as saying that Propionibacterium acnes is not as easily cowed by the drugs tetracycline and erythromycin as it once was.

The story states: "As antibiotic-resistant acne becomes a growing concern, dermatologists are moving away from using antibiotics as a primary weapon against acne, fearing that the long-held go-to treatments may be contributing to communal antibiotic resistance. If they do prescribe antibiotics, it may be for only a limited time, usually a few months, and it's often combined with another medication that can lessen the drug resistance. Previously, patients might have continued on antibiotics for years."

The piece goes on to point out that the bigger, more serious issue is one of antibiotic resistance in general.

Here's an earlier warning from WebMD: "Drug-resistant acne: All in the family; antibiotic-resistant acne germ can spread within families."

Another one from NPR: "Doubts raised over antibiotic use for acne."

And still an earlier one from the British Journal of Dermatology: "Antibiotic-resistant acne: lessons from Europe."

-- Tami Dennis

Photo: Take care of your skin. Antibiotics may become less useful in that respect. Credit: Al Seib / Los Angeles Times

Antibiotic-resistant salmonella? Not this time

There was one lucky break in the ongoing salmonella outbreak that has so far led to 637 confirmed illnesses in 44 states and may be linked to nine deaths:

The strain of salmonella involved responds to antibiotics.

Like the nasty bugs highlighted in a story in today's paper, salmonella belongs to a large category of bacteria called "gram-negative," referring to how they respond to a lab test called a Gram stain. These bacteria are especially hard to fight because they are wrapped in a double membrane and harbor enzymes that chew up many antibiotics.

Already somewhat resistant to antibiotics naturally, some of these microbes -- including Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter baumannii -- have mutated to become resistant to almost every known treatment.

Salmonella infections usually resolve in five to seven days without antibiotics. Often they require little treatment besides liquids to replace fluids lost in diarrhea. Severe cases may require intravenous fluids.

In the rare cases in which salmonella infections spread beyond the intestines, however, antibiotics are necessary. And some salmonella strains have become resistant, according to the national Centers for Disease Control and Prevention.

Four years ago, the Infectious Diseases Society of America sounded the alarm about the dearth of new wonder drugs to treat antibiotic superbugs. The report called on Congress to provide incentives to drug companies, who find it more profitable instead to focus on therapies for high cholesterol and other chronic conditions.

Fortunately -- if anything that involves so many illnesses can be called fortunate -- there are still antibiotics that work to treat the strain of Salmonella Typhimurium involved in the ongoing outbreak, should drugs be needed. If that were not the case, public health officials say, the outbreak could be even worse than it is.

-- Mary Engel

Photo credit: AP / The Indianapolis Star, Michelle Pemberton

A new MRSA threat: children's ear, nose and neck infections

The community strain of methicillin-resistant Staphylococcus aureus behind an explosion in nasty skin infections across the country is now causing ear and sinus infections and neck abscesses in children nationwide, a new study has found.

Of 21,000 pediatric staphylococcus infections from 2001 to 2006, 22% were the aggressive community MRSA strain known to scientists as USA300.

Moreover, the six-year review of data from more than 300 hospitals revealed an "alarming nationwide increase" in these infections, from just under 12% of in 2001 to 28% in 2006, according to the study published Monday in Archives of Otolaryngology -- Head and Neck Surgery. 

"Because of the proximity of the head and neck to important areas like the brain, the eyes and the chest, [these infections] need to be taken very seriously and treated aggressively," said Dr. Steven E. Sobol, a pediatric otolaryngologist at Emory University School of Medicine and one of the authors of the study.

As with the skin infections, some children seem to be more at risk than others for the ear, nose and neck infections. Living in crowded conditions, often because of poverty, is one risk factor. (Skin infections also have plagued football teams, wrestlers, gym rats and others who engage in sweaty, skin-contact sports.)

But Sobol said that he has seen ear, sinus and neck infections caused by USA300 in children who didn't appear to live in crowded conditions or have other risk factors.

The average patient infected was between 6 and 7 years old, an age at which immune systems aren't fully developed and children tend to catch infections easily, he added.

Infectious disease experts say that the increase in USA300-caused infections is not surprising. About one in three of us harbor staph on our skin or in our noses as part of our normal bacterial flora. Since the USA300 strain first appeared in the 1990s, it has been spreading across the nation and the world, pushing out other strains to become the dominant one.

Which is not to say that the spread isn't alarming. As long as staph stays where it's supposed to stay --on the outside -- it does little harm. But when it becomes invasive, slipping into a part of the body where it shouldn't be, any strain can cause severe infections of bones, joints, blood and lungs. And USA300 is particularly virulent, or capable of causing disease.

Sobol and co-authors Dr. Iman Naseri of Emory and Dr. Robert C. Jerris of Children's Healthcare of Atlanta at Egleston are completing a series of studies that look at how children who contracted these infections fared, how the germs spread and what makes USA300 infections so severe.

Sobol stressed in a phone conversation that parents shouldn't panic, but they and their pediatricians should be aware of the seriousness of these infections. For prevention, he recommended hand washing and avoiding overuse of antibiotics, which can both encourage further resistance and create a niche for bad bugs by destroying other ones.

-- Mary Engel

Cipro joins the 'black box' club

The club may not be as elite as it once was -- or perhaps, in an ideal world, should be -- but the Food and Drug Administration has decided Cipro and its ilk deserve to be members.

As such, the class of antibiotics known as fluoroquinolones will now bear a boxed warning, also known as a "black box," because of reports that the drugs increase the risk of tendinitis and tendon rupture. The FDA has told the manufacturers that the label, the agency's most serious warning, is necessary to ensure that the drugs' benefits outweigh the risks. Always a good thing. It's also told them, while they're at it, to throw in a medication guide to inform patients of potential side effects.

Most people may remember the drugs from their heady days as simply-must-have protection against a potential anthrax attack. But we've all grown older and wiser and less panicked and are now more worried about simply being able to move about the house without hurting something. Says the FDA's release: "The risk of developing fluoroquinolone-associated tendinitis and tendon rupture is further increased in people older than 60, in those taking corticosteroid drugs, and in kidney, heart and lung transplant recipients."

The prescribing information already includes warnings about the potential problem, but sifting through that material isn't easy even for professionals. They're busy, you understand. And besides, there's just something about that black box label that tends to give prescribers -- and prescribees -- pause.

If you've had problems with the drugs (or any drugs), you can offer your two cents at MedWatch, a more user-friendly way of referring to the FDA Safety Information and Adverse Event Reporting Program.  Otherwise, how will anyone know?

For an easy-to-read list of other drugs with black box warnings, go to FormWeb. The information is easier to find than on the government site.

-- Tami Dennis

Photo: When anthrax was discovered at a New York mail processing facility in 2001, workers there were given Cipro as a precautionary measure. Other Americans soon wanted it too.

Credit: Gary Friedman / Los Angeles Times