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Infections and antibiotics.

This is part two in a series of articles about antibiotics (and how they apply to SCI) and other medications.

The March PN briefly discussed a history of infectious disease and the many attempts people have made to combat infecting organisms. Individuals with spinal-cord injury (SCI) have battled infections since the beginning of recorded history. The earliest records of spinal injury are found around 750,000 years ago, but it is only since last century that most people with SCI lived very long. The primary reasons people died were due to their inability to urinate or have bowel movements along with breathing problems and skin breakdown. If they lived through these problems, infections quickly followed.

The urinary-tract system is of particular concern. It is important to keep the kidneys clear of minerals and sediment and to flush the bladder to keep it clean. Urinary-tract-system infections usually result from long-term catheterizations, by the introduction of an organism into the system, and from poor fluid maintenance. Adequate amounts of water inhibit the growth of organisms that cause infections by flushing them out. Without adequate fluid intake organisms can grow and affect the bladder, urethra, ureters, and kidneys (all parts of the urinary-tract system).

What Is an Infection?

An infection is when microorganisms reproduce in large enough amounts in the patient's own tissues to cause "problems" or make the individual "sick." The body's natural defenses (immune system) provide a mechanism that generally keeps invading microorganisms from attacking the body. In SCI, the body's defenses can be compromised. Most people with SCI have experienced infections repeatedly; urinary-tract infections (UTIs) are common.

Prevention is the key. Sterile, timely catheterization; good diet; and adequate fluid intake contribute to good urinary-tract health. However, many people with SCI experience chronic UTIs and flareups. Long-term antibiotic use--with the intermittent addition of other antibiotics--might be helpful when flareups occur.

Antibiotics have aided in keeping many infections from overtaking people with SCI. Since World War II, antibiotics have become increasingly important drugs. Many times, however, they are overused. For example, viral infections will not respond to antibiotics. In some cases doctors prescribe antibiotics to protect the sick person from getting an additional infection secondary to the viral infection. This situation can become very complicated.

How Do Antibiotics Work?

Antibiotics are chemical substances that prevent the growth of or destroy microorganisms. They inhibit or kill microorganisms in the affected area without seriously damaging the cells. They do this by interfering with the microorganisms' functions. A drug should not damage the person receiving it. For example, an antibiotic might interfere with an enzyme system necessary for microorganism nutrition but not bother the person because the concentration of the drug is not high enough to disturb the human but high enough to stop the offending microorganism.

Certain infections can be effectively treated with the use of only one antibiotic, while some may require several. In selecting appropriate antibiotics, the effect against the offending microorganism must be considered along with the ease of administering the drug, toxicity, cost of the drug, and patient reaction.

Doses must be adequate to bring about recovery from illness as soon as possible and to discourage the development of drug resistance by the microorganism. Excessive dosage, however, increases the likelihood of toxic reactions. It is key to take your prescribed antibiotics as directed and to follow up with your physician if symptoms worsen.

A good antibiotic should be harmless to human tissues, especially blood and blood-forming organs, the liver, and the kidneys. To be effective, it must remain in the body tissues for a relatively long period of time, and if the infection is severe, the dosage, as well as the length of time during which it is administered, may have to be increased; low toxicity is a primary qualification. An antibiotic should be stable and not destroyed by enzymes; not inhibited by the presence of serum, pus, or blood; and not eliminated too rapidly by the kidneys. The infecting microorganisms should not develop resistance to it, and it should diffuse readily through the body tissues and not sensitize the patient. The drug should not alter the normal organisms in the body, thus avoiding superinfections.

Problems With Antibiotics

Resistance is the ability of a microorganism to withstand an antibiotic. You may have seen articles about infections that are difficult to cure. MRSA (methycillin resistant staphylococcus aureus) and VRE (vancomycin resistant enterococci) are some of the acronyms you might see related to antibiotic-resistant organisms. The staphylococcus organism is adept at developing resistance to many antibiotics.

Increased resistance to a growing number of antibiotics is a serious problem facing infection-control experts. It is wise to reserve certain new antibiotics for use in treating serious infections due to potential development of resistance.

"Superinfections" occur when the normal distribution of organisms in the body is depleted by the use of antibiotics. It is common for people to develop yeast infections after antibiotics have been used. These must then be treated with appropriate medications. Call your physician if you think you have a yeast infection.

Many people are extremely sensitive to antibiotics. Some have allergic reactions with the first dose. Overuse, however, may result in hypersensitive reactions to antibiotics, so caution must be used when these drugs are taken. Before you use any antibiotic, your physician, nurse, or pharmacist must find out if you are allergic or hypersensitive to the drug you are prescribed. Seek medical attention if you think you are having a reaction.

Learn About Your Illness

If you have an infection, find out all you can about how to clear it up and avoid it in the future. Learn how you can prevent spreading it to others and what the complications are of your infection and the antibiotics you take. Be an informed consumer.

Contact: AnnA@pva.org.
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Title Annotation:living WELL
Author:Adair, Ann
Publication:PN - Paraplegia News
Date:May 1, 2005
Words:966
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