6 ms·

> Medical professions risk losing a patient or being sued if hey misdiagnose a condition, so the understandable reaction is to throw antibiotics at the problem

by atmosx 10y ago

> Medical professions risk losing a patient or being sued if hey misdiagnose a condition, so the understandable reaction is to throw antibiotics at the problem rather than waiting for test results to come-back to determine whether a specific course of care is appropriate. As a pharmacist, my experience says otherwise. I think the following are the main reasons for bacterial resistance: a) Patient doesn't respect doctor's/pharmacist's guidelines. He feels much better after day 3, so he stops his class X ATB in day 4 instead of day 7. If bacteria survives, might very well be class X ATB-resistant. b) Patient has a relative who when was feeling sick took ATB XYZ and got better. The main reason for this is poverty: A visit to the doctor might cost 25-120 EUR. c) Hospitals. MRSA became "MR" in hospitals, where bacteria conjugation takes place. That said, at some in point, we should expect bacterial organisms to evolve some kind of resistance. That's how evolution works.

Retric 10y ago
This ignores livestock which is both a huge vector for resistance and part of the food chain. It's not like this is new, Sulfa drugs worked really well for a short period of time before penicillin and are now somewhat useful.
- photoJ 10y ago
  This. FDA estimated 80% of antibiotics are used for livestock. Cite: https://www.govtrack.us/congress/bills/112/hr965/text https://www.govtrack.us/congress/bills/112/hr965/text
jp555 10y ago
"That's how evolution works" - good point, and also probably a promising area to look for new ideas. e.g. bacteriophages
- Florin_Andrei 10y ago
  Fight (blind) evolution with (directed) evolution. In the long run, it's the only strategy that works.
chrisgd 10y ago
How much of bacterial resistance is from patient's not finishing a dose of medicine and how much is from increased use of antibiotics as a whole (in the farm system, in people, etc)?
- photoJ 10y ago
  Researchers are not totally clear on this. One particularly dangers spread is counterfeit medications that don't reach the MIC required to kill the Bacteria, and instead create in people exactly the same situation that biologist use to grown AMR bacteria in the lab.
iLoch 10y ago
Regarding (a) - do you know that I've never been told why I need to finish my antibiotics? For some reason (arrogance?) doctors don't explain their reasoning in many cases (I live in Canada FWIW.) If I was told "hey, you need to finish your antibiotics or you'll risk becoming immune to them, potentially putting yourself or your family, colleagues, or friends at risk" I don't think even the dumbest person would ignore that warning. Then they could even explain WHY that is, if the patient was curious. Instead, here in Canada, you say you're sick, the doctor will likely immediately perscribe antibiotics, then shuffle you out the door in less than 5 minutes.
- atmosx 10y ago
  > Regarding (a) - do you know that I've never been told why I need to finish my antibiotics? Drug therapies have specific regimens that need to be respected in order to ensure the highest degree of success. An average regimen for penicillins (penicillin-derivatives) is 7 days because that's how many days it takes for the ATB to kill the bacterial infection. Now all the above is the N-th level of abstraction. If you really want to know what's on you need to start doing evaluations. You need data like from the patient like: - Age - Kg - Health state (liver, nephrons, stomach, allergies, etc.) - History the specific class of ATBs (how did your body and the infection react to this class of ATB in the past?) - Other medication (are there interactions with other drugs a patient might be taking?) - Food (e.g. you shouldn't eat St. John's Wort while on drugs, because it's a CYP3A4 inducer and so on and so forth...) - etc. And it goes further down the rabbit hole depending on the case. So, I of course prefer doctors who are big on explaining what's happening, but I understand those who don't. The thing is that once the doctor starts talking ,you will probably start asking why, especially if you're an engineer who wants to put everything into context. At some point you'll just won't be able to understand - which means he'll have to make silly analogies, even more explanation, etc. Add to that you might have been his 20th patient that day and you get the point. On the other hand, if you pay for it, you should be able to get a doctor which gives you the appropriate amount of care/explanations.
- aggie 10y ago
  I had also never heard an explanation before. I'd like to think I would inquire if it came up (haven't needed antibiotics since I was a kid), but many people aren't inquisitive. I had a similar lightbulb moment when I heard why you shouldn't slouch, even though it can be comfortable: the intervertebral discs in your spine are poorly innervated[1], so you don't feel the damage you are causing until it is severe. 1 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2913007/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2913007/
foobarian 10y ago
I understand there is also a d) feeding farm animals antibiotics to promote growth/weight gain.
fencepost 10y ago
> Patient doesn't respect doctor's/pharmacist's guidelines. This is not at all restricted to antibiotics. I still treasure the memory of listening to a cardiologist ream out a patient over the phone on either Christmas or New Year's Eve (I was waiting for him to leave so I could take the servers down). Said patient hadn't been seen in the office in 6+ months, had gotten things prescribed by other docs in the interim, and had decided to stop taking some of what had been prescribed effectively self-medicating. The basic message being passed to him was "You're an idiot, you're going to die, if you have problems over this long holiday weekend call the doc who saw you most recently or get to the ER, did I mention idiocy and death?, we haven't seen you in months and didn't prescribe what you're doing and are not responsible for your stupidity, I'm documenting this in your chart." IIRC, in this case the patient had kept taking a diuretic that had a side effect of potassium elimination but had decided to stop taking the potassium supplements needed to counter that.

by atmosx 10y ago

Retric 10y ago

This ignores livestock which is both a huge vector for resistance and part of the food chain. It's not like this is new, Sulfa drugs worked really well for a short period of time before penicillin and are now somewhat useful.

photoJ 10y ago
This. FDA estimated 80% of antibiotics are used for livestock. Cite: https://www.govtrack.us/congress/bills/112/hr965/text https://www.govtrack.us/congress/bills/112/hr965/text

jp555 10y ago

"That's how evolution works" - good point, and also probably a promising area to look for new ideas. e.g. bacteriophages

Florin_Andrei 10y ago
Fight (blind) evolution with (directed) evolution. In the long run, it's the only strategy that works.

chrisgd 10y ago

How much of bacterial resistance is from patient's not finishing a dose of medicine and how much is from increased use of antibiotics as a whole (in the farm system, in people, etc)?

photoJ 10y ago
Researchers are not totally clear on this. One particularly dangers spread is counterfeit medications that don't reach the MIC required to kill the Bacteria, and instead create in people exactly the same situation that biologist use to grown AMR bacteria in the lab.

iLoch 10y ago

Regarding (a) - do you know that I've never been told why I need to finish my antibiotics? For some reason (arrogance?) doctors don't explain their reasoning in many cases (I live in Canada FWIW.) If I was told "hey, you need to finish your antibiotics or you'll risk becoming immune to them, potentially putting yourself or your family, colleagues, or friends at risk" I don't think even the dumbest person would ignore that warning. Then they could even explain WHY that is, if the patient was curious. Instead, here in Canada, you say you're sick, the doctor will likely immediately perscribe antibiotics, then shuffle you out the door in less than 5 minutes.

atmosx 10y ago
> Regarding (a) - do you know that I've never been told why I need to finish my antibiotics? Drug therapies have specific regimens that need to be respected in order to ensure the highest degree of success. An average regimen for penicillins (penicillin-derivatives) is 7 days because that's how many days it takes for the ATB to kill the bacterial infection. Now all the above is the N-th level of abstraction. If you really want to know what's on you need to start doing evaluations. You need data like from the patient like: - Age - Kg - Health state (liver, nephrons, stomach, allergies, etc.) - History the specific class of ATBs (how did your body and the infection react to this class of ATB in the past?) - Other medication (are there interactions with other drugs a patient might be taking?) - Food (e.g. you shouldn't eat St. John's Wort while on drugs, because it's a CYP3A4 inducer and so on and so forth...) - etc. And it goes further down the rabbit hole depending on the case. So, I of course prefer doctors who are big on explaining what's happening, but I understand those who don't. The thing is that once the doctor starts talking ,you will probably start asking why, especially if you're an engineer who wants to put everything into context. At some point you'll just won't be able to understand - which means he'll have to make silly analogies, even more explanation, etc. Add to that you might have been his 20th patient that day and you get the point. On the other hand, if you pay for it, you should be able to get a doctor which gives you the appropriate amount of care/explanations.
aggie 10y ago
I had also never heard an explanation before. I'd like to think I would inquire if it came up (haven't needed antibiotics since I was a kid), but many people aren't inquisitive. I had a similar lightbulb moment when I heard why you shouldn't slouch, even though it can be comfortable: the intervertebral discs in your spine are poorly innervated[1], so you don't feel the damage you are causing until it is severe. 1 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2913007/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2913007/

foobarian 10y ago

I understand there is also a d) feeding farm animals antibiotics to promote growth/weight gain.

fencepost 10y ago

> Patient doesn't respect doctor's/pharmacist's guidelines. This is not at all restricted to antibiotics. I still treasure the memory of listening to a cardiologist ream out a patient over the phone on either Christmas or New Year's Eve (I was waiting for him to leave so I could take the servers down). Said patient hadn't been seen in the office in 6+ months, had gotten things prescribed by other docs in the interim, and had decided to stop taking some of what had been prescribed effectively self-medicating. The basic message being passed to him was "You're an idiot, you're going to die, if you have problems over this long holiday weekend call the doc who saw you most recently or get to the ER, did I mention idiocy and death?, we haven't seen you in months and didn't prescribe what you're doing and are not responsible for your stupidity, I'm documenting this in your chart." IIRC, in this case the patient had kept taking a diuretic that had a side effect of potassium elimination but had decided to stop taking the potassium supplements needed to counter that.