MRSA and CAM

by Ronald D. Whitmont, M.D.

Abstract: The history and emergence of MRSA are discussed with reference to causative factors and several CAM strategies that may be effective in treatement.

Keywords: MRSA, Antibiotics, Antibiotic Resistance, Homeopathy, Honey.

Introduction

According to the Centers for Disease Control (CDC) Antibiotic resistance is “one of the world’s most pressing public health problems.” Methicillin Resistant Staphylococcus Aureus, or M.R.S.A. is one of the newest plagues on our way of life. MRSA is just one member of a group of micro-organisms demonstrating increased resistance to conventional antibiotic treatment strategies. These organisms have only recently emerged from the fabric of our disturbed environment since the medicine, hygiene and agricultural industries have adopted the routine use of antibiotics.

Community aquired strains of MRSA are interesting and unique because they combine antibiotic resistance with a powerful increase in virulence and invasiveness. Infectious outbreaks involving these organisms don’t originate in hospitals or nursing homes, but have sprung up in the community at an unprecedented rate.

With mounting public concern, the lay media has responded by filling the information gap with explanations and suggestions. Unfortunately, many of these suggestions involve the same orthodox antibiotic strategies that created this problem. Guidelines generated by medical authorities including the CDC and groups like the New York City-based Committee to Reduce Infection Deaths (RID) follow the same orthodox methodologies. These offices appear to be at a loss when it comes to suggesting effective alternative strategies.

Judging by the lay media coverage and professional review analyses, viable alternative strategies for dealing with this situation in an efficacious manner are simply nonexistent. This article will refute that point by providing background information on the nature of antibiotic resistance and explore several effective complementary and alternative medical (CAM) approaches that can be safely and effectively utilized to curtail the problem.

Bacteria

The bacterial world is poorly understood. Ever since the discovery of bacteria in pond water by the Dutch scientist Anton van Leeuwenhoek, in 1676, only a small number of bacteria have been associated with disease. The vast majority of micro-organisms are not associated with diseases. Most of the organisms found on the human body are associated with health. Out of necessity, medical scientists focused on the disease carrying potential of bacteria and largely ignored the more beneficial organisms, considering them as merely “innocent bystanders” until only recently. This narrow focus on disease association has had several unfortunate results. By associating most bacteria with infection, the public has learned to fear bacteria and has employed many techniques for trying to eliminate bacteria from the environment.

The landmark event that lead us down this avenue began with the Austrian physician Ignaz Philipp Semmelweis, who demonstrated the pathogenicity of bacteria in the maternity ward in 1847. Semmelweis was ultimately ostracized and humiliated for this revolutionary concept, but since that time our culture has adopted his views and taken them to the opposite extreme. The pendulum has swung the other way and we are now faced with a society that vilifies and fears bacteria. The grey area in-between these two viewpoints is in need of further exploration.

The grey area suggests that bacteria play many roles in health and illness, but they are intrinsically necessary for our own survival and that of the environment. Bacteria are collectively essential as the mortar that holds both our health and the ecosystem together. It is important to modify the way society views of bacteria to incorporate the scientific understanding of how important these organisms really are..

Recent investigations demonstrate that the biomass of bacterial species are not only the most abundant, but they are also the most important organisms on this planet as well as on our bodies. Disturbances of health and physical functioning are increasingly being tied to the imbalances that result from the destruction and elimination of these organisms because of antibiotic strategies.

Far from being uniformly dangerous, bacteria are essential to the health of the body and to the environment. The healthy mouth is home to more than 200 different bacterial species and the human body is home to several trillion resident bacteria.

Antibiotic sensitive Staphlococcus aureus (MSSA) is a ubiquitous bacterial species found throughout the ecosystem, on the skin and in the respiratory tracts of most healthy humans. Its presence is normal and not a cause for any alarm or concern. MSSA poses no risk to human health as long as the immune system is functioning normally. MSSA is part of the “normal bacterial flora” existing on and in the human body. Infections with MSSA can develop when normal immunity breaks down or is disrupted by some other factor. Disruption of immunity can occur for many reasons, both extrinsic and intrinsic to the host organism.

Such immune breakdowns can be triggered by various events, including mechanical breaks in the skin and epithelium (trauma and injury), pre-existing illnesses that weaken the immune system (diabetes, leukemia, obesity, etc), medications that suppress the immune system (steroids, antibiotics and immune modulating agents), nutritional factors (vitamin deficiency, dietary errors), and even emotional factors (including stress and depression).

When immune disruption occurs, infection with MSSA can develop as a secondary process. Left to its own devices, MSSA is not normally an invasive or aggressively infectious organism. When the immune system is suppressed, damaged or disrupted, the situation changes and it can become opportunistically invasive.

Antibiotics

The strategy of using antibiotics to fight infections began innocently enough with the introduction of penicillin in the 1940’s. However, in the last 70 years the use of antibiotics has skyrocketed, resulting in indiscriminate, random and arbitrary over-use of these agents.

The premise on which antibiotic use is based is simple: antibiotics are meant to provide chemical weaponry for the selective elimination of targeted pathogenic bacterial species. This chemical warfare is meant to act like a selective clean-up to assist the immune system, which is then free to complete the process and restore health.

The process is a bit more complicated:
Antibiotics rarely, if ever completely eliminate a bacterial pathogen from the body, even under ideal conditions. These drugs are effective in eliminating the weaker organisms while sparing the hardy.
Antibiotics aren’t able to selectively eliminate one pathogenic bacterial species over another. Their actions are largely indiscriminate, destroying large numbers of nonpathogenic, pro-biotic bacterial species in the process.
The immune system is frequently incapable of finishing the job that’s started by the antibiotics it’s been suppressed through a number of pathways.

Even in controlled “in vitro” experiments in the laboratory, antibiotics have been found to induce bacteria to enter dormant states, alter their physiology and aquire resistance. In the body, the potential for bacteria to evade the effects of these drugs is even more pronounced. These organisms are able to exist in zones of the body inaccessible to antibiotic penetration, thereby achieving asylum.

Antibiotics are unable to target single bacterial species. Even the most “narrow spectrum” agents destroy members of many different species of bacteria, from so called “friendly fire”. In this way they lead to imbalance and dysbiosis on the skin and in the gastrointestinal and respiratory tracts. Many essential species of bacteria are thereby disturbed and affected by this approach. The “broad spectrum” antibiotics are even more effective in destroying a wide range of bacterial species, taking along beneficial bacteria with pathogenic ones. Opportunistic yeast and monocultures of surviving (and frequently resistant) bacteria are the result. The effects of these disruptions can be widespread and long lasting.

The use of antibiotics and the subsequent disturbances of bacterial flora in and on the body have been linked to a wide variety of adverse sequellae including Inflammatory Bowel Disease, Pseudomembranous Colitis, Sudden Cardiac Death, Gastroesophageal Reflux Disease , Inflammatory Airway Diseases, including Asthma and Bronchiectasis, kidney stones, breast cancer, and allergies in later life.

According to researchers at the Drug Safety Clinic at Sunnybrook health Science Center in Toronto Canada, antibiotics cause the majority of adverse drug reactions in children.

The use of antibiotics leads to the emergence of resistance, and alters native bacterial flora. It also has direct adverse effects upon the immune system. According to leading pharmacologists, antibiotics directly suppress the immune system through several different pathways including:

Decreased leukocyte chemotaxis, the process whereby white blood cells migrate to areas of infection in the body,
Decreased lymphocyte and monocyte transformation, or cellular immunity, the process whereby inactive white blood cells are activated into cells that attack invading bacterial organisms,
Decreased antibody production, or humoral immunity, the process of producing specific antibodies against distinct classes of organisms, which enable activated white blood cells to selectively destroy selected bacteria,
Decreased phagocytosis, the process whereby certain white blood cells actively swallow and digest bacteria,
Decreased microbiocidal action of polymorphomultinucleated leukocytes, the process whereby certain white blood cells release toxic chemicals to destroy bacteria.

The combination of these suppressive factors impair the immune system making it more susceptible to a wide variety of fungal and viral super-infections while increasing the risk of developing recurrent bacterial infections.

Antibiotics also cause antibiotic resistance: in direct proportion to the frequency and duration of their use. Without the use of antibiotics there would be no crisis of antibiotic resistance. Antibiotic resistance is a direct effect of the way in which these agents work. Antibiotics eliminate “weaker”, more fragile and susceptible bacteria and create a type of selective breeding program for stronger, hardier, more resistant (and in the case of community aquired MRSA) more aggressive strains.

Antibiotic resistant organisms are a predictable and inevitable outcome of antibiotic use. The more prolonged the course of treatment, the more likely that resistant organisms (like MRSA) will develop. The only way to ensure that resistance to antibiotics does not develop is to avoid the use of these agents altogether.

Overuse

According to the Mayo Clinic in Rochester, Minnesota, MRSA is the direct result of three major events:

Overuse of antibiotics by the health care sector to treat minor self-limited illnesses,
Antibiotic spread into the food chain and water supply from agriculture and human waste,
The normal (and essential) property of bacterial mutation and genetic sharing.

In short, MRSA is a direct result of human activity in health, medicine, agriculture and the hygiene industries. The crisis is caused by a society-wide over-reliance on these drugs. The current problem is completely iatrogenic. Antibiotic resistant bacteria are the direct result of an antibiotic-abusing world that has normalized the overuse of these drugs in agriculture, medicine and hygiene.

Agribusiness is a heavy contributor to the antibiotic problem. Antibiotics are routinely utilized in agriculture and veterinary industries to suppress infections and to stimulate livestock growth. In the U.S. over 25 million pounds of antibiotics are consumed annually (compared with 3 million pounds prescribed by the medical profession each year). These agents are frequently added to animal feed to stimulate growth and to suppress infection. As a result significant antibiotic residues enter the food supply and the water table. Many outbreaks of human illness caused by antibiotic resistant bacteria have been traced directly back to these sources.

The beauty and hygiene industries have also contributed to the current antibiotic dilemma. Both these groups foster and cater to a growing public anxiety that all bacteria in the environment pose a threat to human health. Through strategic marketing tactics the public is kept in a state of fear and told that the solution lies in even greater use of antiseptic and antibiotic products in personal hygiene. These industries market products in the form of antibiotic soaps, and cleaning products to “sanitize and sterilize” the body. The result is a backfire that increases the antibiotic resistance problem.

The advertising industry contributes to this crisis by promoting a societal fear of bacteria, and suggesting that cleanliness and sterility (with respect to bacteria) not only improves personal health, but is socially responsible and makes one more attractive and sexy. Beauty, attractiveness and sexuality are the main marketing tools utilized to sell these products. Collective paranoia and fear of appearing unattractive or unsanitary drives greater consumption and increases reliance on these products.

MRSA

MRSA was first identified in 1961, only two years after the 1959 development of the antibiotic methicillin. It was first noticed in hospitals where antibiotics were routinely over-utilized. In response, hospitals mandated “rigorous hygiene” through isolation precautions, frequent hand washing and use of antibacterial sterilization procedures. These precautions had no noticeable effect except to increase the incidence of these infections. These rigorous control measures did nothing to contain MRSA which spread from hospitals to other treatment facilities, including nursing homes and tertiary care facilities.

The CDC estimates that invasive disease due to MRSA has doubled since 2001 and in the ICU they have tripled. MRSA colonizes at least 1% of the global population and is increasing due to continued routine and indiscriminate antibiotic use. In 2004 two thirds of the isolates of S aureus from intensive care units were MRSA. In 2005 alone there were 368,600 U.S. hospital stays associated with MRSA , 100,000 cases of invasive MRSA and 18,650 deaths due to MRSA.

Vancomycin, long considered the antibiotic of last resort in the treatment of MRSA is now becoming increasingly ineffective. There are now cases of Vancomycin resistant MRSA known as VRSA, hVISA and VISA depending upon the degree of resistance. Reported rates of hVISA vary from 2% to 76%.

MRSA is just one example of the many species of bacteria that have adapted to and survived antibiotic use. MRSA has become resistant to every antibiotic ever developed to fight it. Other antibiotic resistant bacteria that have emerged include: multi-drug resistant tuberculosis, clostridium difficile, vancomycin-resistant enterococcus, and multi-drug resistant streptococcus pneumoniae. These organisms are the “tip of the iceberg” representing a few examples of the effects of increasing antibiotic use throughout the world. Bacteria have recently been isolated from the soil which actually utilize antibiotics as food.

Crisis

Resistance is a normal and predictable outcome from antibiotics usage. Its emergence is dependent upon the frequency and duration of antibiotic use. Continual employment of antibiotics will result in even more resistance. Newer antibiotics temporarily forestall this process, but do not halt or reverse it.

Antibiotic resistant organisms, including MRSA, are widely dispersed around the globe. They exist in every niche, including institutional living environments, hospitals, homes and schools throughout the world. This unfortunate reality is directly correlated with irresponsible and overuse use of antibiotics.

The more antibiotics are used to fight infections, including MRSA, the more “aggressive” this organism has become. The newest strains of community associated MRSA (or CA-MRSA) are even more destructive and invasive than the original hospital aquired mutations that were originally isolated.

The medical profession continues to deny that there is a problem. Medical authorities are unrelenting in their assertion that there is nothing wrong with the antibiotic-based system of medicine, but choose to blame “a few antibiotic overusers” as the sole cause for the current crisis. More “prudent” use of antibiotics is the proposed solution.

This position is specious. The crisis of antibiotic-resistant bacteria plagues our entire world. It is the result, not of exceptional cases, but widespread reliance on antibiotics everywhere. The antibiotic approach to infectious disease, agriculture and hygiene has proven to be a time bomb with serious repercussions in health and the environment. Overuse of antibiotics has accelerated this trend, but even “prudent” use of these agents would have the same result.

The use of antibiotics as a continuing strategy to fight the spread of MRSA or any other organism that is not immediately life threatening is not only ineffective, but it is fundamentally short-sighted and irresponsible.

CAM

There are safe viable alternative treatments for infectious illness and antibiotic resistant bacteria that do not worsen the crisis. Several CAM modalities approach this problem from a completely different angle: instead of focusing on aggressive chemical warfare (that can be resisted) some CAM modalities focus on strengthening host immune defenses. This approach recognizes that balance may be more effectively achieved by strengthening defenses rather than attacking offensively. Effective CAM modalities also recognize that most bacteria are vital in health and enlisting their support is equally important.

CAM implies, at it’s heart, an ecologically responsible approach to medicine and the environment that takes into account the local and global effects of treatments and interventions in both the short and long term. Good CAM practices recognize that all treatments and approaches to health, agriculture, and personal hygiene must first be ecologically sustainable and safe at all levels of the environment.

Several CAM systems strengthen host immunity without creating toxic results. CAM strategies to be considered when dealing with antibiotic resistance, including MRSA and VRSA follow two basic routes: (1) topical applications that help re-establish a stronger barrier to bacterial (biofilm) incursion, and (2) internal treatments that augment higher levels of immune functioning and resistance to infection.

Topical Treatments

Topical Staphylococcal infections are more likely to occur when an individual’s immunity is suppressed or disrupted by either an intrinsic or extrinsic breach in the integrity of the skin. Staphylococcal bacteria which penetrate the skin or respiratory tract and produce an infection are unopposed if the immune system is compromised or suppressed. Otherwise, staphylococcal bacteria on the skin and in the respiratory tract ordinarily cause no problems, but may even play a functional role in maintaining skin integrity.

The major factors mediating susceptibility to infections with staph and other bacteria are primarily host factors, not intrinsic bacterial properties. When the host’s immune system breaks down, a normally benign organism is free to enter the body and cause problems. This requires a breakdown at some level of the immune system’s outermost defenses before this can occur.

When most MSSA bacteria infect healthy individuals, the infections tend to cause mild reactions that resolve quickly, without need for medical intervention. Antibiotics are usually not needed because the immune system is usually capable of handling these infections with little or no assistance. These infections tend to go unnoticed since they are minor, self-limited and minimally symptomatic. They pose little if any risk to health.

If a skin infection is present, then basic hygiene and skin ecology is of paramount importance, and disinfection and sterilization is usually not necessary (and may be harmful). It is important to cleanse and irrigate wounds, but not with toxic antibacterial soaps. Wounds, lacerations and abrasions should be thoroughly cleaned with plain water and regular soap if necessary, until dirt and particulate matter are removed.

Antibacterial soaps are not only ineffective, but potentially toxic to the host. They promote the development of topical antibiotic-resistant bacteria. Skin integrity and the preservation of its native bacterial ecology are essential elements in maintaining an adequate barrier defense. Normal flora and bacterial balance on the skin must be encouraged.

The use of probiotics in foods and the avoidance of antibacterial products on the body is essential in this respect. In addition, normal skin oil content must be maintained through maintenance of adequate dietary intake of oils and essential fatty acids. The use of appropriate topical oil based applications is also important. Use of water soluble lotions and harsh detergents that strip oil from the skin should be avoided whenever possible.

Pure, raw, unfiltered honey is an extremely effective and safe topical therapy against many dermatologic bacterial and fungal infections. When this material is applied to any skin surface that demonstrates a break in its integrity, it is effective in preventing and treating superficial bacterial infection. Use of food grade filtered honey may also be effective.

Superficial wounds, lacerations and abrasions can be effectively treated using a poultice of raw unfiltered honey. The topical application of honey is extremely simple and effective in treating and preventing minor infections caused by staphylococcal and other bacteria. The U.S. FDA recently approved a skin care product containing Leptospermum honey from the Manuka bush in an absorbent dressing for this purpose.

Honey has been used extensively in Europe and New Zealand where it has undergone side-by-side testing with conventional antibiotic-based applications. Data from studies indicates that honey is just as effective against MRSA as it is against MSSA. Honey does not seem to act primarily by toxic means, but by forming a disruptive mechanical barrier that overwhelms the bacteria. It exerts no toxic pressure on the bacteria and poses no environmental or toxic risk to the host. There is no evidence that it selects for any resistance.

Honey appears to act by inhibiting the growth of bacteria through several different mechanisms.
Honey’s high sugar concentration exerts an osmotic effect which draws moisture and foreign particles (including bacteria) out of wounds and abrasions.
This osmotic effect appears to exert a bacteriostatic effect directly on bacterial organisms, by dehydrating them, thus preventing their growth.
Honey contains enzymatic peroxidases that work against a wide range of organisms including fungi, anaerobic, aerobic, gram-negative and gram-positive bacteria.

Applications of medicinal clay have proven to be quite helpful inhibiting bacterial activity. Certain clays have bacteriostatic activities against a wide range of bacteria. Clay also appears to act primarily by establishing an impermeable barrier, but more investigative work needs to be accomplished in this area. At present it appears that at least some bacteriostatic activity is due to ionic charges associated with the clay molecules.

Auto urine therapy is currently utilized across Asia and many parts of Europe. It involves the topical application, (in some cases also the ingestion or injection) of one’s own fresh urine. Auto urine therapy has been exhaustively investigated and found to be highly effective and safe in the treatment of many superficial infections. Urine has been shown to have many antibacterial, antiviral and antifungal characteristics both in vitro and in vivo. The proposed mechanism of action is based upon several of the components of urine which include urea, antibodies, and various amino acids. Investigators have failed to find any adverse or toxic reactions from this form of therapy.

Urine also makes an effective irrigation solution that is safe for topical application anywhere on the body. It may be applied directly to wounds, burns and abrasions. It’s activity appears to be bacteriostatic, bacteriocidal and fungicidal.

Internal Treatments

Homeopathy is a system of medicine that has been in world-wide use for over two hundred years. It is currently used in many clinics, both on its own and side by side with conventional medical treatment. The mechanism by which homeopathy works is unknown. It appears to support the immune system by accenting intrinsic mechanisms, thereby enabling it to improve overall efficiency. This may, in turn, assist in the return to homeostasis in the body. Homeopathy has a long anecdotal track record of successful cure, but a much more limited history of successful scientific inquiry into its use.

A limited number of well-designed studies have demonstrated marked therapeutic effectiveness of homeopathic treatment over placebo. These inquiries have shown benefit in many areas, including, acute infectious diarrhea, sinusitis and acute otitis media.

Homeopathy appears to work well when utilized across a wide variety of methodologies including the “classical” and the “pluralist” approach. Homeopathy is environmentally sound, with no known negative environmental impact. Further work is definitely needed to support the initial hypothesis that homeopathy is effective as a treatment of infectious illness, but enough data already supports its efficacy across a wide range of conditions to merit its immediate application without further delay.

Conclusion

The emergence of MRSA and other antibiotic resistant organisms reflects widespread ubiquitous over-use of antibiotics on a global scale. MRSA and other resistant bacteria have been unwittingly and selectively favored by our society’s over-reliance on and overuse of antibiotic drugs. This process has taken place over several decades and is the combined result of activities in medicine, agriculture and the cosmetic-hygiene industries.

Not only do antibiotics fail to eliminate resistant bacteria, but they actually encourage their growth. Infectious organisms are impelled into more aggressive and virulent states as a direct result of, and in direct proportion to the frequency and duration of antibiotic exposure. The medical profession, the agricultural, and the beauty-cosmetic industries as well as the general public must face the fact that current antibiotic strategies are leading to a widespread environmental and public health disaster. Failure to interpret the current trend and make appropriate changes is a serious mistake.

The use of antibiotic agents should be severely curtailed in health, agriculture and the hygiene industries. Their use in medicine should be reserved for the most serious and life-threatening circumstances only. CAM measures should be utilized on a broad scale to treat day to day infections, to support immunity and to protect against the occurrence of infections.

To avert catastrophe the medical profession must recognize that the current antibiotic system has failed and that a new approach based upon rational, scientific validated therapies must be implemented. The agricultural industries must abandon their harmful antibiotic approach in favor of more natural, self sustaining methods. The beauty and hygiene industries must cease and desist in their strategy of marketing unnecessary products on the basis of fear.

The new course in these industries should focus on sound environmentally sustainable strategies that work within the natural systems rather than against them. Proper hygiene, nutrition and healthy lifestyle factors must be thoroughly emphasized holistically and bacteriologically. The use of CAM modalities, including homeopathy and other natural products should be more broadly instituted.

Bio: CONTACT _Con-3CE37C271 \c \s \l Ronald D. Whitmont, MD is Associate Clinical Professor, Department of Preventive and Community Medicine, New York Medical College, Valhalla, New York. He is currently president of the Homeopathic Medical Society of the State of New York and Treasurer of the American Institute of Homeopathy. He maintains a private practice of Classical Homeopathy in New York. He can be reached at www.homeopathicmd.com

This paper was initially presented at the annual meeting of the Homeopathic Medical Society of the State of New York (hmssny.org) on November 10, 2007.

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