R. Villano - Superbugs & superdrugs (p.te 2: issues and contrast of antibiotics)

Superbugs & Superdrugs
6
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Raimondo Villano
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Contents index
Sommario 13
Abstract 15
Résumé 17
Abstrakt 19
Abstracto 21
1. A brief history of antibiotics 25
2. Issues and contrast of antibiotic 33
3. Major resistance to antibiotics 49
4. Look back at some super diseases 55
5. Technologies and research directions 65
6. New therapeutic compounds 77
7. Appendix 85
8. Author profile 169

Raimondo Villano
9
“Life is short, art is long,
the favorable opportunity,
attempting misleading,
the difficult decision”
Hippocrates

Raimondo Villano
11
Parole chiave
antibiotici, resistenza, batteri.
Keywords
antibiotics, resistance, bacteria.
Classification LCC
RM 265 - 267.
Title
Antibiotic resistance.

Raimondo Villano
13
Sommario
Si tracciano cenni storici sul concetto di antibiosi, su ricerche, scoperta e
produzione degli antibiotici e sul loro ruolo mondiale non solo terapeutico
ma anche strategico dal secondo dopoguerra. Poi, si esaminano a livello
nazionale ed internazionale: le problematiche inerenti consumo, uso
improprio e abuso di antibiotici nell’uomo, in zootecnia, agricoltura e,
quindi, nel ciclo alimentare e nell’ambiente; le politiche di contrasto al
fenomeno dell’iperprescrizione e nei cittadini il grado di informazione e
consapevolezza dei rischi; le linee guida di buona prassi comportamentale
del malato; i documenti principali di lotta a tale emergenza. Si effettuano,
inoltre, una rassegna analitica e un approfondimento su alcune super
patologie (tubercolosi, gonorrea, meningite, ecc.) e sulle resistenze
batteriche ai principali antibiotici. Si realizzano, infine, una ricognizione
sull’attualità delle tecnologie e degli indirizzi di ricerca applicata e una
rassegna sulle principali recenti nuove terapie. Chiude il lavoro
un’appendice tecnica contenente un apparato essenziale di normative e
direttive ministeriali italiane e comunitarie europee sul tema.

Raimondo Villano
15
Abstract
You plot historical notes on the concept of antibiosis, on research,
discovery and production of antibiotics and their global role not only
therapeutic but also strategic since World War II. Then, you look at
national and international issues related consumption, misuse and overuse
of antibiotics in humans, in animal husbandry, agriculture, and thus in the
food chain and the environment; policies to combat the phenomenon of
excessive prescription and citizens in the degree of information and
awareness of the risks; guidelines of good practice behavior of the patient;
the main documents of struggle in this emergency. We make also an
analytical overview and a discussion of some super diseases (tuberculosis,
gonorrhea, meningitis, etc.) And bacterial resistance to major antibiotics.
We realize, finally, a survey on current technologies and addresses of
applied research and a survey on major recent new therapies. Closes work
a technical appendix containing an apparatus essential regulations and
ministerial directives Italian and European Community on the theme.

Raimondo Villano
17
Résumé
Vous tracez notes historiques sur le concept de antibiose, sur la recherche,
la découverte et la production d’antibiotiques et de leur rôle dans le monde
non seulement thérapeutique, mais aussi stratégique depuis la Seconde
Guerre mondiale. Ensuite, vous regardez les questions nationales et
internationales liées à la consommation, utilisation abusive et excessive
d’antibiotiques chez l’homme, dans l'élevage, l'agriculture et, donc, dans la
chaîne alimentaire et l’environnement; politiques de lutte contre le
phénomène de la prescription excessive et les citoyens dans le degré
d’information et de sensibilisation des risques; lignes directrices de bonne
conduite de la pratique du patient; les principaux documents de lutte dans
cette situation d’urgence. Nous faisons également un aperçu analytique et
une discussion de certaines super maladies (tuberculose, la gonorrhée, la
méningite, etc.) et de la résistance bactérienne aux antibiotiques majeurs.
Nous nous rendons compte, enfin, une enquête sur les technologies et les
adresses de la recherche appliquée en cours et une enquête sur les
principales nouvelles thérapies récentes. Ferme fonctionne une annexe
technique contenant les règlements essentiels de l’appareil et les directives
ministérielles italiennes et de la Communauté européenne sur le thème.

Raimondo Villano
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Abstrakt
Sie plotten historische Anmerkungen über das Konzept der Antibiose, auf
Forschung, Entdeckung und Herstellung von Antibiotika und ihre Rolle in
der Welt nicht nur therapeutisch, sondern auch strategische dem Zweiten
Weltkrieg. Dann schauen Sie auf nationalen und internationalen Fragen im
Zusammenhang mit Konsum, Missbrauch und übermäßige Einsatz von
Antibiotika bei Menschen, in der Tierhaltung, Landwirtschaft, und damit in
die Nahrungskette und die Umwelt; Politik zur Bekämpfung des
Phänomens die übermäßige Verschreibung und Bürger in den Grad der
Information und Sensibilisierung der Risiken; Leitlinien für die gute Praxis
Verhalten des Patienten; die wichtigsten Dokumente des Kampfes in
diesem Notfall. Wir machen auch einen analytischen Überblick und eine
Diskussion einiger Super Krankheiten (Tuberkulose, Gonorrhö, Meningitis,
etc.) und bakterieller Resistenz gegen wichtige Antibiotika. Wir wissen,
schließlich eine Umfrage zu aktuellen Technologien und Adressen von
angewandter Forschung und eine Umfrage zu den wichtigsten aktuellen
neuen Therapien. Schließt Arbeit eine technische Anlage, die eine
Vorrichtung wesentliche Vorschriften und Ministerialrichtlinien
italienischen und europäischen Gemeinschaft über das Thema.

Raimondo Villano
21
Abstracto
Trazar notas históricas sobre el concepto de antibiosis, en la investigación,
el descubrimiento y la producción de antibióticos y su papel global no sólo
terapéutico, sino también estratégico desde la Segunda Guerra Mundial. A
continuación, nos fijamos en los asuntos nacionales e internacionales
relacionados con el consumo, el mal uso y abuso de los antibióticos en los
seres humanos, en la ganadería, la agricultura, y por lo tanto en la cadena
alimentaria y el medio ambiente; políticas de lucha contra el fenómeno de
la prescriptión excesiva y los ciudadanos en el grado de información y
conocimiento de los riesgos; pautas de comportamiento de buenas
prácticas de la paciente; los principales documentos de lucha en esta
emergencia. Hacemos también un resumen analítico y una discusión de
algunas enfermedades súper (tuberculosis, gonorrea, meningitis, etc.) y la
resistencia bacteriana a los principales antibióticos. Nos damos cuenta,
por último, un estudio sobre las tecnologías y las direcciones de la
investigación aplicada en curso y una encuesta sobre las principales
nuevas terapias recientes. Cierra funciona un anexo técnico que contiene
un aparato regulaciones esenciales y directivas ministeriales italianas y de
la Comunidad Europea sobre el tema.

Raimondo Villano
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S U P E R B U G S & S U P E R D R U G S

Raimondo Villano
33
2. Issues and contrast of antibiotic

Raimondo Villano
35
Thanks to antibiotics, then, after World War II, medical science has been
able to obtain the total control of almost all infections. It is to this class of
medications the quality and life expectancy enjoyed by the more developed
countries.
However, antibiotics are also the basis of a substantial modification of the
ecosystem and the environment, not knowing stop the use and especially
the misuse (including disorders of minimal importance) and the abuse of
these drugs by citizens and also on animals, the result worrying evolves
from day to day in a situation 'critical' for the increase of resistant bacteria
to molecules currently available(6)
. In general, so far the antibiotic
resistance is present mainly in hospitals and in patients with pluripatologie.
Italy is among the first in Europe to antibiotic consumption and with higher
levels of antibiotic resistance(7)
.
The data shows that "every day a half million people take an antibiotic and
that in 60% of cases these drugs are taken to treat respiratory diseases often
caused by viruses.
This means that are used in an inappropriate manner thus causing double
damage. The first to own health, because antibiotics are not effective
against viruses. The second also to the community, because it encourages
the development of non-sensitive germs that will prevent in the future to
antibiotics to perform their function in the treatment of infections(8)
. "
In Italy 44% of the population received at least one prescription of
antibiotics in 2008, with greater use in children and elderly. In particular, in
that year it was prescribed an antibiotic to 53% of children and 50% of
older people(9)
.
Estimates suggests, also, that consumption in some cases it was even
almost double compared to other countries.
As we age it becomes even greater frequency of antibiotic prescriptions
repeated: patients who received six or more prescriptions account for 13-
14% of the population up to 64 years, 22-24% of the band 65-74 years and
28-32% of those over 75.
______________
(6) Guido Rasi, Director General of Italian drug agency (AIFA, surgery a few years ago
to Rai Uno in the field of computer science devoted to this campaign).
(7) Pharmacist 33, ECDC antibiotic resistance in Italy is among the highest in the EU,
January 22, 2013.
(8) Ibid.
(9) Italian Medicines Agency (AIFA), the first report OSMED on antibiotics, 2009.

36
Among the most frequent causes of prescription antibiotic drugs there are
the pathologies: respiratory (over 40%), genitourinary system (18%),
digestive system (13.6%).
In particular, infections associated with the highest number of antibiotic
prescriptions are: cystitis (9.9%), acute pharyngitis (8.3%), acute bronchitis
(5.7%), dental abscess (5.4%), laryngotracheitis (5%). Classes of
antibiotics used in Italy in 2008 were penicillins followed by macrolides,
quinolones and from the cephalosporins(10)
.
In Italy in 2009 the consumption of systemic antibacterial agents has
increased by 2% compared with 2008, when 44% of the population
received at least one prescription antibiotic.
So, it can be estimated that every day in Italy about a half million people
(2.5% of the population) take, outside the hospital, an antibiotic.
In the hospital, however, it shows that in 2007 were consumed more than
32 million doses of antibiotics and that about 3-4 million patients received
antibiotic therapy.
Unlike for drugs for chronic conditions, consumed 80% of cases by ultra
cinquantacinquenni, the use of antibiotics is not characterized by age-
dependent variations, except an increase in childhood.
Overall in the Italian regions there is a trend of growth in consumption, an
increase of 13% between 1999 and 2007(11)
.
Italy in 2012 appears to have the highest consumption in Europe of
antimicrobials (antibiotics of both natural and not), especially for farm
animals(12)
.
According to the report Ema, in 2012 in Italy we have been consumed
2,156 tons of antimicrobials is the only country where they have been
exceeding 2,000 tons (together with Spain with 2,055 tons).
In Italy of that total quantity over 1,500 tons are used for animals, while in
15 countries of the 26 considered the largest share is used for humans.
______________
(10) Pharmacist 33, Too many antibiotics Italians, 18 December 2009 - Year 5, No. 217.
(11) Ratio Agency Italian Drug Agency (AIFA) and Higher Institute of Health (ISS), in
February 2011.
(12) The first joint report by the authorities for medicines (Ema), for Disease Control
(ECDC) and Food Safety Authority (EFSA), referring to 2012 and published January
30, 2015.
Regarding the per capita consumption of antimicrobials for animal use,
Italy is by far the first in front of Cyprus and Spain while for human
consumption is third after France and Belgium.

Raimondo Villano
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Between 1999 and 2007 in France there has been a reduction of 16% in just
three years 2008-10 and this country has dropped by about 20% the number
of recipes, information campaigns to citizens and doctors.
Even Italy since 2009 has adopted policies to combat the phenomenon
dell'iperprescrizione of antibiotics, known for decades and "also
characterized by wide regional variation: in Calabria and Sicily, territories
less virtuous to do so, you get to prescribe a quantity of drugs double or
even triple compared to the province of Bolzano. This means that, in
contexts very different between them, is different also the prescription and
especially the demand for antibiotics, due to cultural reasons(13)
. "
The World Health Organization warned that the situation could have
radical effects on global medicine, economy and society unless global
actions are taken quickly. A lack of effective antibiotics means that
infected patients will need more extensive care, require longer
hospitalizations and die in greater numbers(14)
.
A more rational use of antibiotics would result in a substantial savings can
be estimated, in Italy alone, in many hundreds of millions of euro a year
and certainly a very positive impact on the entire public health.
In the EU infections caused by drug-resistant bacteria they have produced
in 2010 at a cost, in health care costs and productivity losses, more than 1.5
billion euro(15)
. In 2012 it was estimated that antimicrobial resistant bacteria
cause 25 thousand deaths per year in the European Union, Iceland and
Norway.
In fact, the antibiotic-resistance is steadily increasing around the world, to
certain infections mortality has increased by almost 50%(16)
.
How stress the governments to intervene in this delicate area, considering
the gravity of the problem, the World Health Organization published in
2012 the book 'The evolving threat of antimicrobial resistance'.
In 2014, then, the WHO said that resistance to antibiotics has become a
reality and constitutes "a serious threat to public health(17)
."
______________
(13) Nicola Magrini (Center for evaluation of the effectiveness of health care-CeVEAS
AUSL Modena), Intervenento the presentation of the Report OSMED 2009 on
prescription pharmaceuticals in Italy, July 10, 2010.
(14) Dina Fine Maron, Antibiotic resistance is now rife throughout the whole world,
Scientific American April 30
(15) Framework illustrated 20 November 2011 in Brussels by the European
Commissioner for Health John Dalli and European Commissioner for Research and
Innovation Maire Geoghegan Quinn.
(16) World Health Organization, through its Margaret Chan, Director General of the
World Health Organization, 2012.

38
In 2014 the World Health Organization published the first 'Report on
antimicrobial resistance globally'. The new report takes a picture with all
available so far on antibiotic resistance, by analyzing data from 114
countries.
In the report the UN agency does not mince words and declares a state of
emergency "is one of the most serious health threats, and it is now." Today,
"unless you take significant actions to increase efforts in preventing
infections, and to change the way we produce, use and prescribe
antibiotics, the world will lose what has gradually gained in terms of public
health. And the implications will be devastating. "
The report shows that the crisis of antibiotic resistance is endangering
patients in both developed countries and in those Developing(18)
.
The leadership of the institution, also speak of "post-antibiotic era" and
warn that, "far from being an apocalyptic fantasy, is a very real possibility
for the twenty-first century(19)
" that common infections and mild wounds
can go back and kill urge to action "urgent and coordinated(20)
."
In particular, the paper focuses on antibiotic resistance for 7 different
bacteria responsible for serious diseases common: infection Hematologic,
diarrhea, pneumonia, urinary tract infections, gonorrhea. The results are
defined 'very worrying' and documenting antibiotic resistance, in particular
those of 'last resort'.
The antibiotic-resistance in the EU is more widespread in the countries East
and South; between them there is Italy, where the resistance is monitored
by the ISS, who pours the data in the network of European surveillance
Ears-Net(21)
.
Faced with a solid network of surveillance, response should be improved.
The report by the European Center for Diseases Control (ECDC), published
at the Seventh Day of antibiotics November 18, 2014, boccia Italy in the
correct use of antibiotics as has the unenviable distinction of being the band
with the highest resistance percentage for virtually all bacteria.
______________
(17) Keiji Fukuda, Assistant Director-General for Health Security World Health
Organization (WHO).
Scientific American April 30.
(19) Keiji Fukuda, Ibid.
(20) Keiji Fukuda, Ibid.
(21) Pharmacist 33, WHO Report: the antibiotic resistance is a real threat, May 7, 2014.

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Of the increase in resistance to antibiotics developed by certain bacteria,
Italy is largely responsible along with Greece and, to a lesser extent,
Cyprus and Romania.
Therefore, "the situation is critical because today there are many strains of
bacteria, including the one responsible for tuberculosis have become
resistant to all antibiotics available(22)
" and we have only a few new
molecule next to enter the market .
It seems clear risk "of returning to the same situation that existed before the
discovery of antibiotics when an infection even trivial, since there are no
weapons useful to treat it, put lives at risk(23)
." Many citizens are still
poorly informed about the risks from misuse of antibiotics and the onset of
antibiotic resistance; especially young people appear to be less aware and
more prone to errors(24)
. From the data collected in 2010 in Italy on a
sample of 2,200 people, showed that there are improvements, for example
in the association between prescription medicine and its use (especially in
paediatrics): with more than 80% of the population that associates such
drugs to medical prescription. Among the young only just over 30% know
of this phenomenon, compared with around 70% of adults and 47% of
seniors. In addition, over 40% of young people believe they can buy
antibiotics themselves. The relationship with antibiotics is also complicated
by the wave of influenza details, such as was the case for the pandemic
virus A, Being generated much uncertainty about their therapeutic role.
In seasonal flu, then, at least half of Italians are aware that the antibiotic is
necessary only in case of complications, and found that only 30% know
that the same rule also applies to new influences, such as A, and another
30% were undecided on what to do with antibiotics in a pandemic(25)
.
The European Union in 2011 launched a five-year plan of 12 specific
actions to contribute, first, to change the culture of the use of antibiotics
that still exists among doctors, patients and hospitals, especially in southern
European countries, particularly Greece, Italy and Spain.
On 11 December 2012, then, the European Parliament, after voting in favor
of the Health Committee on November 6, approved in plenary (with 588
votes in favor, 16 against and 23 abstentions) a resolution drafted by Anna
Rosbach (Group conservatives and reformists European).
______________
(22) Nicola Magrini, Ibid.
(23) Nicola Magrini, Ibid.
(24) Ratio Agency Italian Drug Agency (AIFA) and Higher Institute of Health (ISS), in
February 2011.
(25) Pharmacist 33, Antibiotics, young people still uninformed, February 23, 2011.

40
This measure 'imposed' in the United States and the Union to adopt
immediate measures to tackle more firmly the issue of antimicrobial
resistance.
The Strasbourg parliament asks interventions that pass by the development
of new chemicals to be used more economically than existing ones and
improvement of breeding techniques.
The primary objective, in particular, is to preserve the effectiveness of
existing antimicrobials making responsible use.
To this end, the resolution states that it is a need for better training for
doctors, pharmacists, veterinarians, farmers and more understandable to the
public about the damage caused by improper use of antimicrobials.
The resolution, then, points the finger on the major efforts that must be
lavish to combat the misuse of antibiotics, through institutional
communication (53% of EU citizens are still convinced that antibiotics
neutralize the virus! ) and on a large effort required in compliance (patients
do not follow or comply with requirements).
The resolution also calls on the Commission to "study the problem of the
use and improper sales of antimicrobial agents with or without prescription
throughout the entire cycle, from the doctor to the patient through the
pharmacist, in terms of behavior of all actors involved ... ".
Concerning the use of antimicrobials in the field of human health, the
document stresses that antibiotics should never be available without
prescription.
To this end, the resolution also calls on the Commission to modify the
existing package inserts to include a warning that recommends the use of
the product "prescription-only medicine and in the prescribed manner",
because "inappropriate use of antibiotics can lead to the development
resistance harmful to themselves and others. "
The resolution, then, indicates that the ability to prescribe antimicrobials
for animals should be restricted to veterinarians only professionally
qualified, distinguishing the right to prescribe them than to trade it, to avoid
any economic incentive to sell. In addition, the measure calls for
restrictions on the use of antimicrobials for veterinary third and fourth
generation, that the WHO has classified as very important for therapies in
humans. Finally, the European Commission Resolution rivoltge the request
to classify medicated feed as drugs in the forthcoming revision of the Code
of veterinary pharmaceuticals.
For its part, then, the President of the United States Barack H. Obama
declares war on antibiotic resistance, which only in the US reaps at least 23

Raimondo Villano
41
thousand victims a year. The five-year strategy, outlined in a presidential
executive order of 2014, should be elaborated in detail later in February
2015 by a government task force.
The government's plan includes, among other things: incentives for drug
discovery; more controlled use of existing drugs; improvements in the
characterization of the use of antibiotics is that bacteria resistant, even with
use of the sequencing of DNA; prize of $ 20 million for those who can
make a quick test to detect infections(26)
.
In the face of an effective surveillance network, therefore, it is clear that the
interventions needing to be improved. Some countries have addressed the
problem while others need better sanitation, access to clean water, infection
control in health facilities and a vaccination program. But to prevent a
further rise of antibiotic resistance also serve further action on antibiotic
use and infection control in hospitals, lungodegenze and territory.
Only with the proper use of antibiotics can give the assurance that you have
in the future of effective treatments against infections.
It is good to remember that antibiotics are drugs that selectively target the
bacteria that cause infection and the doctor choose them on the basis of an
equation with three variables: what molecule for which patient with what
disease.
So, first of all it is identified with accuracy the infection (and often takes 2
or 3 days to get a clear clinical picture, perhaps with support of chemical-
clinical tests) and, then, it is important to evaluate the patient's condition.
The advice in these circumstances, therefore, is twofold: not feel neglected
if your doctor prescribes an antibiotic immediately; the onset of a few
degrees of fever to avoid self-administration of an antibiotic that you have
at home, and because there is no automatic link between fever and infection
and because it is fundamental to the doctor will always reserve the
prerogative of choosing the answer adequate. On the other hand, when
antibiotic therapy is appropriate (ie, on medical diagnosis and never for self
prescription), once it has started it is essential to strictly follow the
indications of dose and duration of therapy, because arbitrarily discontinue
treatment prematurely makes bacteria more more 'strong'.
There is, then, the case of repeated use of antibiotics well tolerated, deemed
to have no problems because rarely show side effects.
Instead, already 2 treatment cycles performed at 6 months away can cause
cumulative and persistent changes in the composition of the bacterial flora
(constituted, according to conservative estimates, from a thousand different
______________
(26) ANSA, The US Obama plan against antibiotic resistance, 20 September 2014.

42
types of micro-organisms in the gut), carrying out important functions(27)
.
In addition, centenarians have already 'defeated' cancers and heart disease,
the most dangerous for octogenarians, while infections are the leading
cause of death: an analysis(28)
of about 36 thousand death certificates of
British centenarians emerge in first place deaths from old age (26%),
followed by pneumonia (20%). Cancer and heart disease are at respectively
5% and 9%, while between 80 and 85 years exceed 25% and 20%. "In the
very old cell replication it is very slow and the tumors are not dangerous;
Moreover, above a certain age will outweigh the effects of cardiovascular
risk factors. The flip side is that the immune system weakens much,
increasing the risk of infection(29)
. "Centenarians (currently over 16
thousand in Italy, but in 2050 could exceed 200 thousand), require
personalized care: home care, because they can hardly be hospitalized and
therapy can not rely on maximum levels because the risk of serious side
effects, such example kidney with antibiotics may outweigh the benefits.
In particular, for example, examining the effects of ciprofloxacin (which
rarely gives diarrhea or abdominal swelling) using new analytical
techniques of the bacterial flora, it was found that two treatment cycles five
day conducted six months apart produce a subtle effect long- term: the
replacement of bacterial species resident with other related, but also the
complete disappearance of other(30)
.
The general similarity between strains pre-treatment and post-treatment
would explain, according to the authors of the research, the low incidence
of side effects of the antibiotic tested; however, researchers show that a
bacterial species disappearance could play an important biological function,
for example, produce a protein toxic to particular pathogens that, in
practice, is lost.
______________
(27) Research conducted by David Relman from Stanford University School of
Medicine and published in the Proceedings of the National Academy of Sciences.
(28) Study of King's College London published by PLoS ONE.
(29) Paolisso Joseph, President Company Italian Gerontology and Geriatrics). ANSA,
centenarians fight cancers and heart problems, no infections, June 5, 2014.
(30) Even more important would be the deepening of the studies about specific
functions of the different types of intestinal bacteria, even if this appears complex for
composition variable from person to person. If you could do it, you might think, before
and after antibiotic treatment, to valutaziore the relative abundance of species that make
up the flora, to give any specific probiotics that promote the recovery of species-specific
strains in danger.

Raimondo Villano
43
This feature may not be felt for years but become relevant when the
particular pathogen invades the gut of the patient. This, therefore, does not
mean that antibiotic, or other, dangerous or going avoided but again
highlights the problem of their judicious use and possible side effects in the
long term.
Antibiotics also may end up even in the food chain: meat, fish, eggs, milk,
fruit or vegetable may contain antibiotic-resistant bacteria.
This is caused by the use and abuse of antibiotics in agriculture is, for the
protection of crops from infection, both in animal husbandry by farmers to
treat diseases and, in low doses, as additives for growth promotion of
animals for production foods, both in industry, for antibacterial
prophylaxis.
Antibiotics in animal husbandry and other activities therefore affect
humans through the food we consume animals treated.
This will accelerate the bacterial mutations, which in turn are fighting
against the antibiotic.
Therefore, the effects on human health are especially serious because
infections with resistant bacteria transmitted by food are hard to cure.
To reaffirm constantly attention to these phenomena is the World Health
Organization (WHO). Despite the use of antibiotics for animal growth is
banned by the European Union since 2006, in many countries, especially in
Eastern Europe, it is still not regulated and do not need any veterinarian's
prescription to buy them(31)
. A worry the WHO is also resistance to
antibiotics used for human use in the veterinary, for example in 2008 the
resistance to fluoroquinolones was 18% in the salmonella bacteria in
chicken: in Italy, where there are many poultry farms, has reached 30%. A
confirmation of the positive effects from reduced amounts of antibiotics in
the feed of animals for human consumption comes from Australia, which
has a legislation which strongly limits the amount administered in farms
and from time prohibits some, including the fluoroquinolones, for the
poultry. So the resistance to ciprofloxacin of Campylobacter jejuni, which
causes severe diarrhea and even death, on 585 citizens positive bacterium
dropped to 2%, against an average of 29% in other Western nations. A
confirmation of the effectiveness of the Australian in Europe are Norway,
who has never allowed the use of antibiotics in animal feed, and Sweden,
which prohibits the administration from 1986: both countries record low
resistance of Campylobacter jejuni(32)
.
______________
(31) Srdan Matic, Coordinator of Environment and Health of WHO Europe, April 2011.
(32) Study published in Clinical Infectious Diseases in 2006.

44
In addition, since 2006 the WHO Regional Office for Europe of WHO has
produced the publication "Tackling antibiotic resistance from a food safety
perspective in Europe" with the aim of supporting Member States in the
containment policy that originates from abuse the use of antibiotics for
farm animals. The publication, intended primarily to politicians and
authorities in the fields of public health, agriculture, food production and
veterinary medicine, outlines the initiatives that can be taken to prevent and
contain the phenomenon of antibiotic resistance transmitted from the food
chain. At Community level, then, it is considering banning the use of
antibiotics in animals destined for human health. In animal health, yet, the
European Union aims to develop new legislation that puts the emphasis on
prevention by strengthening the surveillance of antibiotic resistance and the
consumption of antimicrobials in veterinary medicine.
Italy has long been engaged in food safety, working to reduce dust in
places of farms and companies that produce medicated feed, so you will not
be dispersed in the environment and do not remain in the subsequent
processing(33)
.
There is, then, the problem of watercourses, which can become perfect
'farms' of resistant bacteria if you do not pay attention to what they
download. This is demonstrated by numerous studies, including one of the
most recent was conducted in a region of India where it is produced most
of the active ingredients of drugs used throughout the world. From the
study in situ in the rivers, by analyzing samples of water from three sites
near Hyerabad (area with 90 factories drugs), it was found a quantity of
antibiotic equal to that which a man would in the blood during a therapy(34)
.
Using a new technique in parallel that can recognize immediately genes
linked to resistance to antibiotics, experts have found that 2% of all the
DNA of the bacteria found in the water was just the type that confers
resistance. The analysis also showed that the bacteria were resistant to
several types of antibiotics, also not produced at the site analyzed, while in
the case of ciprofloxacin resistance was absent, probably because the
amount of active substance was so high as to break down also the same
resistant bacteria(35)
.
______________
Scientific American April 30, 2014.
(34) Study of the researchers at the University of Gothenburg, published by PLoS ONE,
2011.
(35) Ibid.

Raimondo Villano
45
A similar phenomenon has been studied for several years in the waste of
Lombardy by Ettore Zuccato (Mario Negri Institute in Milan), which
effectively remedy purifiers from treatment plants: the modern ones are
able to eliminate much of the drug residues and should be applied on a
large scale, even though they cost more(36)
.
To address the problem require coordinated action on a global scale, that
nations are taking to mitigate and adapt to climate change. The UN report
recommends about a multipronged approach.
______________
(36) Pharmacist 33 Antibiotic resistance comes into waterways, February 24, 2011.

Raimondo Villano
169
8. Author profile

Raimondo Villano
171
Born in 1960. He lives in Rome and Torre Annunziata. Role:
General Manager Villano International Business Team (from
2012); Chiron CEO Publisher, Honorary Member (2013) and
Associate Professor in History of Health Pharmaceutical
Administration Department of Ruggero II University (Miami,
2014), Trader (since 1976), Trader operating financial
independent of bags and forex (since 1983), Knight SMO Malta
(since 2002), President of Chiron Humanitarian Foundation (since 1985).
Academies: History Art Health-Ministry BC, former papal Tiberina, Melitensi
Studies, Medical Tradition Smithsonian Institution-USA, International Society
History Pharmacy, Acc. History Italian Pharmacy, Soc. Napoletana National
History in. h. Noble College Chemical Pharmaceutical. Over 100 conferences
and chairman in dozens of conferences. He collaborates with important
national and international magazines. You Advisory Board Member for the US
Publisher DPC, which publishes in more than 150 nations. Studies: Classical;
degree and abil .: Pharmacy (1985); courses certificates: Medicinal herbs,
Cosmetic Techniques, Corporate Security, HACCP, History, Social Doctrine of
the Church, theology. Degrees h.c.: Human and Social Sciences (2009); History
and Philosophy (2010); Communication Sciences (2013). Master h.c.: Science
Medical Ethics (2010). He was author, organizer and chairman Safety Course for
managers, obtaining the High Patronage of the Head of State and the UN (2000),
Secretary International Committee Biothecnologies Wabt-Unesco 2008-13,
Diplomatic Adviser AEREC dpt ENVA (from 2011), member of World
Academy Biomedical Technology (Unesco 2007-12), 11 years in the Scientific
Committee of the Health Security IBD (company responsible for the security of
the Courts Naples Appeal Court), Board Beaumont Foundation Onlus research
on cancer with the Prefect of Naples (2011-12), member of European Academy
for Economic and Cultural Relations (2004-15). 32 years partner and owner of
the pharmacy. Partner since 1990, Secretary to 29 years 1990-95 and 2000
Rotary Club President Pompeii-Vesuvius; Comm.ni in Rotary District 2100-
Italy: Professional Ethics, Global Action, Computer; among the many
international roles: archeology Pompeii-Carthage; Committee Prize Magna
Grecia. Napoli president, national Coordinator and founder Federation Young
Chemists; Representative National Trade Union Federative. Assistant
Microbiology Fac. F.cia Na (1985-90, Chair Prof. Lembo-Inst. Sup. Health).
International awards: Diploma of Honor for exceptional services individually
in 5 Vie Action by President Rotary International (Evanston 2001: only 100 /

172
year / 1.5 million members); Merit Anti-Crime Task Force-Rotary Italy, Albania,
former Yugoslavia, San Marino (Zurich 2001); Sapientia Mundi-Ethics (Rm
2008); Union Legion of Gold-Work (Rm 2010); Veritas in Charitate-Religion
(2011); Bonifaciano-Culture and Society (2011); Norman-Publishing Gold
Medal (Rm 2014); Norman-Health Galen of Pergamum (Rm 2014). National
Awards: Aesculapius-Health Patronage Ministers Council (Rm 1987); LXVIII
Piccinini-Search (Rm 2006); LXV Stramezzi-Health (Rm 2007); Capitolino-
humanitarian activities (Rm 2010); Tiberino-Culture (Rm 2012); LXXIV
Serono-History (Rm 2012), AEREC-Culture (Rm 2013); Merit Public Health
(DPR 2013), Tiberino-Science (Rm 2014). Author of over 730 publications
health, professional, scientific, historical, religious; more than 50 books (many
translated into English, French, some German, Spanish) with prestigious
publishers as Zanichelli and sponsorship by the Ministry of Cultural Heritage,
Unesco, Rotary, University, etc., present in Italian libraries (including:
Quirinale, National Academy Science, Ministries) and more than 40 countries
(including: National Health Institute-USA, Nationale de France, Congress UK),
in cultural institutes, Universities, Museums; a book made its debut at the
Frankfurt Fair. Catalogues: 2000 Outstanding Intellectuals IBC-Cambridge from
2010; OPAC SBN with over 160 works; from 2010 Sheet Authority Ministry
BAC. Various books are appreciated by authorities, including several times the
Head of State and the Holy Father.
Some books: Global Information Society, 1996; Rotary for Man, 2001;
Managing security in Pharmacy (pres. Dr. Renzulli, already the UN Security
Consultant, 2004); Art and history Pharmacy (pres. Professor Ledermann, Presid.
Em. International Pharmacy History Society, 2 ed., 2006); History and activities
of the SMOM (4th ed., 2007); Pharmaceutical meridians between secular ethics
and Catholic moral (pres. Professor Tarro, Comm. Naz.le Bioethics, 3 ed., 2008);
Thesaurus Pharmacologicus (pres. Presid. Pharmacists Italian Dr. Mandelli
2009); Time sculpted silent eternity. Reflections on diachronic investigation for
memory homo faber (pres. Eminent historian Fra 'von Lobstein and critic Prof.
Carosella, 2 ed., 6 repr., 2010); Pharmaceutical business United Naples (Pres .:
Presid. It Accemia. History Pharmacy Dr. Ravens, 2010); Logos and Theophany
in the digital time (pres. Mons. Trafny, President Dpt Science-Faith Pontifical
Cons. Culture, 2012); Religious aspects and ecclesial dimension SMOM (2013).
Among the more than 40 multimedia: Outline art and history pharmacy (patr.
AISF, 2002); Influenza A / H1N1 (patr. Unesco, 2009).

Raimondo Villano
173
“There are remedies worse than the disease”
Publilius Syrus, Sentences

R. Villano - Superbugs & superdrugs (p.te 2: issues and contrast of antibiotics)

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