I can see it now: Method and process for reducing MRSA infections by not using drugs.

Don't even try it without paying.

I've heard a number of international folks complain that antibiotics are almost never prescribed in the UK and yet a number of UK hospitals have had MRSA outbreaks. Does anyone have a league table of the cleanliness of each country's hospitals?

On holiday in Malaysia my son was sick so we took him to a doctor. The doctor couldn't really do anything. My son was reacting to the climate and refusing to eat solids but he gave us a bottle of antibiotic dispensed from his surgery "just in case"

So I queried that and he quickly said oh well don't worry about it if you don't think he needs it. It seems that everybody in Malaysia just gets antibiotics automatically when they go to the doctor. My wife grew up in Malaysia and when she gets a cough she gets it for weeks at a time.

As a medical doctor, I can attest to a general over-prescription of antibiotics. I work in Sweden, where we generally don't use as much antibiotics as other parts of the world, but I would say that we use far too much anyway. I am a surgical resident, who is often on call and have a lot of out-patients. The demand from patients that you prescribe some kind of antibiotics is huge, absolutely huge, even for simpler infections where there is little evidence that it will actually shorten the length of illness or level of symtoms. Trying to educate a patient on the matter in a few minutes is no easy task, and other than a general sense of responsibility, nothing keeps one doing just that. Even then, I often hear of my patients going to a different doctor after one or a couple of days and then getting a prescription, even if they haven't gotten any worse. I don't think that there is any easy fix to this problem. People expect a life free of disease, and if they do get some minor illness, they expect immediate recovery. (I am speaking very generally here, of course...)

At first the doctors blew it off as a normal infection even though I rarely get infections of any kind and it felt severe to me. The first few times they just perscribed regular antibiotics which knocked it back but it'd come back in two or three weeks. Finally some one though to check it out and it turned out to be MRSA so they gave me yet another antibiotic which followed the same knock it back comes back in a couple of week pattern. I was then told there was a better one for MRSA so they tried that. Same pattern but in the meantime I moved to another state and wound up with a new doctor that didn't trust her memory. She looked it up and said they were all using the wrong antibiotics and even the one she was going to perscribe was no longer recommended. Finally that series worked and I've been MRSA free for four months. Also I got a secondary infection from all the antibiotics that no one spotted inspite of complaints from me about another problem. That required medicine other than antibiotics to cure. Basically I received five different antibiotics mostly from doctor incompetence. And they wonder why antibiotics are over used? A lot of the problem too is doctors not believing patients. I rarely go to doctors but they still at first thought I was overreacting when I said I thought it was a serious infection. It was in my jaws and throat and I had trouble breathing and swallowing and even wound up going to the hospital once when my throat closed up. They still didn't take it seriously until the tests came back showing MRSA. Even then they didn't give me the right antibiotics. I also now have several scars on my face from later infections that could have been avoided if they had gotten it right the first time and not been so quick to blow me off. Medicine in the US is a train wreck. Did you know tens of thousands of patients die in hospital from neglect every year? I think the last number I heard a few years back was 80,000. That's a disgrace.

As I understood it, there are 2 separate things Norway is doing to fight MRSA, and they are not related (although the article doesn't point that out):

1. Norway is tracking the spread of Staph and quarantining victims to limit the spread.

2. According to the article, Norway isn't prescribing modern antibiotics. This ensures that the Staph that is being passed around Norway probably isn't resistant to antibiotics. This does not make Staph less problematic or control its spread in any way. I'm all for stemming the overuse of antibiotics, but this article smacked of propaganda--or it simply didn't tell the whole story.

About 5 years ago, I had to give up my health insurance (Kaiser Permanente HMO, really) because we moved to a more rural area where they don't have local infrastructure. I didn't get regular health insurance from another company because my Kaiser coverage had been subsidized through an old employer plan, and everything else was too expensive. I worried that I'd get really sick and not have my HMO coverage, because I was used to going a few times a year for various things.

Fast forward 5 years later, and I haven't been to a doctor or hospital at all in that time. I seem to get sick less often than I did before when I'd go to the HMO 3 or 4 times a year with minor ailments, and when I do get sick it's less serious and goes away faster. I've had no antibiotics in that time, just OTC meds (but I avoid fever-reducers unless my fever goes above 102, because fever is one of the body's natural defense mechanisms against microorganisms).

The net result is that me and my immune system are happier, healthier, and wealthier, now that we're not over-relying on doctors and antibiotics. I also believe my household's complete lack of over-cleansing is part of the recipe for good health--people who clean obsessively and use that antibacterial cleanser are destroying harmless bacteria which usually "crowd out" the harmful strains, or at least leave them a minimal space to grow. But when your household is super-clean and a harmful bacterium arrives, it has room to grow everywhere since there's no existing bacterial ecosystem to compete with. Who knew that my stereotypical geeky tendency towards slight messiness and wearing the same clothes 2 days in a row thanks to all-night gaming/writing sessions might increase my health...

I'm sure I'll have to visit the doctor or hospital eventually when something serious happens. Until then, I see my seemingly better health now than when I was going to the doctor several times a year as an anecdotal vindication of the hypothesis that too much cleanliness and hygiene and antibiotic use can be as bad or worse than none, because our immune systems need to develop and thrive by exposure to lesser bacteria in order to be ready to take on serious ones.

I happen to be a bit of an expert in this field - no shit

below is from memory; if people are really interested, i can pull out some references from the scientific literature that back all of this up
MRSA stands for "methicillin resistant Staphylococcus aureus", and it was 1st detected in the UK in the (i think ) '60s

lets backup a bit

the human body is covered, inside and out, with bacteria, which can be harmful, neutral or beneficial - for instance, vitamin B12, a requirement for life, is made by bacteria.
All humans carry Staphylococcus epidermidis; ~ 20% also carry S aureus, which prefers to live in moist places like the inside of the nose (anterior nares) throat, axilla, groin and rectum. Epidermidis is pretty harmless, except for people with implanted devices like catheters; since epi likes "surfaces" it tends to colonize the surface of catheters.
Most people have either epi or aureus, but not both,and these two bugs are a small part of the total skin microflora.

In general, having S aureus on your skin or in your nose does not seem to be harmful; however, if you have a cut, and aureus gains entry to the bloodstream, this is a very serious matter. S aureus , whoose genome is sequenced, carrys a host of "virulence factors" that make it a particularly dangerous infection in the blood; in th era before antibiotics, the mortality rate for aureus septicemia was over 50%, and perhaps 80% in some hospitals (!).

That is, ify ou were a physcian in the most advanced medical center in the world in the 1940s, and a healthy patient got an aureus infection in the blood - perhaps due to infection of a surgical site , where the skin is open- there was a 50% chance that pateint would die. Aureus also tends to grow on the heartvalves, which is the disease known as endocarditis; i should think it obvious that having a film of bacteria on your heart valves is not a good idea.

It is easy to see how penicillin, which was very effective, was viewed as a miracle drug. However, within a few years, aureus became resistant to penicillin, and hospitals were starting to see epidemics of untreatable penicillin resistant aureus.

Luckily, the pharmaceutical compnaies and thier scientists had variations of penicillin - the first was methicillin; since then, dozens of beta lactam antibiotics, the mot advanced of which are the carbapenems and fifth generation cephalosporins (wikipedia is good here) have ben developed.
Staph took 10-20 years to become resistant to methicillin; however, when staph do become resistant, they do so by aquisition of a virus like element (SCCmec) which often carries resistance to a whole host of other antibiotics, so that MRSA is actually a bug that is resistant to many drugs. (technically, SCCmec encodes a replacement for PBP2a, PBP2a', which has a lactam resistant transpeptidase function; but no transglycosylase). the origin of SCCmec is unkown.

The drugs of choice for MRSA are vancomycin, daptomycin and colistin; ceftobiprole, approved in canada and switzerland , is supposed to be very effective.
Vancomycin is very $ and nephrotoxic; the others are worse.

If one looks at different countrys around the world, one sees that some countrys - in particular the netherlands and the scandanavian countrys - have very low rates of MRSA, that is most of the aureus is methicillin sensitive.

However, if you look in detail - and believe me, a lot of scientists have looked very hard - it is hard to find one particular reason why these countrys have low rates of MRSA; rather, it seems to be due to a "bundle" of practices. In general, these countrys have good antibiotic stewardship - drugs are not prescribed unless you need them; they spnd a lot on controlling outbreaks, and they are very carefull to test people from outside the country, who might hve MRSA, when they enter the hospital.

In the US, the statistics on how many people get MRSA and how many die have been compiled by several authors; the most well known is monica klevens of the CDC.
Now it