News & Current Affairs

September 18, 2008

Antibiotic ‘cerebral palsy link’

Antibiotic ‘cerebral palsy link’

cerebral palsy

Antibiotics appeared to treble the risk of cerebral palsy

A study has linked a small number of cases of cerebral palsy to antibiotics given to women in premature labor.

The UK study found 35 cases of cerebral palsy in 769 children of women without early broken waters given antibiotics.

This compared with 12 cases among 735 children of women not given the drugs. Advice is being sent to the study’s 4,148 mothers and a helpline set up.

Medical experts stressed pregnant women should not feel concerned about taking antibiotics to treat infections.

These findings do not mean that antibiotics are unsafe for use in pregnancy
The Royal College of Obstetricians and Gynaecologists

The Oracle study was the largest trial in the world into premature labor and was set up to investigate whether giving antibiotics – which might tackle an underlying symptomless infection – to women with signs of premature labor would improve outcomes for babies.

One in eight babies in the UK is born prematurely and prematurity is the leading cause of disability and of infant death in the first month after birth.

Premature labor

In 2001, ORACLE found the antibiotic erythromycin had immediate benefits for women in premature labor (before 37 weeks gestation) whose waters had broken. It delayed onset of labor and reduced the risk of infections and breathing problems in babies.

Erythromycin and the other antibiotic studied – co-amoxiclav – showed no benefit or harm for the women whose waters were still intact, however, and doctors were advised not to routinely prescribe them in such circumstances.

To study the longer-term outcomes, the Medical Research Council-funded scientists followed up the children seven years later.

Pregnant women should not feel concerned about taking antibiotics to treat infections
Chief Medical Officer Sir Liam Donaldson

Unexpectedly, both antibiotics appeared to increase the risk of functional impairment – such as difficulty walking or problems with day to day problem solving – and treble the chance of cerebral palsy in the children of the women whose waters had not broken.

Of the 769 children born to mothers without early broken waters and given both antibiotics, 35 had cerebral palsy, compared with 12 out of 735 whose mothers did not receive antibiotics in the same circumstances.

The reasons behind this link are unclear, particularly as there was no increased risk of cerebral palsy in women whose waters had broken.

Hostile environment

The researchers believe cerebral palsy is unlikely to be a direct effect of the antibiotic but rather due to factors involved in prolonging a pregnancy that might otherwise have delivered early.

Researcher Professor Peter Brocklehurst of Oxford University said: “We have a suspicion that infection is implicated in premature labour.

“Antibiotics may merely suppress levels of infection to stop preterm labour, but the baby remains in a hostile environment.”

Infections during pregnancy or infancy are known to cause cerebral palsy.

In a letter to doctors and midwives advising them about the findings, Chief Medical Officer Sir Liam Donaldson says: “Pregnant women should not feel concerned about taking antibiotics to treat infections.

“It is important to note that these women had no evidence of infection and would not routinely be given antibiotics.”

Where there is obvious infection, antibiotics can be life-saving for both mother and baby, the CMO says.

The Royal College of Obstetricians and Gynaecologists said: “These findings do not mean that antibiotics are unsafe for use in pregnancy. Pregnant women showing signs of infection should be treated promptly with antibiotics.”

Cerebral palsy can cause physical impairments and mobility problems.

It results from the failure of a part of the brain to develop before birth or in early childhood or brain damage and affects one in 400 births.

A helpline is available for study participants on 0800 085 2411 between 0930 and 1630 BST. NHS Direct has information available for other members of the public.

A spokeswoman from the special care baby charity Bliss said: “This highlights the importance of fully understanding both the immediate and long-term impact of the care and treatment that both mother and baby receive at this crucial time.”

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September 10, 2008

Antibiotic resistance rise fears

Antibiotic resistance rise fears

Antibiotic pills

The NHS is being warned about its use of antibiotics

The rise in antibiotic resistance is reaching worrying levels, experts say.

The Health Protection Agency said while the focus on infections such as MRSA had been largely successful, new trends in other bugs were now posing a threat.

For instance, 12% of bloodstream infections by E. coli in England, Wales and Northern Ireland now show some signs of not responding to drugs.

The HPA said the NHS must be careful over antibiotic use and urged industry to look into developing new drugs.

There are two main families of bacteria known as gram-positive, such as MRSA, and gram-negative, which includes E. coli and other less common bugs Acinetobacter and Pseudomonas.

There are some cracks in the system, but they are not big ones yet
Dr David Livermore, of the HPA

The HPA said there had been a drive to tackle MRSA in recent years which had helped reduce infection rates and led to a host of new antibiotics to be developed.

By comparison, the development of antibiotics targeting gram-negative bacteria such as E coli, which can cause a range of symptoms from mild diarrohea to abdominal cramps and kidney damage, was much less common.

The fight against drug resistance is an on-going battle because many bacteria constantly mutate, gaining resistance to current antibiotics in the process.

This is what has been happening in recent years to the likes of E coli.

HPA data shows that there are about 20,000 bloodstream infections of E. coli each year – although the true level of infections would be much higher if urinary tract infections were taken into account.

Of these, 12% show signs of resistance – up from about 4% at the turn of the century.

The infections are mostly not yet resistant to all forms of antibiotics, just what doctors call the first-line.

This means they are having to use back up drugs, which tend to have more side effects and raises the prospect of the widespread emergence of a new strain which is totally antibiotic resistant.

Cases

Indeed, reports have already emerged of such a scenario in Israel and the US, while four cases have been reported in the UK.

Dr David Livermore, an infections expert at the HPA, urged industry to start looking at developing new antibiotics.

But he added: “The NHS must be careful over its use of antibiotics to slow down the development of resistance.

“Hospitals must make sure they use the right dose, for the right length of time.

“GPs should not prescribe – nor patients expect – antibiotics for routine coughs and colds.

“Resistance has been accumulating. We are having to use reserve antibiotics more than previously… that is worrying.

“There are some cracks in the system, but they are not big ones yet.”

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