Despite danger of enhancing antimicrobial resistance, San Francisco Health Dept. recommends prophylactic use of antibiotics for certain people

Less than seven million people have died of/with COVID since the “pandemic” began, according to the authorities. That’s seven million over a period of almost three years. Meanwhile, in 2019 alone, almost fourteen million people died of infections of one kind or another, according to a recent study published in The Lancet. Almost eight million deaths were associated with 33 main bacterial pathogens – that’s one in eight of all deaths – making bacteria-related deaths the second leading cause of death globally in that year (the leading cause was ischaemic heart disease).

According to another study in the same journal, from January of this year, 1.27 million people who died due to bacterial infection in 2019 could have been saved if the antibiotics available to treat their infection had not become redundant due to AMR, antimicrobial resistance. This study, described as “the most comprehensive estimate of AMR burden to date,” examined 23 pathogens, all those for which AMR is clinically relevant and for which sufficient data are available, across 204 countries, covering around 471 million records.

Most scientists are in agreement that this number is only increasing from year to year, despite efforts to combat it. The problem is most acute in western sub-Saharan Africa and mildest in Australia and New Zealand. The pathogens most linked with AMR-related deaths are: Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonos aeruginosa. What this means in practice is that diseases such as tuberculosis which were once seen as curable have reasserted themselves as killers, not only in the developing world but also in the United States and Europe.

According to the study’s authors, AMR is now “a health problem whose magnitude is at least as large as major diseases such as HIV and malaria, and potentially much larger,” and it is “the 12th leading ... cause of death globally, ahead of both HIV and malaria.” They suggest a number of steps governments should be taking to address the problem more adequately, including infection control and prevention (hygiene and sanitation), investing in new antimicrobials, reducing overall exposure in non-medical settings (such as in the livestock industry, where animals are commonly pumped full of antibiotics), and minimizing use in humans when unnecessary (for example, not prescribing antibiotics for viral complaints).

In many parts of the world, physicians have long been taking AMR extremely seriously. In San Francisco, however, the Public Health Department has decided that in certain cases, using antibiotics prophylactically (to prevent disease rather than to treat it) is not only permissible but advisable. These certain cases are those relating to people who are considered to be at high risk of contracting STI (sexually transmitted infections) due to their lifestyle choices.

Apparently, clinical trials have demonstrated that people who take a “preventive dose” of the antibiotic doxycycline after engaging in risky behavior are less likely to contract infections such as chlamydia, syphilis and gonorrhoea. The number of cases of these diseases has been increasing steadily over the past decade.

In the United Kingdom, the Health Security Agency and the British Association for Sexual Health and HIV do not endorse what is being called the “doxyPEP strategy” for prevention of syphilis or chlamydia, in part due to concern regarding the likelihood of enhancing the phenomenon of antimicrobial resistance. A microbiologist at the Institute of Tropical Medicine in Antwerp, Belgium, told the journal Nature that using doxycycline to prevent infections will “drastically increase” a person’s exposure to the antibiotic, pointing out that in the DoxyPEP trial, some participants took more than 20 doses of doxycycline each month, an amount that he called “astronomical”.

Given that doxycycline is seen as a critically important drug for treating certain widespread conditions such as skin infection caused by Staphylococcus aureus and bacterial pneumonia, the creation of doxycycline-resistant versions of these pathogens is extremely worrying. Furthermore, the San Francisco target population tends to have multiple partners, meaning that any drug-resistant bacteria emerging from this population would likely spread fast and wide.

The U.S. Centers for Disease Control and Prevention (CDC) calls antimicrobial resistance “a global threat” and dedicates an entire section of its website to describing the steps it is taking to combat it. As of the time of this writing, the CDC had yet to respond to a Frontline News inquiry on its stance regarding the San Francisco Health Department's new policy on prophylactic antibiotic use for those who wittingly expose themselves to risk.