5 ms·

Wouldn't low dose antibiotics be more likely to create antibiotic resistant bacteria than high dose?

by benaadams 9y ago

banku_brougham 9y ago
That is precisely the concern.
deleted 9y ago
[deleted]
cratermoon 9y ago
Precisely. Constant exposure to less-than-therapeutic doses of antibiotics is a huge source of resistance. The bacteria in an animal with low doses or antibiotics are not exposed to enough of the drug to outright kill them, but the bacteria start to develop defenses. Bacteria can evolve extremely rapidly -- they don't even need to reproduce, as bacteria can exchange DNA horizontally[1]. Also, this is why if your doctor prescribes a course of antibiotics you should always complete the entire course, even if you feel fine. Stopping the antibiotics early can select for resistant strains. 1. http://learn.genetics.utah.edu/content/microbiome/resistance/ http://learn.genetics.utah.edu/content/microbiome/resistance...
- atmosx 9y ago
  I was extremely fascinated by bacterial resistance growth mechanisms (DNA exchange). It was the first time I realized how immensely complicated the biosystem is at lower level. The 2nd time I had this feeling was when introduced to space of possible protein structures & the futility of prediction strategies. Suddenly the “known universe” and things like “number of known stars” started looking “reasonably sized” or even small. Fascinating stuff. People can read more about it here: https://en.m.wikipedia.org/wiki/Protein_structure_prediction https://en.m.wikipedia.org/wiki/Protein_structure_prediction
  - chriswarbo 9y ago
    > The 2nd time I had this feeling was when introduced to space of possible protein structures & the futility of prediction strategies. Suddenly the “known universe” and things like “number of known stars” started looking “reasonably sized” or even small. This is a common experience in combinatorics ( https://en.wikipedia.org/wiki/Combinatorics https://en.wikipedia.org/wiki/Combinatorics ). Similar things happen when beginner programmers (like me!) try to solve chess by recursing/looping through possible moves (there are about 10^123 separate paths, if duplicate configurations are merged together), or brute-force a cryptographic hash/key (2^k possibilities for keys of length k; keys of length 2048 and above are common). The "standard big number" that gets thrown around when pop-sci articles talk about this stuff is the number of atoms in the observable universe, which is estimated at around 10^80. It irks me that this is used so much for comparison, since combinations of things are so overwhelmingly larger than collections of things that it feels like a category error to compare them. After all, "the number of atoms in the observable universe" isn't a particularly intuitive quantity; unlike, say, "football field" as a unit of length or "bag of sugar" as a unit of mass/weight (UK media loves to use the latter; since a bag of sugar is 1kg, it shows off both their laziness and lack of faith in their audience...). Also, picking "the number of atoms in the universe" is really trying hard; yet these combinatorial numbers (protein foldings, chess positions, etc.) are actually small, everyday examples! People have no problems (either conceptually or practically) with playing board games, choosing passwords, etc. despite these large numbers lurking in there. The "atoms in the universe" number would be a hopeless comparison if we really tried to make a big combinatorial number. For example, "the number of binary sequences that can be represented by all the world's computer storage"; a quick Google search estimates the world's data storage as 295 exabytes, so that makes this number around 256^(295 * 10^18)
    - taneq 9y ago
      > It irks me that this is used so much for comparison, since combinations of things are so overwhelmingly larger than collections of things that it feels like a category error to compare them. I think this is the core of the issue. "Atoms in the universe" is only such a relatively 'small' number if you assume that the way they're arranged is unimportant.
    - wk2jkhkjdfglsl 9y ago
- mrob 9y ago
  >Stopping the antibiotics early can select for resistant strains. Some people are claiming this is not supported by evidence: http://www.bmj.com/content/358/bmj.j3418.full http://www.bmj.com/content/358/bmj.j3418.full Previous HN discussion: https://news.ycombinator.com/item?id=15311274 https://news.ycombinator.com/item?id=15311274
  - Retric 9y ago
    Depends on what you do with the 'saved' medication. If you get 5 day subscription stop on day 3, then take the rest next week that's bad.
  - cratermoon 9y ago
    Ah, that's relatively recent in the literature, and I found a reference to it at the NIH[1] as well. I'm glad for all the research into causes of antibiotic resistance, and if medicine comes up with a better way to treat infections and minimize resistance, I'm all for it. 1. https://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines/news/2017-07-27-questions-over-advice-to-finish-courses-of-antibiotics/ https://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines...
Brockenstein 9y ago
Yes. The long term consequences don't factor in though because the immediate gains in production and profits are too attractive. Whether or not people understand, believe the concerns are overblown or believe that we'll always be one step ahead, or will only stop when things get really bad, amounts to the same thing; misuse of anti-biotics. It's a very human behavior to prefer a pound of cure to an ounce of prevention. It's magnified when you won't be responsible for the cure or the cost of it yourself. It's a weight that will be borne by all of society.

Wouldn't low dose antibiotics be more likely to create antibiotic resistant bacteria than high dose?

banku_brougham 9y ago

That is precisely the concern.

deleted 9y ago

[deleted]

cratermoon 9y ago

Precisely. Constant exposure to less-than-therapeutic doses of antibiotics is a huge source of resistance. The bacteria in an animal with low doses or antibiotics are not exposed to enough of the drug to outright kill them, but the bacteria start to develop defenses. Bacteria can evolve extremely rapidly -- they don't even need to reproduce, as bacteria can exchange DNA horizontally[1]. Also, this is why if your doctor prescribes a course of antibiotics you should always complete the entire course, even if you feel fine. Stopping the antibiotics early can select for resistant strains. 1. http://learn.genetics.utah.edu/content/microbiome/resistance/ http://learn.genetics.utah.edu/content/microbiome/resistance...

atmosx 9y ago
I was extremely fascinated by bacterial resistance growth mechanisms (DNA exchange). It was the first time I realized how immensely complicated the biosystem is at lower level. The 2nd time I had this feeling was when introduced to space of possible protein structures & the futility of prediction strategies. Suddenly the “known universe” and things like “number of known stars” started looking “reasonably sized” or even small. Fascinating stuff. People can read more about it here: https://en.m.wikipedia.org/wiki/Protein_structure_prediction https://en.m.wikipedia.org/wiki/Protein_structure_prediction
- chriswarbo 9y ago
  > The 2nd time I had this feeling was when introduced to space of possible protein structures & the futility of prediction strategies. Suddenly the “known universe” and things like “number of known stars” started looking “reasonably sized” or even small. This is a common experience in combinatorics ( https://en.wikipedia.org/wiki/Combinatorics https://en.wikipedia.org/wiki/Combinatorics ). Similar things happen when beginner programmers (like me!) try to solve chess by recursing/looping through possible moves (there are about 10^123 separate paths, if duplicate configurations are merged together), or brute-force a cryptographic hash/key (2^k possibilities for keys of length k; keys of length 2048 and above are common). The "standard big number" that gets thrown around when pop-sci articles talk about this stuff is the number of atoms in the observable universe, which is estimated at around 10^80. It irks me that this is used so much for comparison, since combinations of things are so overwhelmingly larger than collections of things that it feels like a category error to compare them. After all, "the number of atoms in the observable universe" isn't a particularly intuitive quantity; unlike, say, "football field" as a unit of length or "bag of sugar" as a unit of mass/weight (UK media loves to use the latter; since a bag of sugar is 1kg, it shows off both their laziness and lack of faith in their audience...). Also, picking "the number of atoms in the universe" is really trying hard; yet these combinatorial numbers (protein foldings, chess positions, etc.) are actually small, everyday examples! People have no problems (either conceptually or practically) with playing board games, choosing passwords, etc. despite these large numbers lurking in there. The "atoms in the universe" number would be a hopeless comparison if we really tried to make a big combinatorial number. For example, "the number of binary sequences that can be represented by all the world's computer storage"; a quick Google search estimates the world's data storage as 295 exabytes, so that makes this number around 256^(295 * 10^18)
  - taneq 9y ago
    > It irks me that this is used so much for comparison, since combinations of things are so overwhelmingly larger than collections of things that it feels like a category error to compare them. I think this is the core of the issue. "Atoms in the universe" is only such a relatively 'small' number if you assume that the way they're arranged is unimportant.
  - wk2jkhkjdfglsl 9y ago
mrob 9y ago
>Stopping the antibiotics early can select for resistant strains. Some people are claiming this is not supported by evidence: http://www.bmj.com/content/358/bmj.j3418.full http://www.bmj.com/content/358/bmj.j3418.full Previous HN discussion: https://news.ycombinator.com/item?id=15311274 https://news.ycombinator.com/item?id=15311274
- Retric 9y ago
  Depends on what you do with the 'saved' medication. If you get 5 day subscription stop on day 3, then take the rest next week that's bad.
- cratermoon 9y ago
  Ah, that's relatively recent in the literature, and I found a reference to it at the NIH[1] as well. I'm glad for all the research into causes of antibiotic resistance, and if medicine comes up with a better way to treat infections and minimize resistance, I'm all for it. 1. https://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines/news/2017-07-27-questions-over-advice-to-finish-courses-of-antibiotics/ https://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines...

Brockenstein 9y ago

Yes. The long term consequences don't factor in though because the immediate gains in production and profits are too attractive. Whether or not people understand, believe the concerns are overblown or believe that we'll always be one step ahead, or will only stop when things get really bad, amounts to the same thing; misuse of anti-biotics. It's a very human behavior to prefer a pound of cure to an ounce of prevention. It's magnified when you won't be responsible for the cure or the cost of it yourself. It's a weight that will be borne by all of society.