5 ms·

Can you say clickbait? We've been on the cusp of an antibiotic resistance epidemic (according to the media and select physicians) for decades. 1979 - http://w

Can you say clickbait? We've been on the cusp of an antibiotic resistance epidemic (according to the media and select physicians) for decades. 1979 - http://www.ncbi.nlm.nih.gov/pubmed/45521 http://www.ncbi.nlm.nih.gov/pubmed/45521 1992 - http://science.sciencemag.org/content/257/5073/1064 http://science.sciencemag.org/content/257/5073/1064 But, as @reasonattlm said far more eloquently than I: humans seem need these stories to provide the motivation to use existing antibiotics less and to get moving on creating new antibiotics.

daveguy 10y ago
> ...to provide the motivation to use existing antibiotics less... But always complete your antibiotic prescription.
- astazangasta 10y ago
  This bit of folk/medical wisdom has been around for a few decades, but for the life of me I can't understand the logic - beyond the notion that merely being asymptomatic doesn't mean you've killed all the bugs. How this can possibly contribute to the spread of antibiotic resistance is mystifying to me, as is the basis of this advice - is there ANY evidence that patients not completing their drug courses causes resistance?
  - hga 10y ago
    Absolutely! As I learned as a rule of thumb while doing microbiological research in a NSSF Summer Science Training Program in 1977, most random antibiotics would fail to kill E. Coli at a rate of 1 in a million, and it went up to 1 in a billion with streptomycin (this is with random mutations, no plasmid acquisition involved, which is another story). However, these surviving bugs are generally not as fit as wild type, they've probably survived by sacrificing something, or doing something that consumes more energy. This helps your immune system mop them up, and note if antibodies are involved (don't know about that) it takes a while to come up with new ones, plus if there's any sort of bacteria ecology in the target area that survives the antibiotic they'll out-compete them. It shouldn't take much research on your part to confirm the basics of what I've related above, it's a tremendous problem, especially with TB, who's defenses require long and obnoxious drug schedules, resulting in more and more MDR and XDR (multi- and extensively-drug resistant) strains. If you get XDR, you're probably going to die, in a era where that's squalid instead of romantic. And I just came across "Totally drug-resistant tuberculosis" https://en.wikipedia.org/wiki/Totally_drug-resistant_tuberculosis https://en.wikipedia.org/wiki/Totally_drug-resistant_tubercu... Not official yet, but....
    - astazangasta 10y ago
      As I said, completing your course is useful in eliminating residual disease. How does it help in preventing drug resistance? If anything it seems by increasing exposure to the drug it encourages the development of resistance, since it gives the (otherwise less-fit) resistant bacteria a fitness advantage. Completing a course of a drug that the bacteria is already-resistant to will accomplish nothing other than eliminating its non-resistant competitors, so what's the logic?
      - photoJ 10y ago
        What's curious about this view, is that it ignores how researchers create AMR bugs in the lab. Namely low doses of Antibiotics to allow time for the bacteria to mutate and develop resistance. If you're interested you can look up MIC Minimal Inhibitory Concentration, I think you would find it illuminating. Also the assertion that the resistant phenotype is "otherwise less-fit" is not accurate.
        astazangasta 10y ago
        The resistant phenotypes often ARE less fit, as the guy above me said - if you have to run a solute pump in order to remove drug from your cytoplasm, that has a cost in energy and protein. EVERY phenotype has a cost that must be paid. You don't get to hang onto a useless genotype in the absence of a selective pressure that maintains it. Low doses allow you to provide a continuous challenge that doesn't kill the entire population. That's not what's happening when you stop your drug course early.
        photoJ 10y ago
        DNA absolutely hangs on to useless genotypes for some period of time. Horizontal gene transfer allows for redundant genes to exist. They have increased mutation which MIGHT lead to some productive change, but for an extended period of time they don't. Not to mention biological mechanism which exist for many many generations even though they aren't used in some grow medium. The disagreement here is about time scale. If it were true that resistant phenotypes often ARE dramatically less fit to the degree you imply we could simply stop taking Antibiotics and everything would revert back to it Susceptible state. When you stop a dosage early you've very likely applying a low dosage to some subpopluation. Dosages are not linear, nor evenly applied throughout the entire population of bacteria in a human body.
simonh 10y ago
Sure, but it is a real problem. Many antibiotics that were useful in the past are much less useful now, and more antibiotics with undesirable side effects are being used as treatments of last resort. If nothing had been done to mitigate the issue since 1979 or 1992 we'd be in a pretty dire situation by now.
- dluan 10y ago
  Not really, new resistant strains and new antibiotics to fight those strains is a constant inevitable march of evolution, and for the most part, driven by money from large pharma companies. An equivalent might be murphy's law and silicon chips. It's hardly dire, and arguably the disaster headlines of each new MRSA strain is more damaging to public awareness about how antibiotics actually work.
  - photoJ 10y ago
    Not may researchers agree with this view. Note the decrease in discovery of new antibiotic over time. Cite: http://smellslikescience.com/a-need-for-new-antibiotics/ http://smellslikescience.com/a-need-for-new-antibiotics/ Also if you need more info, more people are estimated to die from AMR then cancer in 2050. Cite: http://www.bbc.com/news/health-30416844 http://www.bbc.com/news/health-30416844
    - dluan 10y ago
      That's given the techniques used so far. See the recent work by the Lewis group [1] which uses a new method to culture soil bacteria to identify new antibiotics and opens up an entirely new pipeline. Previously, we've never been able to keep these strains of bacteria alive, but now we're able to allowing for sequencing and isolation of tons of new antibiotics. It's estimated that we'll be using this new technique for a long time. New antibiotic finds are black swan events, they tend to come from new areas that unless you specifically are looking there, you're not going to find. It's like an oil well, and the usage of the the few "last-resort" antibiotics, which ones get produced and sold, is highly controlled by a handful of pharma companies so they eke out whatever monetary value is left. [1] http://www.nature.com/nature/journal/v517/n7535/full/nature14098.html http://www.nature.com/nature/journal/v517/n7535/full/nature1... https://directorsblog.nih.gov/2015/01/13/digging-up-new-antibiotics/ https://directorsblog.nih.gov/2015/01/13/digging-up-new-anti... http://www.the-scientist.com/?articles.view/articleNo/41850/title/New-Antibiotic-from-Soil-Bacteria/ http://www.the-scientist.com/?articles.view/articleNo/41850/... http://www.npr.org/sections/health-shots/2015/01/07/375616162/compound-from-soil-bacteria-may-help-fight-dangerous-germs http://www.npr.org/sections/health-shots/2015/01/07/37561616... http://www.smithsonianmag.com/science-nature/new-antibiotic-dirt-soil-can-kill-drug-resistant-bacteria-180953828/?no-ist http://www.smithsonianmag.com/science-nature/new-antibiotic-...
hga 10y ago
humans seem need these stories to provide the motivation to use existing antibiotics less and to get moving on creating new antibiotics. Are drug company executives humans ^_^? Because one of the biggest problems in bringing new ones to market is that after you've spent more than a strategic bomber getting them there, they're put on last resort lists ensuring they won't get prescribed often. To even come close to breaking even they have to have seemingly insane prices, which gets them horrible PR for the crime of saving lives in a system that's stacked against them. Why bother? I'm sure a lot do because they don't want them and their's dying from a superbug in the future, but they've still got to keep their company out of bankruptcy.

daveguy 10y ago

> ...to provide the motivation to use existing antibiotics less... But always complete your antibiotic prescription.

astazangasta 10y ago
This bit of folk/medical wisdom has been around for a few decades, but for the life of me I can't understand the logic - beyond the notion that merely being asymptomatic doesn't mean you've killed all the bugs. How this can possibly contribute to the spread of antibiotic resistance is mystifying to me, as is the basis of this advice - is there ANY evidence that patients not completing their drug courses causes resistance?
- hga 10y ago
  Absolutely! As I learned as a rule of thumb while doing microbiological research in a NSSF Summer Science Training Program in 1977, most random antibiotics would fail to kill E. Coli at a rate of 1 in a million, and it went up to 1 in a billion with streptomycin (this is with random mutations, no plasmid acquisition involved, which is another story). However, these surviving bugs are generally not as fit as wild type, they've probably survived by sacrificing something, or doing something that consumes more energy. This helps your immune system mop them up, and note if antibodies are involved (don't know about that) it takes a while to come up with new ones, plus if there's any sort of bacteria ecology in the target area that survives the antibiotic they'll out-compete them. It shouldn't take much research on your part to confirm the basics of what I've related above, it's a tremendous problem, especially with TB, who's defenses require long and obnoxious drug schedules, resulting in more and more MDR and XDR (multi- and extensively-drug resistant) strains. If you get XDR, you're probably going to die, in a era where that's squalid instead of romantic. And I just came across "Totally drug-resistant tuberculosis" https://en.wikipedia.org/wiki/Totally_drug-resistant_tuberculosis https://en.wikipedia.org/wiki/Totally_drug-resistant_tubercu... Not official yet, but....
  - astazangasta 10y ago
    As I said, completing your course is useful in eliminating residual disease. How does it help in preventing drug resistance? If anything it seems by increasing exposure to the drug it encourages the development of resistance, since it gives the (otherwise less-fit) resistant bacteria a fitness advantage. Completing a course of a drug that the bacteria is already-resistant to will accomplish nothing other than eliminating its non-resistant competitors, so what's the logic?
    - photoJ 10y ago
      What's curious about this view, is that it ignores how researchers create AMR bugs in the lab. Namely low doses of Antibiotics to allow time for the bacteria to mutate and develop resistance. If you're interested you can look up MIC Minimal Inhibitory Concentration, I think you would find it illuminating. Also the assertion that the resistant phenotype is "otherwise less-fit" is not accurate.
      - astazangasta 10y ago
        The resistant phenotypes often ARE less fit, as the guy above me said - if you have to run a solute pump in order to remove drug from your cytoplasm, that has a cost in energy and protein. EVERY phenotype has a cost that must be paid. You don't get to hang onto a useless genotype in the absence of a selective pressure that maintains it. Low doses allow you to provide a continuous challenge that doesn't kill the entire population. That's not what's happening when you stop your drug course early.
        photoJ 10y ago
        DNA absolutely hangs on to useless genotypes for some period of time. Horizontal gene transfer allows for redundant genes to exist. They have increased mutation which MIGHT lead to some productive change, but for an extended period of time they don't. Not to mention biological mechanism which exist for many many generations even though they aren't used in some grow medium. The disagreement here is about time scale. If it were true that resistant phenotypes often ARE dramatically less fit to the degree you imply we could simply stop taking Antibiotics and everything would revert back to it Susceptible state. When you stop a dosage early you've very likely applying a low dosage to some subpopluation. Dosages are not linear, nor evenly applied throughout the entire population of bacteria in a human body.

simonh 10y ago

Sure, but it is a real problem. Many antibiotics that were useful in the past are much less useful now, and more antibiotics with undesirable side effects are being used as treatments of last resort. If nothing had been done to mitigate the issue since 1979 or 1992 we'd be in a pretty dire situation by now.

dluan 10y ago
Not really, new resistant strains and new antibiotics to fight those strains is a constant inevitable march of evolution, and for the most part, driven by money from large pharma companies. An equivalent might be murphy's law and silicon chips. It's hardly dire, and arguably the disaster headlines of each new MRSA strain is more damaging to public awareness about how antibiotics actually work.
- photoJ 10y ago
  Not may researchers agree with this view. Note the decrease in discovery of new antibiotic over time. Cite: http://smellslikescience.com/a-need-for-new-antibiotics/ http://smellslikescience.com/a-need-for-new-antibiotics/ Also if you need more info, more people are estimated to die from AMR then cancer in 2050. Cite: http://www.bbc.com/news/health-30416844 http://www.bbc.com/news/health-30416844
  - dluan 10y ago
    That's given the techniques used so far. See the recent work by the Lewis group [1] which uses a new method to culture soil bacteria to identify new antibiotics and opens up an entirely new pipeline. Previously, we've never been able to keep these strains of bacteria alive, but now we're able to allowing for sequencing and isolation of tons of new antibiotics. It's estimated that we'll be using this new technique for a long time. New antibiotic finds are black swan events, they tend to come from new areas that unless you specifically are looking there, you're not going to find. It's like an oil well, and the usage of the the few "last-resort" antibiotics, which ones get produced and sold, is highly controlled by a handful of pharma companies so they eke out whatever monetary value is left. [1] http://www.nature.com/nature/journal/v517/n7535/full/nature14098.html http://www.nature.com/nature/journal/v517/n7535/full/nature1... https://directorsblog.nih.gov/2015/01/13/digging-up-new-antibiotics/ https://directorsblog.nih.gov/2015/01/13/digging-up-new-anti... http://www.the-scientist.com/?articles.view/articleNo/41850/title/New-Antibiotic-from-Soil-Bacteria/ http://www.the-scientist.com/?articles.view/articleNo/41850/... http://www.npr.org/sections/health-shots/2015/01/07/375616162/compound-from-soil-bacteria-may-help-fight-dangerous-germs http://www.npr.org/sections/health-shots/2015/01/07/37561616... http://www.smithsonianmag.com/science-nature/new-antibiotic-dirt-soil-can-kill-drug-resistant-bacteria-180953828/?no-ist http://www.smithsonianmag.com/science-nature/new-antibiotic-...

hga 10y ago

humans seem need these stories to provide the motivation to use existing antibiotics less and to get moving on creating new antibiotics. Are drug company executives humans ^_^? Because one of the biggest problems in bringing new ones to market is that after you've spent more than a strategic bomber getting them there, they're put on last resort lists ensuring they won't get prescribed often. To even come close to breaking even they have to have seemingly insane prices, which gets them horrible PR for the crime of saving lives in a system that's stacked against them. Why bother? I'm sure a lot do because they don't want them and their's dying from a superbug in the future, but they've still got to keep their company out of bankruptcy.