Influenza and Antibiotics

From the archives comes this post about the effect antibiotic resistance could have during an influenza outbreak.

I recently corresponded with someone in a position to make public health policy who wanted to know what effect antibiotic resistance would have on avian influenza (this makes me think of Kristof’s recent column). Since I regularly encounter similar questions, I thought it worthwhile to share this (I’ve removed other parts that aren’t relevant to the matter).
Also, on occasion, I like to demonstrate that the Mad Biologist isn’t always Mad…:

  1. Anti-viral resistance. While antibiotic resistance will not be a direct concern (antibiotics are effective against bacteria, not viruses such as influenza), antiviral resistance will be. In other words, Tamiflu and other antiviral drugs could become ineffective if not administered correctly. There has been one reported case of this in Vietnam, which resulted from doctors administering an insufficient dose of Tamiflu. This resulted in the evolution of Tamiflu-resistant influenza. We need to inform health care providers and patients that they need to take the full course of treatment (a similar problem currently exists with TB; preventing it from arising in influenza would be desirable), and we need to tell health care providers what those guidelines are.
  2. Secondary bacterial infections. About half of the deaths from influenza are not caused by the influenza virus directly, but from secondary bacteria pneumonial infections (note: 50% is a rough estimate; obviously, there are many things that could increase or decrease this number). Some have called for vaccination against some of the most common bacteria that cause pneumonia, but in the absence of such a program, these secondary bacterial infections will have to be treated with antibiotics. Given the critical state of the patient, the newest antibiotics which have the highest probability of successand which also are the ‘antibiotics of last resort’-will be used disproportionately. It is not unrealistic to think that during an avian influenza outbreak that anywhere from 250,000 to 1,000,000 patients during a six-month period (or however long the outbreak might last) could need antibiotic therapy. While we can not definitively predict what might happen, having to treat so many patients with a very small subset of important antibiotics in such a concentrated time frame would most likely increase antibiotic resistance in these organisms-and these organisms also cause pneumonia in non-influenza settings and others can cause other diseases unrelated to pneumonia (e.g., K. pneumoniae, Acinetobacter).
This entry was posted in Antibiotics, Influenza, Microbiology, Public Health, Viruses. Bookmark the permalink.

2 Responses to Influenza and Antibiotics

  1. Tobasco da Gama
    Joshua says:

    Seems to me that the middle of a flu outbreak is really the worst possible time to start evolving antibiotic-resistant strains of pneumonia bacteria. It’d be painfully easy for someone carrying the bacteria to pass it on to another person whose immune system is already busy fighting off flu viruses — and, hey, one of the symptoms of both flu and pneumonia is a cough that spreads around whatever junk happens to be in the lungs. Antibiotic-resistant bacteria, for example.

  2. Bear
    Steven says:

    I get the flu shot every year around september. One year in the last 7 or 8 years I forgot to get it and I ended up getting the flue. I mean the real flu not that silly thing people call flu.
    I was bid ridden for 8 days. When I describe it to people I say it is like 1) Having the worst common cold ever 2) Having the worst hangover ever 3) being run over my a car every hour on the hour. Roll 1,2 and 3 together and that is what having the flu was like for me. Ever since I had it I jump on people who say they have it when they are out and about doing stuff. Confusing a silly little rhinovirus or adenovirus with the mighty Influenza. How dare they. I know her well and she is a bitch, lol.
    It was bad.

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