Antibiotics may stamp out bacterial infections, but when taken for long periods of time these drugs stamp like bulls in a china shop kicking up side effects varying in severity from headache to hearing loss.

In this week’s issue of Science Translational Medicine, scientists from Harvard University’s Wyss Institute for Biologically Inspired Engineering published findings showing how antibiotics that kill bacteria can cause oxidative stress in cultures of human cells, and in cells of mice. As Science Daily reports, researchers tested two strategies for avoiding these side effects.

“Clinical levels of antibiotics can cause oxidative stress that can lead to damage to DNA, proteins and lipids in human cells, but this effect can be alleviated by antioxidants,” said Jim Collins, Ph.D., who led the study.

…

[Researchers] were able to prevent oxidative stress by using a bacteriostatic antibiotic — an antibiotic such as tetracycline that stops bacteria from multiplying but doesn’t kill them. They could also ease oxidative stress by mopping up chemically reactive oxygen molecules with an FDA-approved antioxidant called N-acetylcysteine, or NAC, that’s already used to help treat children with cystic fibrosis.

Researchers say further animal studies are needed to determine the optimal ways for correcting oxidative stress related to long-term antibiotic use.

Holly MacCormick is a writing intern in the medical school’s Office of Communication & Public Affairs. She is a graduate student in ecology and evolutionary biology at University of California-Santa Cruz.

Previously: New method may speed identification of antibiotic targets,“Clinical trial in a dish” may make common medicines safer, say Stanford scientists, Image of the Week: Bacterial growth in multicolor and Harnessing evolutionary forces to develop more effective methods for treating superbugs.
Photo: Sameer Kalghatgi and Catherine S. Spina

For many of us, mosquitoes are merely irritants with wings. But for approximately 3.3 billion people (about half of the world’s population) living in the tropics and subtropics, the high-pitched drone of a mosquito could portend a deadly malaria infection.

Though potentially fatal, we can treat and prevent malaria. Efforts are being made to control, and possibly eradicate the disease, as was done with smallpox. But malaria has several aspects that make it challenging to stamp out.

Sepideh Modrek, PhD, an instructor of medicine at Stanford, joined lead author Jenny Liu, PhD, MPP, and her University of California, San Francisco team to address this pesky problem in the debut issue of The Lancet Global Health. They write:

Never mind the spoonful of sugar, new research shows that cardiac patients will take their medicine - and keep taking it - if they are simply given more time. A study conducted at Women’s College Hospital and the Institute for Clinical Evaluative Sciences found that cardiac patients ages 65 and older are more likely to adhere to a regimen of heart medications when the duration of the first prescription lasts for more than 30 days.

In the study, Noah Ivers, MD, of Women’s College Hospital, and his team investigated how long cardiac patients took three different kinds of heart medications when the duration of the initial prescription varied. They found that patients given an initial prescription lasting more than 60 days were 2.4 to 4.1 times (depending on the medication) more likely to continue to take the medication than patients given initial prescriptions lasting less than 30 days.

This finding is important because, as Ivers explains, patients are sometimes given small initial prescriptions to encourage them to attend follow-up appointments. Yet, the team’s research suggests that short initial prescriptions may be an unnecessary annoyance that has little effect on the likelihood of follow-up care. According to Science Daily:

“The majority of patients in our study left hospital with a prescription for cardiac medications for 30 days or less,” said Dr. Ivers, [lead author of the study]. “This may be a result of the common clinical perception that short prescriptions encourage patients to go to their followup appointments, yet our study found regardless of the duration of the prescription, nearly all patients did, in fact, attend their followup appointment.”

Short prescriptions may inadvertently suggest to patients and family physicians alike that long-term adherence isn’t necessary, the authors suggest.

“When we reduce the requirement for early refills, patients still follow up with their family physician or cardiologist and they are more likely to remain on the medications as well, Dr. Ivers said. “We certainly want to encourage early outpatient follow up after hospitalization, but holding medications ransom may not be the best way to do it.”

Holly MacCormick is a writing intern in the medical school’s Office of Communication & Public Affairs. She is a graduate student in ecology and evolutionary biology at University of California-Santa Cruz.

Previously: A moose no longer: How I faced down my fears of heart disease, NIDA accepting proposals of mobile apps designed to help patients take their meds, Raising awareness about the importance of taking medications properly and No co-pays mean more people take their medicine

The five most-read stories on Scope this week were:

Short and sweet: Three days in a sugar solution, and you’ve got your see-through tissue sample: Following on the heels of CLARITY, Japanese researchers at the RIKEN Center for Developmental Biology have developed a faster method for making brains transparent. CLARITY is a breakthrough method pioneered by Stanford’s Karl Deisseroth, MD, PhD, that renders tissue transparent while leaving it structurally intact.

What if obesity has nothing to do with overeating?: In a recently posted TEDMED talk, Peter Attia, MD, explains how his struggle to lose weight transformed his personal and professional perception of obesity.

Record number of organ transplants saves five lives in a day: In the most recent issue of Inside Stanford Medicine, Robert Dicks explains how an otherwise ordinary Monday became a record-setting marathon of organ transplants for the Stanford medical team at Lucile Packard Children’s Hospital. The team transplanted five organs in a twenty-four hour period (one heart, two kidneys, and two livers), a record for the hospital.

The mystery surrounding lung-transplant survival rates: An October article in the San Francisco Chronicle offered a look at the challenges facing lung transplant patients and explored why a significant number don’t live beyond the five-year mark, despite improvements in survival rates.

Germ-zapping robots help prevent infections at Stanford hospital: An Inside Stanford Medicine article explains why Stanford Hospital & Clinics is now employing a team of disinfection robots to do the dirty work of killing germs. A mere ten minutes is all it takes for robots Frost and Dazzle work their magic.

They’re tiny terrors that are best known for the millions of people they’ve killed. Few us of would want to meet them, or their relatives. But for researchers like Verena J. Schuenemann, PhD, and Johannes Krause, PhD, uncovering the pedigrees of the world’s most lethal pathogens is an important step in combating the diseases we avoid like the plague.

Earlier this week in Forbes, writer John Farrell told the tale of the two scientists from the University of Tübingen in Germany, and how they hunt down some of the most notorious pathogens in history.

Studies such as work done by Schuenemann, Krause, and a team of international researchers on potato blight, the Black Death, and (most recently) leprosy, are changing our understanding of diseases that were once buried in the past. As Ann Gibbons of Science recently wrote (subscription required):

Awash in data, several labs are racing neck-and-neck to cull DNA from a Most Wanted list of legendary killers: tuberculosis (TB), plague, cholera, Leishmania, leprosy, the potato blight, and AIDS. They gather traces of these culprits from ancient teeth, bones, hair, feces, and—in the case of potato blight—from skin and leaves, then unleash the sequencers. The work, which began in earnest 3 years ago, adds a new dimension to our understanding of historical events, revealing the true nature of the villains responsible for humanity’s worst epidemics. “There are a lot of diseases described in the historical record that we don’t know what the pathogen is,” says molecular anthropologist Anne Stone of Arizona State University, Tempe.

One persistent question is how the deadliest pathogens evolve over time. As Farrell outlines in his piece, Schuenemann’s team found that the bacteria (Yersinia pestis) responsible for plagues in Africa today are genetically similar to the bacteria that unleashed the Black Death on Europeans in 1347. But, today’s plagues are less lethal - which suggests that evolution knocked a few teeth out of Black Death’s lethal bite.

Understanding when and how evolution changes a pathogen’s virulence is important because the plague is a re-emerging disease and history could repeat itself.

Previously: A journalist’s experience with tuberculosis, the “greatest infectious killer in human history”, Image of the Week: Leprosy bacteria and interferon-beta and Tropical disease treatments need more randomized, controlled trials, say Stanford researchers
Image, of the skull of a 25-year-old woman with leprosy, from Ben Krause-Kyora, PhD, with Kiel University. The genetic material extracted from the skeleton enabled the decoding of the genome of the leprosy pathogen.

For most of us, a change of heart takes some time. But for the team of Stanford medical professionals at Lucile Packard Children’s Hospital, a change of heart - plus two livers and two kidneys - can happen in less time than it takes to ease into the workweek.

Five organ transplants in twenty-four hours is no typical feat for this Stanford hospital. Though medical teams at Packard Children’s Hospital perform about 70 liver and kidney and 15 heart transplants a year, they had never attempted this many organ transplants in a single day.

Since donor organs are scarce, medical teams must be ready to perform an organ transplant (or five) at a moment’s notice. In the most recent issue of Inside Stanford Medicine, Robert Dicks explains the extraordinary circumstances and determination leading to this surgical marathon. From the piece:

“This was the ultimate demonstration of the passion we have for healing children through transplant,” said [Waldo Concepcion, MD, professor of surgery], who once led five kidney transplants in two days. “Care teams throughout the hospital immediately got into it. Experience matters, and they all put in lots of extra hours in order to ensure everything would go smoothly.”

Concepcion also noted that other surgeons postponed scheduled cases to make room for the transplants. “It was impressive but not surprising,” he said. “Everyone was thrilled to see so many transplants save so many lives in such a short period of time.”

Holly MacCormick is a writing intern in the medical school’s Office of Communication & Public Affairs. She is a graduate student in ecology and evolutionary biology at University of California-Santa Cruz.

Previously: The mystery surrounding lung transplant rates, Film about twin sisters’ double lung transplants and battle against cystic fibrosis available online and Pediatric social worker discusses the emotional side of heart transplants
Photo of members of the transplant teams by Robert Dicks