Expert Interview on Antibiotic Resistance

In trying to understand more about antibiotic resistance and evolution we consulted Dr Bruce Hodges who practices Geriatric medicine and also an expert in Alzheimer's disease in Overland park, Kansas. Dr Hodges agreed to sit down with us for an interview on February, 27, 2009 at 9.00 am. The following is the transcript of the interview.

Question1. Dr Hodges tell us about yourself and why did you decide to pursue medicine?

After graduating college in Oklahoma I tried to find a job but my certificates were rejected that I had attended an institution that was not accredited. This was in the 50's soon after the end of world war II when the troops returned home, the GI bill was passed I decided to pursue medicine of which after graduating I went into teaching for a while and later Family practice. I then left family practice and began specializing in Geriatrics and Alzheimer's disease.

Question2. What are the common diseases that have shown resistance to antibiotics?

There are several, but Clostridium Difficile Colitis is most prevalent. It used to be one case a month but now it's one case every week. Also there is staphylococcus infections among them is Methicillin Resistant Staphylococcus Aureus (MRSA) that have shown resistance to Methicillin.

Question3. How do you attend to patients in the event that the infection has become resistant to available antibiotics?

We are running out of antibiotic choices because these bugs have developed resistances to the common organisms and vancomycin is one of our last resorts, rifampin is also another antibiotic that we are now combining with vancomycin for instance like Clostridium Difficile Colitis the treatment used to be flagyl and it worked very well but we have an organism now that has developed a resistance to flagyl so we added vancomycin. And now they are becoming resistant to vancomycin so we have to add rifampin.

Question4. Are there any guidelines governing the administration of antibiotics let's say from government agencies?

Well we have guidelines for antibiotics, the first thing is, in medicine try to do no harm, but on the same token our society has been taught to think that an antibiotic is a cure all and sometimes families or patients come to the doctor demanding an antibiotic when they really don't need one for instance, they will have a viral cold, an upper respiratory infection that's due to a virus but they want an antibiotic which is not going to affect the virus and if the doctor does not give them an antibiotic they will go to another doctor and get an antibiotic and the patients now are searching the internet to practice their own medicine and it makes it increasingly difficult because the family practioner in turn is trying to fulfill the needs of the patient at the Same time trying to practice good medicine. And sometimes the families do not want to hear that, what they are asking for is not good medicine, we see it not only with antibiotics, but with other medicine, you know we are in an Alzheimer's facility here and the families will research almost every drug that we recommend and they will see a possible side effect and think it will cause a side effect, it's possible but it doesn't necessarily mean every person is going to develop it as a result, that's a big part of medicine, is trying to convince the patient ... let me try this..Let me do this, this is why? But its constant education process.

Question5. So do you think it's important for doctors to know about evolution?

Oh yes, because we know that when you talk about evolution of resistance, that comes about by mutations and genetic changes and so forth and we do know that organisms mutate and change within a species, we do not have direct evidence that organisms progress from one species to another, I think people who believe in evolution have thought that's what happens and we do seem to have an evolutionary chain, a progression of organisms but we have yet to have proof of one organisms actually evolving into a different species, but we know that within a species organisms change. So do you believe in evolution? I believe in evolution in the fact that obviously things change, theirs physical evolution and biological evolution I don't have the final answer.

Question6. Did you celebrate Darwin's day?

No I recognized it in my mind um... theirs a poem I wish I could remember it all, it goes something like three monkeys were sitting in a coconut tree discussing things as they said to me said one to the other, now listen you two the idea that man descended is a big taboo and they went on to say that no monkey ever put a fence around his coconut tree permitting all others to enjoy the coconut and no monkey ever beat his wife or took a knife and took another's life. And it goes on like that and at the end it says man may have descended the ornery curse but he sure didn't descend from us. ....it's kind of a clever poem.

Question7. So in a group of let's say four patients that you have attended how many do you think are knowledgeable about the use of antibiotics?

You mean in my patients? YES ...out of four patients? YES .....most of them think that an antibiotic is a miracle, it's going to cure every problem they seem to think that one antibiotic can cure every disease which we know is not true and the knowledge that the general public hears is that if you get sick and you take the antibiotic and don't get well because you had a virus and they think the doctor didn't know what he was doing

Question8. So is that the common misconception that people have concerning antibiotics?

A lot of misconceptions of antibiotics exist and it's very difficult to convince people you don't need an antibiotic in this situation and we grow....let's take this Alzheimer's facility 80 - 90 % of these little ladies if we culture their urine they would have a positive urine culture but they are not infected, they are colonized and they are asymptomatic, they do not need an antibiotic. First of all the antibiotic won't clear the urinary tract infection or if it does they will be recolonized within a few weeks because they are most likely incontinent the urethral opening is weak so if an organism migrates up into the bladder it will colonize and infect.