10 ms·

Relevant story: As a kid, one of my friends would frequently get strep throat. So his mom would give him amoxicillin until he appeared better... and then save t

by tjohns 10y ago

Relevant story: As a kid, one of my friends would frequently get strep throat. So his mom would give him amoxicillin until he appeared better... and then save the rest of the bottle for the next time he'd (invariably) get strep throat. And that's how antibiotic resistance happens.

dijit 10y ago
The biggest issue for antibiotic resistance is farming. Farmers use antibiotics basically by default and in large doses to avoid bacterial problems with their cattle. I remember reading a stat that said 93% of all anti-biotics use is in agriculture.
- smellf 10y ago
  Reasons for agricultural antibiotic use are twofold. On the one had it is as you said, as a preventative measure to head off infection (which is obviously very bad), but it's worse than that - industrial farmers use antibiotics so they don't have to inspect and treat each animal. Just dump antibiotics into their food and if they are injured somewhere along the way it will hopefully heal on its own. Inspecting and treating each animal individually would be a lot more expensive. The other reason antibiotics are given to livestock is to cause weight gain. If the antibiotics cost less than the value of the extra meat produced, then you make more money. It's a fucked up practice that we'll be all pay for in a few decades. Note the wiki page is an ok source, but is in need of some attention from someone outside the industry. https://en.wikipedia.org/wiki/Antibiotic_use_in_livestock https://en.wikipedia.org/wiki/Antibiotic_use_in_livestock
  - bflesch 10y ago
    How about a startup that uses image recognition from video feeds to identify and track individual anmials, and then tags those to be medicated once symptoms pop up? Or will the continuing dosage of antibiotics in the food prevent symptoms from appearing at all? I see some great opportunities in technology for streamlining processes behind fair and high-quality agricultural products.
    - ttraub 10y ago
      This sounds like an "Internet of things" opportunity: an implant that monitors an animal's temperature, antibody levels etc. Then they could target only the animals with telltale symptoms.
      - has2k1 10y ago
        The implants still have to be cheaper than the antibiotics.
        mjevans 10y ago
        So you're saying the correct answer is a massive tax on all antibiotics not dispensed in response to a human doctor's prescription for a patient that is seen?
        ttraub 10y ago
        The implants would likely be pretty cheap -- a one time purchase of an RFID sensor encased in glass or similar non-immunogenic coating. RFID tags are on the order of a few cents. Probably this type of sophisticated sensor is going to be more like a few dollars in quantity. The reader and the software are going to be a few hundred dollars or maybe a couple thousand. But it's a one time investment, plus ongoing implants as the herd changes over time. I suspect the main selling point is going to be the one-time capital investment aspects and the fact that antibiotics are being painted as an undesirable additive in meat and dairy. When the general public starts to dislike a substance, suppliers scramble to distinguish their products, e.g. "No added growth hormones" and the like.
    - mhb 10y ago
      How does that address the practice of using antibiotics because it makes more meat and is profitable?
      - fucking_tragedy 10y ago
        It also doesn't address the fact that it's dirt cheap to buy these antibiotics in bulk, but what if we throw a startup at it??
  - mirimir 10y ago
    Yes, and for increasing feed efficiency, they use low doses. Which is just perfect for selecting resistance. At some point, it will become obvious enough that victims' estates will start winning lawsuits :)
- frik 10y ago
  Exactly. Example: almost all turkey meat that's so in fashion today comes from farmers that use antibiotics as preventative measure. I personally source meat from small family run farms that adhere to biological agriculture principles, (there only ill animals get antibiotics and those aren't butchered and sold later as meat).
jtedward 10y ago
Or she doesn't use it and the strain spreads to ten other people who use antibiotics and start developing resistant strains.
- dijit 10y ago
  Ah, The Futility Illusion "If I don't do it, somebody else will." It is a famous and time-honored rationalization that sidesteps doing the right thing because the wrong thing is certain to occur anyway. The logic is faulty and self-serving, of course. Sometimes someone else won't do it. The soldiers asked to fire on their own people when the Iron Curtain governments were crumbling all refused, one after another. Sometimes someone else does it, but the impact of the refusal leads to a good result anyway. When Elliot Richardson was ordered by Richard Nixon to fire Watergate Special Prosecutor Archibald Cox, he refused and resigned. Cox ended up being fired anyway, but Richardson's protest helped turn public opinion against the White House. Even if neither of these are the final result, the individual's determination to do right is always desirable in itself. The Futility Illusion is just a sad alternative to courage.
  - jtedward 10y ago
    I thought this would be some people's reactions because they don't want to address the science. It could very well be possible that we are under prescribing antibiotics to the point where they can stay in the population long enough to develop immunities. Everyone seems to think this a crazy idea, but can't produce a shred of evidence to refute it.
    - maxerickson 10y ago
      The pattern described by the OP can reasonably be described as under prescribing the antibiotics. Rather than following the recommended schedule which may last longer than the person feels sick, the mother was only giving enough to treat the immediate symptoms. The prescription is to give more!
      - dragonwriter 10y ago
janvidar 10y ago
This was precisely addressed by Sir Alexander Fleming's 1945 Nobel Prize speech: “But I would like to sound one note of warning. Penicillin is to all intents and purposes non-poisonous so there is no need to worry about giving an overdose and poisoning the patient. There may be a danger, though, in underdosage. It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body. The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant. Here is a hypothetical illustration. Mr. X. has a sore throat. He buys some penicillin and gives himself, not enough to kill the streptococci but enough to educate them to resist penicillin. He then infects his wife. Mrs. X gets pneumonia and is treated with penicillin. As the streptococci are now resistant to penicillin the treatment fails. Mrs. X dies. Who is primarily responsible for Mrs. X’s death? Why Mr. X whose negligent use of penicillin changed the nature of the microbe. Moral: If you use penicillin, use enough.” Edit: Fleming's full Nobel lecture: http://www.nobelprize.org/nobel_prizes/medicine/laureates/1945/fleming-lecture.pdf http://www.nobelprize.org/nobel_prizes/medicine/laureates/19...
- Florin_Andrei 10y ago
  It's amazing how long ago this issue was understood. And yet not much was done meanwhile, on a global scale, to address it.
  - Vraxx 10y ago
    that's because it doesn't seem to be a technical hurdle, it seems like it's a social issue. We, as a species, haven't proven terribly adept at handling those yet.
    - fleitz 10y ago
      It's actually really easy to handle the problem, you have a few sets of anti-biotics and you rotate through sets every 5 years. Furthermore in Hospitals you make people wash their hands (as in you post security gaurds at the hand washing stations and none shall pass a station without washing) and you have separate wards for those with MRSA and those without MRSA. If you need an antibiotic that is not in rotation, you are hospitalized while everyone makes sure you take your full course. Doing these things eliminates about 90% of the problem.
superuser2 10y ago
Erm. Strep throat is pretty severe, and also actually a bacterial infection. That's not a great example of antibiotic overuse. Better example is doctors writing prescriptions for common cold infections that are viral anyway so they can appease patients by "doing something."
- thomyorkie 10y ago
  I think his point was that the boy's mom wasn't careful to ensure all the bacteria had actually been killed. The boy probably kept getting strep because some bacteria had survived and thus the bacteria could have become resistant to the antibiotic.
- hanklazard 10y ago
  Primary care doc here. I agree that strep is "severe" as in "makes you uncomfortable with a fever, sore throat, enlarged tonsils, etc" but the infection generally resolves without antibiotics, if given proper time. The main rationale for treating strep pharyngitis (aside from appeasing patients) is prevention of rheumatic fever, a rare but devastating heart condition that occurs as a sequelae of untreated strep throat. Given the rareness of RF in the developed world, there are those in the infectious disease and primary care communities who think it is an excellent example of antibiotic overuse.
  - danjayh 10y ago
    I had untreated strep when I was a kid, because the strep screen came back negative. Turns out it was group C, which didn't show up on the strep screen, but also didn't resolve itself. Some months later it got much worse. Somebody finally did a culture, figured it out, and gave me antibiotics (which cleared it up). Fast forward to age 29, when I had to have open heart surgery to get a mechanical mitral valve, for which I have to be on warfarin for the rest of my life (which comes packaged with increased risk of stroke and hemorrhage for the rest of my life) along with a beta blocker ('bystolic', aka nebivolol) because something happened to mess up my heart rate regulation during the surgery. I'd call strep pretty serious.
officialjunk 10y ago
There are studies that indicate the opposite, actually http://discovermagazine.com/2014/oct/8-stop-taking-antibiotics-when-you-feel-better http://discovermagazine.com/2014/oct/8-stop-taking-antibioti...
toomanybeersies 10y ago
I have a couple of mates who have done that, they take antibiotics until they feel better, and then stop. They really don't seem to understand the concept of antibiotic resistance. They're all engineers too, they really should know better.
- knodi123 10y ago
  I used to work with a guy who bought veterinary antibiotics, cut them in half until they were a human dose, and took them whenever he felt a sniffle, and stopped when he felt better. And he completely understood the concept of antibiotic resistance. He just gave a sheepish grin when I confronted him like "Aw, shucks, ain't I a scamp". He was a really nice guy, except for this case where he was a sociopathic asshole.
deepGem 10y ago
<rant> You won't believe how prevalent this is in India. You can hardly count people who'll take the full course of antibiotics. The general rhetoric is 'oh I'm fine' or the doctor is an ass, he always prescribes more than required. Not one person, even the so called educated class adheres to what the physician says, they all somehow think they know better and in the process, endanger every one else's life. </rant>
idiocracy2016 10y ago
I only took 7 days of my 10, and had to go on a Z-pack because it came back :-( Some studies suggest though that 90% of cases can be resolved with less antibiotics.

by tjohns 10y ago

dijit 10y ago

The biggest issue for antibiotic resistance is farming. Farmers use antibiotics basically by default and in large doses to avoid bacterial problems with their cattle. I remember reading a stat that said 93% of all anti-biotics use is in agriculture.

smellf 10y ago
Reasons for agricultural antibiotic use are twofold. On the one had it is as you said, as a preventative measure to head off infection (which is obviously very bad), but it's worse than that - industrial farmers use antibiotics so they don't have to inspect and treat each animal. Just dump antibiotics into their food and if they are injured somewhere along the way it will hopefully heal on its own. Inspecting and treating each animal individually would be a lot more expensive. The other reason antibiotics are given to livestock is to cause weight gain. If the antibiotics cost less than the value of the extra meat produced, then you make more money. It's a fucked up practice that we'll be all pay for in a few decades. Note the wiki page is an ok source, but is in need of some attention from someone outside the industry. https://en.wikipedia.org/wiki/Antibiotic_use_in_livestock https://en.wikipedia.org/wiki/Antibiotic_use_in_livestock
- bflesch 10y ago
  How about a startup that uses image recognition from video feeds to identify and track individual anmials, and then tags those to be medicated once symptoms pop up? Or will the continuing dosage of antibiotics in the food prevent symptoms from appearing at all? I see some great opportunities in technology for streamlining processes behind fair and high-quality agricultural products.
  - ttraub 10y ago
    This sounds like an "Internet of things" opportunity: an implant that monitors an animal's temperature, antibody levels etc. Then they could target only the animals with telltale symptoms.
    - has2k1 10y ago
      The implants still have to be cheaper than the antibiotics.
      - mjevans 10y ago
        So you're saying the correct answer is a massive tax on all antibiotics not dispensed in response to a human doctor's prescription for a patient that is seen?
      - ttraub 10y ago
        The implants would likely be pretty cheap -- a one time purchase of an RFID sensor encased in glass or similar non-immunogenic coating. RFID tags are on the order of a few cents. Probably this type of sophisticated sensor is going to be more like a few dollars in quantity. The reader and the software are going to be a few hundred dollars or maybe a couple thousand. But it's a one time investment, plus ongoing implants as the herd changes over time. I suspect the main selling point is going to be the one-time capital investment aspects and the fact that antibiotics are being painted as an undesirable additive in meat and dairy. When the general public starts to dislike a substance, suppliers scramble to distinguish their products, e.g. "No added growth hormones" and the like.
  - mhb 10y ago
    How does that address the practice of using antibiotics because it makes more meat and is profitable?
    - fucking_tragedy 10y ago
      It also doesn't address the fact that it's dirt cheap to buy these antibiotics in bulk, but what if we throw a startup at it??
- mirimir 10y ago
  Yes, and for increasing feed efficiency, they use low doses. Which is just perfect for selecting resistance. At some point, it will become obvious enough that victims' estates will start winning lawsuits :)
frik 10y ago
Exactly. Example: almost all turkey meat that's so in fashion today comes from farmers that use antibiotics as preventative measure. I personally source meat from small family run farms that adhere to biological agriculture principles, (there only ill animals get antibiotics and those aren't butchered and sold later as meat).

jtedward 10y ago

Or she doesn't use it and the strain spreads to ten other people who use antibiotics and start developing resistant strains.

dijit 10y ago
Ah, The Futility Illusion "If I don't do it, somebody else will." It is a famous and time-honored rationalization that sidesteps doing the right thing because the wrong thing is certain to occur anyway. The logic is faulty and self-serving, of course. Sometimes someone else won't do it. The soldiers asked to fire on their own people when the Iron Curtain governments were crumbling all refused, one after another. Sometimes someone else does it, but the impact of the refusal leads to a good result anyway. When Elliot Richardson was ordered by Richard Nixon to fire Watergate Special Prosecutor Archibald Cox, he refused and resigned. Cox ended up being fired anyway, but Richardson's protest helped turn public opinion against the White House. Even if neither of these are the final result, the individual's determination to do right is always desirable in itself. The Futility Illusion is just a sad alternative to courage.
- jtedward 10y ago
  I thought this would be some people's reactions because they don't want to address the science. It could very well be possible that we are under prescribing antibiotics to the point where they can stay in the population long enough to develop immunities. Everyone seems to think this a crazy idea, but can't produce a shred of evidence to refute it.
  - maxerickson 10y ago
    The pattern described by the OP can reasonably be described as under prescribing the antibiotics. Rather than following the recommended schedule which may last longer than the person feels sick, the mother was only giving enough to treat the immediate symptoms. The prescription is to give more!
    - dragonwriter 10y ago

janvidar 10y ago

This was precisely addressed by Sir Alexander Fleming's 1945 Nobel Prize speech: “But I would like to sound one note of warning. Penicillin is to all intents and purposes non-poisonous so there is no need to worry about giving an overdose and poisoning the patient. There may be a danger, though, in underdosage. It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body. The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant. Here is a hypothetical illustration. Mr. X. has a sore throat. He buys some penicillin and gives himself, not enough to kill the streptococci but enough to educate them to resist penicillin. He then infects his wife. Mrs. X gets pneumonia and is treated with penicillin. As the streptococci are now resistant to penicillin the treatment fails. Mrs. X dies. Who is primarily responsible for Mrs. X’s death? Why Mr. X whose negligent use of penicillin changed the nature of the microbe. Moral: If you use penicillin, use enough.” Edit: Fleming's full Nobel lecture: http://www.nobelprize.org/nobel_prizes/medicine/laureates/1945/fleming-lecture.pdf http://www.nobelprize.org/nobel_prizes/medicine/laureates/19...

Florin_Andrei 10y ago
It's amazing how long ago this issue was understood. And yet not much was done meanwhile, on a global scale, to address it.
- Vraxx 10y ago
  that's because it doesn't seem to be a technical hurdle, it seems like it's a social issue. We, as a species, haven't proven terribly adept at handling those yet.
  - fleitz 10y ago
    It's actually really easy to handle the problem, you have a few sets of anti-biotics and you rotate through sets every 5 years. Furthermore in Hospitals you make people wash their hands (as in you post security gaurds at the hand washing stations and none shall pass a station without washing) and you have separate wards for those with MRSA and those without MRSA. If you need an antibiotic that is not in rotation, you are hospitalized while everyone makes sure you take your full course. Doing these things eliminates about 90% of the problem.

superuser2 10y ago

Erm. Strep throat is pretty severe, and also actually a bacterial infection. That's not a great example of antibiotic overuse. Better example is doctors writing prescriptions for common cold infections that are viral anyway so they can appease patients by "doing something."

thomyorkie 10y ago
I think his point was that the boy's mom wasn't careful to ensure all the bacteria had actually been killed. The boy probably kept getting strep because some bacteria had survived and thus the bacteria could have become resistant to the antibiotic.
hanklazard 10y ago
Primary care doc here. I agree that strep is "severe" as in "makes you uncomfortable with a fever, sore throat, enlarged tonsils, etc" but the infection generally resolves without antibiotics, if given proper time. The main rationale for treating strep pharyngitis (aside from appeasing patients) is prevention of rheumatic fever, a rare but devastating heart condition that occurs as a sequelae of untreated strep throat. Given the rareness of RF in the developed world, there are those in the infectious disease and primary care communities who think it is an excellent example of antibiotic overuse.
- danjayh 10y ago
  I had untreated strep when I was a kid, because the strep screen came back negative. Turns out it was group C, which didn't show up on the strep screen, but also didn't resolve itself. Some months later it got much worse. Somebody finally did a culture, figured it out, and gave me antibiotics (which cleared it up). Fast forward to age 29, when I had to have open heart surgery to get a mechanical mitral valve, for which I have to be on warfarin for the rest of my life (which comes packaged with increased risk of stroke and hemorrhage for the rest of my life) along with a beta blocker ('bystolic', aka nebivolol) because something happened to mess up my heart rate regulation during the surgery. I'd call strep pretty serious.

officialjunk 10y ago

There are studies that indicate the opposite, actually http://discovermagazine.com/2014/oct/8-stop-taking-antibiotics-when-you-feel-better http://discovermagazine.com/2014/oct/8-stop-taking-antibioti...

toomanybeersies 10y ago

I have a couple of mates who have done that, they take antibiotics until they feel better, and then stop. They really don't seem to understand the concept of antibiotic resistance. They're all engineers too, they really should know better.

knodi123 10y ago
I used to work with a guy who bought veterinary antibiotics, cut them in half until they were a human dose, and took them whenever he felt a sniffle, and stopped when he felt better. And he completely understood the concept of antibiotic resistance. He just gave a sheepish grin when I confronted him like "Aw, shucks, ain't I a scamp". He was a really nice guy, except for this case where he was a sociopathic asshole.

deepGem 10y ago

<rant> You won't believe how prevalent this is in India. You can hardly count people who'll take the full course of antibiotics. The general rhetoric is 'oh I'm fine' or the doctor is an ass, he always prescribes more than required. Not one person, even the so called educated class adheres to what the physician says, they all somehow think they know better and in the process, endanger every one else's life. </rant>

idiocracy2016 10y ago

I only took 7 days of my 10, and had to go on a Z-pack because it came back :-( Some studies suggest though that 90% of cases can be resolved with less antibiotics.