Antimicrobial resistance: Transdisciplinary research on humans, antimicrobials and microbes

Calls for action on antimicrobial resistance (AMR) have existed almost as early as the discovery of penicillin and the sulpha drugs. Since then solutions to AMR have circled around the development of new antimicrobials and the rationalisation of their use via various configurations of regulation of access and distribution, promotion of diagnostics and education of prescribers and consumers. Research by historians and social scientists (HSS) are increasingly demonstrating the various limitations and unintended consequences of many of these approaches, while also seeking to propose not only different ways to study AMR as a problem, but also address it. Part of this, involves serious engagement with microbiological insights (i.e. related to the microbiome) and methods to move beyond the impasses of outdated concepts (e.g. germ theory), methodological reductionism and disciplinary boundaries. Based on our empirical research on AMR and human microbiome science, we demonstrate how AMR is a transdisciplinary problem requiring contributions from HSS’s research and expertise in order to devise socially meaningful and microbiologically effective solutions. We have identified four areas where such contributions would be beneficial: (1) policies (e.g. AMR policies still assume germ theory and operate within silos); (2) AMR solutions are human centred (i.e. neglect of the microbiome and pay limited attention to other nonhumans) vs one health; (3) epidemiological variables and microbiological discourse (i.e. often employ outdated anthropological and philosophical concepts, such as westernised, modern, traditional); (4) Rhetorics and lexicon (i.e. can be morally and conceptually simplistic, like ‘war’, ‘sweets’, ‘good’/’bad’ bugs, ‘irrational’).

Acetazolamid orális alkalmazása mellett jelentkező chorioidealeválás két esete: ismert idioszinkráziás hatás szokatlan megjelenési formája?

Sulpha drugs are widely employed in medicine for various diseases and disorders. During the last several decades, numerous papers had been published on supra ciliary and posterior choroidal effusion likely presenting as an idiosyncratic effect of these drugs especially of acetazolamide. In each publication, the effusion was associated with either an acute angle-closure glaucoma or transitory myopia or both of these as leading symptoms. In the current publication, authors report on two cases where the acetazolamide-induced choroidal effusion was an accidental finding without either a myopic shift in refraction or an acute elevation in intraocular pressure. To our best knowledge, ours is the first report in the literature describing this unusual, “silent” form of a sulpha drug-induced choroidal effusion. Since the choroidal involvement may vary in size and location, and is not necessarily associated with acute glaucoma and myopia, one can assume that a considerable amount of acetazolamide-related ocular side-effects will not be discovered. The above case report aims to draw the attention of other specialities to the need for ophthalmic examination for their patients taking sulpha drugs with acute visual deterioration. Orv Hetil. 2017; 158(50): 1998–2002.