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CNN Saturday Morning News
"Weekend House Call"
Aired January 24, 2004 - 08:31 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
HEIDI COLLINS, CNN ANCHOR: For now, "Weekend House Call" with Dr. Sanjay Gupta.
DR. SANJAY GUPTA, CNN CORRESPONDENT: Good morning and welcome to "Weekend House Call."
I'm Dr. Sanjay Gupta.
Well, antibiotic resistance has been called one of the world's most pressing public health problems and a new study warns that a resistant form of a common skin infection is now spreading into our communities. That bug is known as MRSA and it's resistant to most commonly used antibiotics and found only in hospitals. But the super bug may also be soon heading into your neighborhood.
(BEGIN VIDEOTAPE)
GUPTA (voice-over): It's called MRSA, Methicillin Resistant Staph Aureus. Untreated, it goes from a minor pimple to a gruesome wound in a matter of days. Doctors around Los Angeles County told CNN the same thing, at least half the skin infections they see are resistant to the usual medicine.
DR. GREG MORAN, UCLA OLIVE VIEW HOSPITAL: Two years ago, this was completely unheard of. And it's remarkable how quickly it's gone from something that was nonexistent to one of the most common things that we see.
GUPTA: It even struck seven players on the country's number one ranked football team at the University of Southern California. Five ended up in the hospital. Antibiotics work to cure a patient by killing all of the harmful bacteria. Resistance arises when some of the bugs survive, for example, if you only take half your prescription.
Those surviving bugs, with genes that fight off the antibiotic, grow back and multiply. What make this outbreak so worrisome is that the patients were not taking antibiotics beforehand, meaning the resistant bacteria strain, MRSA, is already loose in the community, joining a dangerous trend of diseases that have developed resistance to antibiotics that were designed to kill them.
ELIZABETH BANCROFT, LOS ANGELES HEALTH SERVICES: And that's really the big difference. We're seeing resistant syphilis, we're seeing resistant gonorrhea, we're seeing resistant salmonella and now we're seeing these resistant skin infections. And I think that's the new wave of resistance that we're seeing.
(END VIDEOTAPE)
GUPTA: An example of how crafty these bacteria can be to antibiotics, penicillin was the first antibiotic invented in the '40s and by the early '80s was effective against less than 10 percent of birth control infections.
So why is that?
Well, we'll be answering that question and many more this morning.
We want to hear from you, as well, so give us a call at 1-800- 807-2620 or e-mail us at housecall@cnn.com.
And here to help us answer all these questions on antibiotic resistance, Dr. Richard Besser. He's from the CDC. He's also medical director of the Get Smart campaign, the perfect guy to help us work through some of these questions.
Are some people, first of all, are more susceptible to this MRSA? That's what really gets people's attention.
DR. RICHARD BESSER, CDC: There is a lot of concern about MRSA in the community and the concern is that an infection that had only been seen in hospitals among very sick people we're now starting to see among people throughout the community.
GUPTA: But the vast majority of people are going to be probably pretty safe from this? BESSER: That's right. That's right. The big risk comes from being in contact with someone who has one of these infections. It's not something you'll get through casually walking through a neighborhood or through a school. You really have to come in close contact with one of the sores, one of the staph infections.
GUPTA: OK. And Dr. Besser does take care of a lot of patients, as well. Lots of e-mails, no surprise, coming in, e-mails that you might get from your patients, as well.
Let's start with this one from Susan in South Dakota, who asks, "How are people getting these antibiotic resistance staph infections?" She says, "My child's grandfather had a serious MRSA infection this summer." Should her children be careful around him so as not to get something similar? BESSER: Well, I definitely would not keep them away from their grandfather. That kind of interaction is very important. But they want to practice very good hand hygiene, hand cleanliness. So if they're visiting their grandfather, they want to make sure that after visiting they wash their hands very well with soap and water. And it's not just the quick rinse and dip. You want to make sure that they're washing their hands well with soap for at least 15, 20 seconds.
GUPTA: And we're going to talk more at the hand washing and the best way to do it.
Let's look at, let's go to our phone lines now, as well.
Mary in Alabama, good morning and welcome to "Weekend House Call."
MARY: Hello.
Yes, I have emphysema and asthma and I stay on antibiotics about three or four times a year and it doesn't seem to work so much anymore. Do you have a solution to it, please?
GUPTA: Are you taking the same antibiotic three or four times...
MARY: No, it's different antibiotics, but I'm allergic to Leviquin (ph). So I take different...
GUPTA: OK.
MARY: I have a wonderful doctor, but he puts me on different antibiotics and I'm losing resistance to it.
GUPTA: So what do you say -- so, different antibiotics. She has emphysema, so an underlying medical condition. BESSER: Right. That's right.
GUPTA: What do you tell her? BESSER: Well, you know, our general message to people is that only take antibiotics for a bacterial infection. They don't work for viral infections. Someone with emphysema really should not wait at home to decide later on whether they need an abb. They should see their doctor and be evaluated to see whether an antibiotic is indicated.
GUPTA: OK. And we're going to talk a lot about this, because a lot of doctors are prescribing antibiotics sometimes with a viral infection.
Let's get another e-mail in, though.
Alex in California wanting to know, "What role, if any, does the over use of antibiotics play in the development of these drug resistant infections?" BESSER: Yes.
GUPTA: And this seems like he's striking at the heart of the issue here. BESSER: Yes, I mean that's a great question. That is the issue. If you look at what are the risk factors for having a resistant infection, your own recent antibiotic use is the big one. Not only that, but the amount of antibiotics that are used throughout your community will put you at risk for a resistant infection.
GUPTA: But a lot of people take them, right? I mean doctor, you must be getting pushed occasionally to, you know, somebody has a viral infection probably, but you still get pushed to give the antibiotics. BESSER: That's right. I mean we've done focus groups to find out why are doctors prescribing antibiotics in situations where they know they may not be effective. There are a number of reasons. One is patient demand. Patients come in and say I feel sick, I want something that will get me back to work sooner, I want something that will get my kids to school sooner, I want and abb. And doctors are saying unless we do something to educate patients that antibiotics don't work in these situations, it takes them too long to explain why they're not going to give an abb.
GUPTA: OK, well, let's also get a quick primer in here, as well, as how antibiotics are supposed to be used, because this is an important topic. Most of the time when you get sick, it's caused by one of two things, either a bacterial infection or a viral infection. Antibiotics are only effective against bacterial infections, an important point. Those are things such as strep throat, some types of pneumonia and sinus infections. Antibiotics don't help you feel better or help cure viral infections like the common cold, most coughs and the flu.
And, you know, a lot of links between over use and resistance. I guess we're sort of -- we're going to hit on a lot more of that, as well.
We have another good e-mail on this, as well. Let's go to that. Howard in Silver Springs, Maryland asking, "Why are some doctors caving in to their patients' demand for antibiotics even if they may not be warranted?" And, again, you know, you're an infectious disease doctor, so this is your area of expertise. BESSER: Yes.
GUPTA: But for the primary care doctor out there, maybe the pediatrician out there, is it a lack of understanding on the doctor's part about the potential problems that this overuse might cause? BESSER: There are a number of issues. I mean, as I mentioned, time is a real issue for doctors in a busy practice. It takes a while to explain to a patient that they have a viral infection that an antibiotic won't work for, especially if that patient got an antibiotic before. I see children, their parents bring them in because the parent is sick and got an antibiotic from their doctor. They say my child has the same thing, can you just give me some amoxicillin?
GUPTA: Right. BESSER: And so not do you have to explain why their child doesn't need an antibiotic, but you're in this situation where you're trying to explain why they themselves actually didn't need an abb.
GUPTA: And a lot of young parents are watching out there, as well. So, and a recent study showed children's doctors prescribed antibiotics about 50 percent more often if they thought the parents wanted them to, wanted them to. So are the parents or the doctors really to blame here? BESSER: Yes, that's a very important study. What it says is if you could just say to your doctor I'm here to find out how to make my child feel better sooner, I'm not here for an antibiotic, if you can start that dialogue, you yourself could reduce the likelihood that you'll get an inappropriate or unneeded abb.
GUPTA: And a lot of times the right answer is for the kid just to go home and sort of ride it out, right? BESSER: That's right.
GUPTA: Ride out the viral infection? BESSER: That's right. And we're giving tools to doctors that they can use to get kids back into school or day care sooner. Some day care teachers are saying your child can come in if your child isn't on an abb. And we have notes that they can bring in that say an antibiotic is not needed.
GUPTA: And real quick about ear infections, because that's one of the most common things a lot of young parents watching, ear infections and antibiotics. BESSER: Yes.
GUPTA: What do you say to them? BESSER: Well, there are new guidelines that are going to be coming out this summer that are very interesting, guidelines by the American Academy of Pediatrics and the American Academy of Family Physicians. The CDC helped work on these. And we anticipate that the guidelines will radically change how we manage ear infections.
GUPTA: OK. BESSER: What they will do is allow for watching a child with an ear infection for two to three days before giving an abb. Certain children, children with mild infections who are older, 80 percent will get better without an abb.
GUPTA: So the watchful waiting may become more of the standard fare. BESSER: That's right.
GUPTA: We've got a lot more still coming up.
Are your anti-bacterial household cleaners and soaps getting you and your home too clean? We want to answer that question. You wouldn't think so, but some say instead of keeping you healthier, they actually increase your chances of getting sick. That's coming up, after the break.
Dr. Besser.
COMMERCIAL
GUPTA: All right, there are about 700 anti-bacterial products on the market today, a staggering number, everything from soaps to cutting boards to anti-bacterial toys. According to the American Medical Association, the jury is still out on whether these products are causing antibiotic resistance. Some experts say they keep us healthy in a society that is so busy that we don't usually wash our hands enough or take other precautions. They also argue the main problem is the misuse of antibiotics.
On the other hand, though, there are those who argue that anti- bacterials can leave people with a false sense of security or protection and that these products not only kill bad bacteria, but also they kill the good bacteria that can act as barriers against invading germs.
So we're talking to Dr. Richard Besser to help us sort through a lot of this.
Lots of questions about this topic, too. These products very, very popular. Let's get straight to an e-mail. Daniel in Illinois wants to know, "With the increased use of anti-bacterial agents such as soaps, detergents, etc. over the past few years, could these have created a new strain of bacteria and flu that are becoming more resistant to antibiotics and other treatments?"
So he's asking not just the antibiotics, but these products, as well, possibly causing this problem. BESSER: OK.
GUPTA: What do you think? BESSER: That's right. Well, there's no evidence to date that these products have led to resistant infections in humans. However, there's also no evidence to show that these products make you any safer or any healthier in your home.
GUPTA: OK. BESSER: There is theoretical evidence and some laboratory evidence that some of the chemicals in these products could select for resistant bacteria. And given that, I mean our message is why not use good old soap and water, why not use bleach to keep your house clean? You don't want to use something that's going to kill, as you had said, bacteria that are very useful to your bodies.
GUPTA: Give us a peek behind the curtain, the home of an infectious disease doctor. What sort of things are you telling your family to wash up with? BESSER: I mean we use plain soap and water. We don't use anti-bacterial products.
GUPTA: What about the wipes? BESSER: We don't use wipes.
GUPTA: You don't use the wipes either? BESSER: No. And when we, my son is in kindergarten and we had to bring in soap for school, I had a hard time finding liquid soap or soft soap that did not contain an anti-bacterial product. And it really is not needed.
GUPTA: So you really, really don't think that that's necessary? BESSER: I really don't.
GUPTA: Let's get another e-mail on this topic, as well.
Terry from California writing, "I work in an elementary school setting and I'm constantly using anti-bacterial wipes to prevent myself from contracting the cold and flu that I come in contact with. Will the over use of those anti-bacterial cleansers make me more susceptible to the stronger strains of virus out there?" BESSER: Yes...
GUPTA: So leaving aside sort of the community overuse, an individual. Let's say, you know, someone comes to work and, you know, they wipe off their phone and their keyboard every day. Is that good? Is that bad? Or does it not matter? BESSER: I think it's probably not necessary.
GUPTA: OK. BESSER: You know, in our school now they're using these alcohol based hand sanitizers. Those are a non-specific killer of germs and would not promote resistance. So if you want something to use that's quick, you could use one of those products and it works well. It's true, I takes a while to use soap and water and to wash up. Those products can do the job much faster.
GUPTA: All right, let's switch gears a little bit now. Let's go back to our phone lines.
Stephanie in New Jersey, good morning and welcome to "Weekend House Call."
STEPHANIE: Good morning.
GUPTA: What's your question ma'am?
STEPHANIE: My question is there's a wide range of herbal medicines, both Chinese and Western, that have antibiotic properties. They include goldenseal, organ grape root, maybe even gensen leaf (ph). Do you think that these hold some promise for avoiding the problem of developing resistant bacteria? More specifically, I've heard that laboratory drugs have a very narrow focus, a single active ingredient that disrupts the bacteria and therefore it's easy for the bacteria to adapt to, while herbs are chemically complex and have multiple active ingredients so that they don't produce resistant bacteria.
GUPTA: That's an interesting point. BESSER: Yes.
GUPTA: I mean you obviously work in the world of antibiotics and things like that. But have you heard much about these herbs possibly being an answer? BESSER: Well, there's more and more efforts being undertaken to try and study these products in a scientific way, to show are they harmful, are they helpful. One of the problems is that there's very poor standardization. If you're buying goldenseal in one health food store, it may be very different from what you're buying that's called goldenseal from another place. And so knowing what you're getting is difficult.
GUPTA: That's a good point. BESSER: The regulation within the country is such that these products are held to a very different standard than are antibiotics. It's not that there isn't promise and potential hope, but if you're going to use these products, make sure to tell your doctor so they know what you're taking. A number of herbal products have been taken off the market over the past couple of years because of very dangerous side effects.
GUPTA: Yes, we've heard about some of that, as well, ephedra and the FDA becoming more and more involved with the herbs. BESSER: That's right.
GUPTA: So standardization may be the key. Maybe herbs later on down the road possibly causing an answer. BESSER: Yes.
GUPTA: Lots of topics when it comes to this.
What's new on the horizon when it comes to battling antibiotic resistance viruses? When we come back, we're going to tell you the latest drugs on the market and if any more of those are in the pipeline.
COMMERCIAL
GUPTA: All right, welcome back to "Weekend House Call." We're talking about antibiotic resistance.
Well, there are some every day steps that you can take to prevent most kinds of infectious disease, important ones. Wash your hands often using soap and water for about 10 to 30 seconds per washing. Clean and disinfect common surfaces regularly, especially such things as kitchen countertops. Also, make sure to get all your recommended shots. Lastly, talk with your doctor about using antibiotics wisely.
We're talking with our doctor, Dr. Besser, about a lot of these things.
You're one of the experts on this particular topic. We hear a lot about antibiotics and the powerful antibiotics that are coming out. Penicillin, we said, only treats about 10 percent of infections anymore.
The question is these new antibiotics, are people starting to develop a resistance to those already, as well? BESSER: Well, we're trying to be very careful in terms of how these new antibiotics are used. What we're seeing is more antibiotics being developed for very specific, targeted infections. If you look at the overall antibiotic pipeline, what drugs we're going to seeing over the next decade, it's really a little scary. There's not a lot coming down the pike. And it's not hard to see why.
When you take a big pharmaceutical company and they're trying to decide what type of product to develop, it makes a lot more sense to develop a drug for a chronic disease that people are going to be taking every day rather than an infectious disease that, where they may take it for a week every couple of years.
GUPTA: So do you envision a time -- I mean there's already people out there that have infections that cannot be treated. Do you think that that number is going to grow, then, as a result? BESSER: Well, it, I think if we don't take action that could be the case. I think we need to work with industry to try and develop some incentives to make them develop anti-infective products.
GUPTA: OK. BESSER: That's very, that's very important to do. And then we need to show proper management of the antibiotics we have so that they're not used widely for infections where they're not needed.
GUPTA: Good education on that, as well. BESSER: That's right.
GUPTA: Bob from Arkansas is joining us on the phone.
Good morning, Bob.
Welcome to "Weekend House Call." BOB: Good morning.
GUPTA: What's your question, sir?
BOB: Well, I have a question for Dr. Besser, specifically, the matroid class of antibiotics tends to be heavily promoted by pharmaceutical companies to the profession, specifically Zithromax or what is commonly called the Zpac.
Do you view this particular class of antibiotics and its over use as a contributor to the problem of resistance? BESSER: Thanks, Bob, that's a great question.
I think that the over use of any antibiotic is a big problem. There are big problems with the marketing of the zpac. If you look at antibiotic recommendations by most of the medical societies, there are very few infections for which that drug, the zpac, is recommended as first line. But I think through marketing, they've created a demand among the public. And I think it's very important when you see your doctor to not ask for a particular antibiotic and not ask for an antibiotic at all.
Come in and say I'm sick, you know, what can I do to feel better and if I do need an antibiotic, what antibiotic do you recommend?
GUPTA: Yes, that's -- you know, Bob brings a really good point up because a lot of people come in -- they may not know the names of any other medications, but they know the name zpac. BESSER: That's right.
GUPTA: Doctor, can you get me that zpac? And people are asking for that all the time. So that's a good message there.
Let's get another e-mail in here, as well.
Lisa from Virginia asking, "How widespread are these infections? Are they mainly in industrialized countries where antibiotics are more prevalent?"
Well, that's a good question, as well. BESSER: That is a good question. The problem of resistance is a global problem and the World Health Organization a year ago issued their global action plan on resistance. If you look at the problem, though, globally, it's much more complex. In many developing countries, you have a segment of the population that has ready access to antibiotics, but you also have a lot of people who have no access to quality medical care, who have no access to antibiotics and a large number of people who are dying from infections that could be treated with antibiotics.
GUPTA: Real quick, is -- would you say the problem is over use more than people not taking their antibiotics in their full doses? BESSER: Well, if you look at the issue in the United States, it's over use.
GUPTA: Over use. BESSER: It's clearly over use.
GUPTA: But still take the full dosage. BESSER: That's right. When an antibiotic is prescribed to you, you want to take it as directed. You want to take the full course. Part of the reason for that is so that you don't leave it in your medicine cabinet for the next time you're sick.
GUPTA: Right. BESSER: And we do see a lot of that behavior.
GUPTA: OK. All good advice.
A lot more ahead, still.
When we come back, we're going to give you some Web sites to check out at home for more information on antibiotic resistance and talk about how you should not be using antibiotics.
COMMERCIAL
GUPTA: All right, we've got some Web sites. www.cdc.gov/drugresistance/community, a big Web site name. You can get a lot more information there from the Centers for Disease Control on antibiotic resistance. Another good source of information is the Mayo Clinic, which you can access from our Web site. That's at www.cnn.com/health.
Let's get a final thought from Dr. Besser.
Lots of good information today. BESSER: Yes.
GUPTA: Anything you want to leave viewers with? BESSER: Yes, I think there is a lot of information we shared. If people want more information they can also visit our Get Smart Web site, www.cdc.gov/getsmart.
GUPTA: OK, all right. Good information. A lot of information about not over using antibiotics, making sure you use them in the full doses, washing your hands. Those are some of the messages to take home today.
It could be a problem in the future, but possibly avoidable if we avoid some of those things. BESSER: That's right. Talk to your doctor.
GUPTA: All right, yes, that's always good advice. Talk to your doctor. Talk to your doctor like Dr. Besser.
Thank you for joining us.
We really appreciate that. BESSER: Oh, it's a real pleasure.
GUPTA: That's all the time we have for today, Dr. Besser.
All the questions this morning, you answered them.
Thank you very much at home, as well, for your e-mails and your phone calls.
Tune in tomorrow for another edition of "Weekend House Call." We'll be checking on the participants of the new year's resolution and we have a trainer and a nutritionist available to answer all your questions about that all year long. That's at 8:30 Eastern, 5:30 Pacific. CNN is the place where you can find all your latest medical news. Thanks for watching.
I'm Sanjay Gupta.
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Aired January 24, 2004 - 08:31 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
HEIDI COLLINS, CNN ANCHOR: For now, "Weekend House Call" with Dr. Sanjay Gupta.
DR. SANJAY GUPTA, CNN CORRESPONDENT: Good morning and welcome to "Weekend House Call."
I'm Dr. Sanjay Gupta.
Well, antibiotic resistance has been called one of the world's most pressing public health problems and a new study warns that a resistant form of a common skin infection is now spreading into our communities. That bug is known as MRSA and it's resistant to most commonly used antibiotics and found only in hospitals. But the super bug may also be soon heading into your neighborhood.
(BEGIN VIDEOTAPE)
GUPTA (voice-over): It's called MRSA, Methicillin Resistant Staph Aureus. Untreated, it goes from a minor pimple to a gruesome wound in a matter of days. Doctors around Los Angeles County told CNN the same thing, at least half the skin infections they see are resistant to the usual medicine.
DR. GREG MORAN, UCLA OLIVE VIEW HOSPITAL: Two years ago, this was completely unheard of. And it's remarkable how quickly it's gone from something that was nonexistent to one of the most common things that we see.
GUPTA: It even struck seven players on the country's number one ranked football team at the University of Southern California. Five ended up in the hospital. Antibiotics work to cure a patient by killing all of the harmful bacteria. Resistance arises when some of the bugs survive, for example, if you only take half your prescription.
Those surviving bugs, with genes that fight off the antibiotic, grow back and multiply. What make this outbreak so worrisome is that the patients were not taking antibiotics beforehand, meaning the resistant bacteria strain, MRSA, is already loose in the community, joining a dangerous trend of diseases that have developed resistance to antibiotics that were designed to kill them.
ELIZABETH BANCROFT, LOS ANGELES HEALTH SERVICES: And that's really the big difference. We're seeing resistant syphilis, we're seeing resistant gonorrhea, we're seeing resistant salmonella and now we're seeing these resistant skin infections. And I think that's the new wave of resistance that we're seeing.
(END VIDEOTAPE)
GUPTA: An example of how crafty these bacteria can be to antibiotics, penicillin was the first antibiotic invented in the '40s and by the early '80s was effective against less than 10 percent of birth control infections.
So why is that?
Well, we'll be answering that question and many more this morning.
We want to hear from you, as well, so give us a call at 1-800- 807-2620 or e-mail us at housecall@cnn.com.
And here to help us answer all these questions on antibiotic resistance, Dr. Richard Besser. He's from the CDC. He's also medical director of the Get Smart campaign, the perfect guy to help us work through some of these questions.
Are some people, first of all, are more susceptible to this MRSA? That's what really gets people's attention.
DR. RICHARD BESSER, CDC: There is a lot of concern about MRSA in the community and the concern is that an infection that had only been seen in hospitals among very sick people we're now starting to see among people throughout the community.
GUPTA: But the vast majority of people are going to be probably pretty safe from this? BESSER: That's right. That's right. The big risk comes from being in contact with someone who has one of these infections. It's not something you'll get through casually walking through a neighborhood or through a school. You really have to come in close contact with one of the sores, one of the staph infections.
GUPTA: OK. And Dr. Besser does take care of a lot of patients, as well. Lots of e-mails, no surprise, coming in, e-mails that you might get from your patients, as well.
Let's start with this one from Susan in South Dakota, who asks, "How are people getting these antibiotic resistance staph infections?" She says, "My child's grandfather had a serious MRSA infection this summer." Should her children be careful around him so as not to get something similar? BESSER: Well, I definitely would not keep them away from their grandfather. That kind of interaction is very important. But they want to practice very good hand hygiene, hand cleanliness. So if they're visiting their grandfather, they want to make sure that after visiting they wash their hands very well with soap and water. And it's not just the quick rinse and dip. You want to make sure that they're washing their hands well with soap for at least 15, 20 seconds.
GUPTA: And we're going to talk more at the hand washing and the best way to do it.
Let's look at, let's go to our phone lines now, as well.
Mary in Alabama, good morning and welcome to "Weekend House Call."
MARY: Hello.
Yes, I have emphysema and asthma and I stay on antibiotics about three or four times a year and it doesn't seem to work so much anymore. Do you have a solution to it, please?
GUPTA: Are you taking the same antibiotic three or four times...
MARY: No, it's different antibiotics, but I'm allergic to Leviquin (ph). So I take different...
GUPTA: OK.
MARY: I have a wonderful doctor, but he puts me on different antibiotics and I'm losing resistance to it.
GUPTA: So what do you say -- so, different antibiotics. She has emphysema, so an underlying medical condition. BESSER: Right. That's right.
GUPTA: What do you tell her? BESSER: Well, you know, our general message to people is that only take antibiotics for a bacterial infection. They don't work for viral infections. Someone with emphysema really should not wait at home to decide later on whether they need an abb. They should see their doctor and be evaluated to see whether an antibiotic is indicated.
GUPTA: OK. And we're going to talk a lot about this, because a lot of doctors are prescribing antibiotics sometimes with a viral infection.
Let's get another e-mail in, though.
Alex in California wanting to know, "What role, if any, does the over use of antibiotics play in the development of these drug resistant infections?" BESSER: Yes.
GUPTA: And this seems like he's striking at the heart of the issue here. BESSER: Yes, I mean that's a great question. That is the issue. If you look at what are the risk factors for having a resistant infection, your own recent antibiotic use is the big one. Not only that, but the amount of antibiotics that are used throughout your community will put you at risk for a resistant infection.
GUPTA: But a lot of people take them, right? I mean doctor, you must be getting pushed occasionally to, you know, somebody has a viral infection probably, but you still get pushed to give the antibiotics. BESSER: That's right. I mean we've done focus groups to find out why are doctors prescribing antibiotics in situations where they know they may not be effective. There are a number of reasons. One is patient demand. Patients come in and say I feel sick, I want something that will get me back to work sooner, I want something that will get my kids to school sooner, I want and abb. And doctors are saying unless we do something to educate patients that antibiotics don't work in these situations, it takes them too long to explain why they're not going to give an abb.
GUPTA: OK, well, let's also get a quick primer in here, as well, as how antibiotics are supposed to be used, because this is an important topic. Most of the time when you get sick, it's caused by one of two things, either a bacterial infection or a viral infection. Antibiotics are only effective against bacterial infections, an important point. Those are things such as strep throat, some types of pneumonia and sinus infections. Antibiotics don't help you feel better or help cure viral infections like the common cold, most coughs and the flu.
And, you know, a lot of links between over use and resistance. I guess we're sort of -- we're going to hit on a lot more of that, as well.
We have another good e-mail on this, as well. Let's go to that. Howard in Silver Springs, Maryland asking, "Why are some doctors caving in to their patients' demand for antibiotics even if they may not be warranted?" And, again, you know, you're an infectious disease doctor, so this is your area of expertise. BESSER: Yes.
GUPTA: But for the primary care doctor out there, maybe the pediatrician out there, is it a lack of understanding on the doctor's part about the potential problems that this overuse might cause? BESSER: There are a number of issues. I mean, as I mentioned, time is a real issue for doctors in a busy practice. It takes a while to explain to a patient that they have a viral infection that an antibiotic won't work for, especially if that patient got an antibiotic before. I see children, their parents bring them in because the parent is sick and got an antibiotic from their doctor. They say my child has the same thing, can you just give me some amoxicillin?
GUPTA: Right. BESSER: And so not do you have to explain why their child doesn't need an antibiotic, but you're in this situation where you're trying to explain why they themselves actually didn't need an abb.
GUPTA: And a lot of young parents are watching out there, as well. So, and a recent study showed children's doctors prescribed antibiotics about 50 percent more often if they thought the parents wanted them to, wanted them to. So are the parents or the doctors really to blame here? BESSER: Yes, that's a very important study. What it says is if you could just say to your doctor I'm here to find out how to make my child feel better sooner, I'm not here for an antibiotic, if you can start that dialogue, you yourself could reduce the likelihood that you'll get an inappropriate or unneeded abb.
GUPTA: And a lot of times the right answer is for the kid just to go home and sort of ride it out, right? BESSER: That's right.
GUPTA: Ride out the viral infection? BESSER: That's right. And we're giving tools to doctors that they can use to get kids back into school or day care sooner. Some day care teachers are saying your child can come in if your child isn't on an abb. And we have notes that they can bring in that say an antibiotic is not needed.
GUPTA: And real quick about ear infections, because that's one of the most common things a lot of young parents watching, ear infections and antibiotics. BESSER: Yes.
GUPTA: What do you say to them? BESSER: Well, there are new guidelines that are going to be coming out this summer that are very interesting, guidelines by the American Academy of Pediatrics and the American Academy of Family Physicians. The CDC helped work on these. And we anticipate that the guidelines will radically change how we manage ear infections.
GUPTA: OK. BESSER: What they will do is allow for watching a child with an ear infection for two to three days before giving an abb. Certain children, children with mild infections who are older, 80 percent will get better without an abb.
GUPTA: So the watchful waiting may become more of the standard fare. BESSER: That's right.
GUPTA: We've got a lot more still coming up.
Are your anti-bacterial household cleaners and soaps getting you and your home too clean? We want to answer that question. You wouldn't think so, but some say instead of keeping you healthier, they actually increase your chances of getting sick. That's coming up, after the break.
Dr. Besser.
COMMERCIAL
GUPTA: All right, there are about 700 anti-bacterial products on the market today, a staggering number, everything from soaps to cutting boards to anti-bacterial toys. According to the American Medical Association, the jury is still out on whether these products are causing antibiotic resistance. Some experts say they keep us healthy in a society that is so busy that we don't usually wash our hands enough or take other precautions. They also argue the main problem is the misuse of antibiotics.
On the other hand, though, there are those who argue that anti- bacterials can leave people with a false sense of security or protection and that these products not only kill bad bacteria, but also they kill the good bacteria that can act as barriers against invading germs.
So we're talking to Dr. Richard Besser to help us sort through a lot of this.
Lots of questions about this topic, too. These products very, very popular. Let's get straight to an e-mail. Daniel in Illinois wants to know, "With the increased use of anti-bacterial agents such as soaps, detergents, etc. over the past few years, could these have created a new strain of bacteria and flu that are becoming more resistant to antibiotics and other treatments?"
So he's asking not just the antibiotics, but these products, as well, possibly causing this problem. BESSER: OK.
GUPTA: What do you think? BESSER: That's right. Well, there's no evidence to date that these products have led to resistant infections in humans. However, there's also no evidence to show that these products make you any safer or any healthier in your home.
GUPTA: OK. BESSER: There is theoretical evidence and some laboratory evidence that some of the chemicals in these products could select for resistant bacteria. And given that, I mean our message is why not use good old soap and water, why not use bleach to keep your house clean? You don't want to use something that's going to kill, as you had said, bacteria that are very useful to your bodies.
GUPTA: Give us a peek behind the curtain, the home of an infectious disease doctor. What sort of things are you telling your family to wash up with? BESSER: I mean we use plain soap and water. We don't use anti-bacterial products.
GUPTA: What about the wipes? BESSER: We don't use wipes.
GUPTA: You don't use the wipes either? BESSER: No. And when we, my son is in kindergarten and we had to bring in soap for school, I had a hard time finding liquid soap or soft soap that did not contain an anti-bacterial product. And it really is not needed.
GUPTA: So you really, really don't think that that's necessary? BESSER: I really don't.
GUPTA: Let's get another e-mail on this topic, as well.
Terry from California writing, "I work in an elementary school setting and I'm constantly using anti-bacterial wipes to prevent myself from contracting the cold and flu that I come in contact with. Will the over use of those anti-bacterial cleansers make me more susceptible to the stronger strains of virus out there?" BESSER: Yes...
GUPTA: So leaving aside sort of the community overuse, an individual. Let's say, you know, someone comes to work and, you know, they wipe off their phone and their keyboard every day. Is that good? Is that bad? Or does it not matter? BESSER: I think it's probably not necessary.
GUPTA: OK. BESSER: You know, in our school now they're using these alcohol based hand sanitizers. Those are a non-specific killer of germs and would not promote resistance. So if you want something to use that's quick, you could use one of those products and it works well. It's true, I takes a while to use soap and water and to wash up. Those products can do the job much faster.
GUPTA: All right, let's switch gears a little bit now. Let's go back to our phone lines.
Stephanie in New Jersey, good morning and welcome to "Weekend House Call."
STEPHANIE: Good morning.
GUPTA: What's your question ma'am?
STEPHANIE: My question is there's a wide range of herbal medicines, both Chinese and Western, that have antibiotic properties. They include goldenseal, organ grape root, maybe even gensen leaf (ph). Do you think that these hold some promise for avoiding the problem of developing resistant bacteria? More specifically, I've heard that laboratory drugs have a very narrow focus, a single active ingredient that disrupts the bacteria and therefore it's easy for the bacteria to adapt to, while herbs are chemically complex and have multiple active ingredients so that they don't produce resistant bacteria.
GUPTA: That's an interesting point. BESSER: Yes.
GUPTA: I mean you obviously work in the world of antibiotics and things like that. But have you heard much about these herbs possibly being an answer? BESSER: Well, there's more and more efforts being undertaken to try and study these products in a scientific way, to show are they harmful, are they helpful. One of the problems is that there's very poor standardization. If you're buying goldenseal in one health food store, it may be very different from what you're buying that's called goldenseal from another place. And so knowing what you're getting is difficult.
GUPTA: That's a good point. BESSER: The regulation within the country is such that these products are held to a very different standard than are antibiotics. It's not that there isn't promise and potential hope, but if you're going to use these products, make sure to tell your doctor so they know what you're taking. A number of herbal products have been taken off the market over the past couple of years because of very dangerous side effects.
GUPTA: Yes, we've heard about some of that, as well, ephedra and the FDA becoming more and more involved with the herbs. BESSER: That's right.
GUPTA: So standardization may be the key. Maybe herbs later on down the road possibly causing an answer. BESSER: Yes.
GUPTA: Lots of topics when it comes to this.
What's new on the horizon when it comes to battling antibiotic resistance viruses? When we come back, we're going to tell you the latest drugs on the market and if any more of those are in the pipeline.
COMMERCIAL
GUPTA: All right, welcome back to "Weekend House Call." We're talking about antibiotic resistance.
Well, there are some every day steps that you can take to prevent most kinds of infectious disease, important ones. Wash your hands often using soap and water for about 10 to 30 seconds per washing. Clean and disinfect common surfaces regularly, especially such things as kitchen countertops. Also, make sure to get all your recommended shots. Lastly, talk with your doctor about using antibiotics wisely.
We're talking with our doctor, Dr. Besser, about a lot of these things.
You're one of the experts on this particular topic. We hear a lot about antibiotics and the powerful antibiotics that are coming out. Penicillin, we said, only treats about 10 percent of infections anymore.
The question is these new antibiotics, are people starting to develop a resistance to those already, as well? BESSER: Well, we're trying to be very careful in terms of how these new antibiotics are used. What we're seeing is more antibiotics being developed for very specific, targeted infections. If you look at the overall antibiotic pipeline, what drugs we're going to seeing over the next decade, it's really a little scary. There's not a lot coming down the pike. And it's not hard to see why.
When you take a big pharmaceutical company and they're trying to decide what type of product to develop, it makes a lot more sense to develop a drug for a chronic disease that people are going to be taking every day rather than an infectious disease that, where they may take it for a week every couple of years.
GUPTA: So do you envision a time -- I mean there's already people out there that have infections that cannot be treated. Do you think that that number is going to grow, then, as a result? BESSER: Well, it, I think if we don't take action that could be the case. I think we need to work with industry to try and develop some incentives to make them develop anti-infective products.
GUPTA: OK. BESSER: That's very, that's very important to do. And then we need to show proper management of the antibiotics we have so that they're not used widely for infections where they're not needed.
GUPTA: Good education on that, as well. BESSER: That's right.
GUPTA: Bob from Arkansas is joining us on the phone.
Good morning, Bob.
Welcome to "Weekend House Call." BOB: Good morning.
GUPTA: What's your question, sir?
BOB: Well, I have a question for Dr. Besser, specifically, the matroid class of antibiotics tends to be heavily promoted by pharmaceutical companies to the profession, specifically Zithromax or what is commonly called the Zpac.
Do you view this particular class of antibiotics and its over use as a contributor to the problem of resistance? BESSER: Thanks, Bob, that's a great question.
I think that the over use of any antibiotic is a big problem. There are big problems with the marketing of the zpac. If you look at antibiotic recommendations by most of the medical societies, there are very few infections for which that drug, the zpac, is recommended as first line. But I think through marketing, they've created a demand among the public. And I think it's very important when you see your doctor to not ask for a particular antibiotic and not ask for an antibiotic at all.
Come in and say I'm sick, you know, what can I do to feel better and if I do need an antibiotic, what antibiotic do you recommend?
GUPTA: Yes, that's -- you know, Bob brings a really good point up because a lot of people come in -- they may not know the names of any other medications, but they know the name zpac. BESSER: That's right.
GUPTA: Doctor, can you get me that zpac? And people are asking for that all the time. So that's a good message there.
Let's get another e-mail in here, as well.
Lisa from Virginia asking, "How widespread are these infections? Are they mainly in industrialized countries where antibiotics are more prevalent?"
Well, that's a good question, as well. BESSER: That is a good question. The problem of resistance is a global problem and the World Health Organization a year ago issued their global action plan on resistance. If you look at the problem, though, globally, it's much more complex. In many developing countries, you have a segment of the population that has ready access to antibiotics, but you also have a lot of people who have no access to quality medical care, who have no access to antibiotics and a large number of people who are dying from infections that could be treated with antibiotics.
GUPTA: Real quick, is -- would you say the problem is over use more than people not taking their antibiotics in their full doses? BESSER: Well, if you look at the issue in the United States, it's over use.
GUPTA: Over use. BESSER: It's clearly over use.
GUPTA: But still take the full dosage. BESSER: That's right. When an antibiotic is prescribed to you, you want to take it as directed. You want to take the full course. Part of the reason for that is so that you don't leave it in your medicine cabinet for the next time you're sick.
GUPTA: Right. BESSER: And we do see a lot of that behavior.
GUPTA: OK. All good advice.
A lot more ahead, still.
When we come back, we're going to give you some Web sites to check out at home for more information on antibiotic resistance and talk about how you should not be using antibiotics.
COMMERCIAL
GUPTA: All right, we've got some Web sites. www.cdc.gov/drugresistance/community, a big Web site name. You can get a lot more information there from the Centers for Disease Control on antibiotic resistance. Another good source of information is the Mayo Clinic, which you can access from our Web site. That's at www.cnn.com/health.
Let's get a final thought from Dr. Besser.
Lots of good information today. BESSER: Yes.
GUPTA: Anything you want to leave viewers with? BESSER: Yes, I think there is a lot of information we shared. If people want more information they can also visit our Get Smart Web site, www.cdc.gov/getsmart.
GUPTA: OK, all right. Good information. A lot of information about not over using antibiotics, making sure you use them in the full doses, washing your hands. Those are some of the messages to take home today.
It could be a problem in the future, but possibly avoidable if we avoid some of those things. BESSER: That's right. Talk to your doctor.
GUPTA: All right, yes, that's always good advice. Talk to your doctor. Talk to your doctor like Dr. Besser.
Thank you for joining us.
We really appreciate that. BESSER: Oh, it's a real pleasure.
GUPTA: That's all the time we have for today, Dr. Besser.
All the questions this morning, you answered them.
Thank you very much at home, as well, for your e-mails and your phone calls.
Tune in tomorrow for another edition of "Weekend House Call." We'll be checking on the participants of the new year's resolution and we have a trainer and a nutritionist available to answer all your questions about that all year long. That's at 8:30 Eastern, 5:30 Pacific. CNN is the place where you can find all your latest medical news. Thanks for watching.
I'm Sanjay Gupta.
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