9 ms·

Why do antibiotics exist?

143 points by maxerickson 5y ago

throwoutway 5y ago
From conversations with medical professionals: Antibiotic “misuse” is one of the most frustrating things in the field. They’re taught about antibiotic resistance in school, but then contribute to the problem by overprescribing it. The y describe the circumstances that patients (and parents) just want “a pill” to solve “a problem”, and that while the doctors know that it’s a viral infection, they still prescribe the antibiotics to placate the patient/parent. Further compounding the problem. They’d be better just prescribing placebos or “drink some ginger garlic tea and rest”
- cortesoft 5y ago
  Isn’t this paper actually debunking that argument (That overuse of antibiotics has increased antibiotic resistance)? The paper says that resistance didn’t diminish when antibiotic use was decreased. It seems that our common understanding of how resistance develops was incorrect, at least partially.
  - commiefornian 5y ago
    If there is selective pressure to increase resistance, resistance increases over time. If there is not selective pressure to increase resistance... nothing. There is no pressure to change anything relating to resistance. It could increase. It could decrease. It could stay the same. There is no reason to expect anything in particular about it.
- fennecfoxen 5y ago
  Well, that’s not covered by my health plan!
- snarf21 5y ago
  Of course, but the US fee-for-service model is aligned elsewhere. I think a lot of them think that as long as they are not prescribing a z-pack every month, it won't be that big of a deal. Also, customer acquisition is hard. Patients will just find another primary or go to an urgent care and get the meds there. For primary care, being seen as "not helpful" won't just lose one patient, but a whole household of them. As you quote above, people want a quick fix. The person consuming 3000 calories of carbs per day wants a magic pill to fix their type 2 diabetes without them having to make any changes. I don't envy them.
  - nradov 5y ago
    SGLT2 inhibitors pretty much are magic pills for type 2 diabetes. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/sodium-glucose-cotransporter-2-sglt2-inhibitors https://www.fda.gov/drugs/postmarket-drug-safety-information... But of course it's better to prevent the condition in the first place.
    - tsol 5y ago
      Wait until people find out the side effects, then you'll get another thread exactly like this one but about SGLT2 inhibitors instead of antibiotics
    - orangepurple 5y ago
      Autophagy is the real silver bullet for T2DM treatment but you won't get that from a pill especially if you continue to ingest sugar.
    - snarf21 5y ago
      Another very promising treatment for type 2 is DMR. We need to do a lot more research on the duodenum as it is clear it is a major linchpin in type 2. [https://gut.bmj.com/content/69/2/295 https://gut.bmj.com/content/69/2/295]
- avgDev 5y ago
  I do not understand why there is a huge gap between scientific knowledge and physicians. I had a problem with an allergic reaction to an antibiotic. This resulted in me actually paying attention to drug labels, side effects and what a drug is being prescribed for. It has quite literally ruined my trust in doctors. Last year I had stomach pain, I thought it was appendix. So, I went to an urgent care because my physician could not see me. They had access to my medical records. Quickly, I receive a diagnosis of "Diverticulitis". 2 minutes later I'm given a prescription for Cipro, which I'm deadly allergic to. New guidelines suggest not using antibiotics in uncomplicated diverticulitis. I didn't take the meds, and I'm pretty sure I just pulled an abdomen muscle as it healed over the next few weeks. I have many stories from sports injuries and doctors offering steroid injections as first line treatment, which is no longer recommended. NSAIDs are also not recommended for tendon injuries and it is the first thing the doctor will offer. I don't get it. The information is easily available. Saying I read a study or a updated recommendation gets most doctors visibly upset. Not sure if it is the long working hours and trying to move as many patients as possible or just lack of giving a fuck.
  - bserge 5y ago
    It's both. On the one hand, I hate the fuckers who don't give a shit, I've met way too many of them. On the other hand, too many times they are overworked and/or underpaid. At some point anyone will stop giving a fuck. Surgeons, dentists, EMTs deserve respect though. Yeah they fuck up, but nowhere near as often or bad as those responsible for gatekeeping useful medicine.
  - peakaboo 5y ago
    It's about money and they just want to get rid of you, because they are understaffed, overworked and not happy people.
  - nradov 5y ago
    I don't have the citation handy but the Institute of Medicine researched this and found it takes about 17 years in average to get all physicians to adopt new clinical practice guidelines. For physicians with a wide scope of practice it's just tough to keep up with all the chances. There might be some opportunities to use technology in clinical decision support systems that warn about potentially inappropriate treatments, but those have to be handled carefully so as to not slow down patient care unnecessarily.
- beached_whale 5y ago
  There was talk to the placebos on SBM at one point, the gist of it being that it would be far worse for them to do so for a few reasons. It erodes trust is the big point. But, I assume, there would be issues with informed consent too. How does one prescribe a placebo where the user can lookup the drug by name online. Not a medical professional, but I think the issue comes down to doctors saying no as a group and being ok if they shop another doctor. If enough do that, the issue goes away.
- cogman10 5y ago
  I have to wonder, though, if it's human prescribed antibiotics that source these super-bugs. It's pretty common practice in the cattle industry, for example, to just pump cows with antibiotics because studies have shown cows constantly on antibiotics grow fatter than cows not on antibiotics. (Likely, because they don't ever really get sick). [1] That makes me wonder how many of our super bugs have origins in the livestock industries where common practice is literally a recipe to bread superbugs. [1] https://www.cidrap.umn.edu/news-perspective/2020/06/report-slams-beef-industry-overuse-antibiotics https://www.cidrap.umn.edu/news-perspective/2020/06/report-s...
  - hyperman1 5y ago
    This is one of the contentious points in trade between the USA and the EU: The EU does not allow preventive antibiotic use, but the USA does. Same for growth hormones. As a result, USA meat can not be imported in the EU. USA claims this is foul play, protectionism, against WTO rules. Now the EU does allow curative antibiotic usage on animals, so I wonder if this is actually such a big difference. If a vet prescribes antibiotics for the slightest reason, there might not be much changed in reality.
    - Fomite 5y ago
      This is certainly a problem when banning antibiotics for growth promotion, but allowing the prophylactic use of antibiotics. Any animal in the type of farm looking for growth promotion is at risk for a bacterial infection basically all the time.
  - Fomite 5y ago
    It's been funny working at the intersection of human and animal health. The medical types all want to blame agriculture. The agriculture types all respond that they're not using major frontline human antibiotics (outside some stuff for companion animals). It's sort of a complex mix - there's a lot of bulk use in agriculture, but the drug-microorganism pairings in human medicine are somewhat more acute.
- MaxBarraclough 5y ago
  It seems odd to me that doctors are even allowed to prescribe antibiotics when they know they aren't necessary. Why shouldn't that be grounds for disciplinary action?
  - deleted 5y ago
    [deleted]
  - cycomanic 5y ago
    That's one of the interesting experiences when moving to Sweden. One is highly unlikely to be prescribed antibiotics here, and one gets prescribed very "old" antibiotics, that my partner who was trained in France said are hardly used anymore in France due to resistances. When she started working as a GP here she found out that it's very hard for doctors to prescribe antibiotics, i.e. the conditions under which doctors are allowed to prescribe them are very strict. There's a lot of things that are frustrating about the medical system here, but the restrictions on antibiotics is one of the very good things.
    - MaxBarraclough 5y ago
      Sounds sensible, but I imagine it won't do much good if it's just Sweden doing it.
      - Zircom 5y ago
        You're right it won't do much good, but it is nice to see a country take a principled stand and actually practice what they preach and be the change they want to see.
- nostromo 5y ago
  I don't buy that the primary issue is with human antibiotic use. Doctors have become increasingly stingy with antibiotics, sometimes at the expense of human well-being -- meanwhile 80% of antibiotics are used in livestock production. We could reduce the need for antibiotics in livestock if we treated animals better. Giving animals a bit of breathing room and fresh air would reduce the need to jack them up on antibiotics from day one. Reducing use in humans seems like banning straws to take on plastic waste -- a feel good policy that won't actually fix much.
- johnisgood 5y ago
  Why prescribe it if we know it is viral? First, the doctor should determine whether or not it is viral or bacterial. If it turns out that it is viral, then DO NOT PRESCRIBE ANTIBIOTICS. Is it because of placebo? Because if so, the costs are too high. Tell them to take zinc or whatever for a week.
sattoshi 5y ago
> In reaction to the antibiotic resistance problem and with treatment options dwindling, public health officials attempted to control antibiotic usage as a means of controlling resistance (20). The expectation was that rates of resistance would diminish as antibiotic usage dropped. However, resistance persisted even in the face of such drug management practices on both small and large scales (20–23). This makes perfect sense to me. Why did this not work? The article continues with an explanation of "the ecological fallacy" but I don't understand how the two are supposed to be connected.
- christkv 5y ago
  There are so many exiting old antibiotics that might be possible to repurpose however no money or willingness to qualify them https://www.sciencedirect.com/science/article/pii/S1198743X15006205 https://www.sciencedirect.com/science/article/pii/S1198743X1... I guess there is no money in requalifying an out of patent antibiotic.
- Fomite 5y ago
  The problem is that there was a very compelling "just so" story that antibiotic-resistant bacteria are inherently at a competitive disadvantage vs. susceptible bacteria absent selective pressure. Take the antibiotics away, and the resistant bacteria will follow. Unfortunately, microbial ecology is much more complex than that, and it hasn't panned out that way. Often because resistance plasmids also carry other helpful genes. For example, I'm currently working on a study where there's high levels of antibiotic resistance to an antibiotic that isn't used in that population because there's other things hanging out on the same plasmid. Also note: That's not what most people mean when they say "ecological fallacy", which is a statistics term.
  - jessriedel 5y ago
    Not all proposed evolutionary mechaniams that turn out to be false, much less merely incomplete, are just-so stories. The fact that the hypothesis was simple makes it more reasonable.
    - 5y ago
Gunax 5y ago
Does antibiotic overuse really contribute a large portion of antibiotic use? I ask because it seems like misuse is blamed for antibiotic resistance: but it seems to me that bacteria don't care whether youre using it legitimately or not: either way has a chance of contributing to resistance.
- jurassic 5y ago
  One thing I hear cited often is the way antibiotics are widely used in animal agriculture to boost margins by helping keep more animals alive in the lowest cost living conditions (often squalid and unhealthy for the animal). This is antibiotic abuse on a massive scale, for the profit of private individuals. :facepalm:
  - vkk8 5y ago
    This feels like a pretty low hanging fruit to regulate away. Ban antibiotics use in agriculture in civilized countries and ban importing antibiotics grown meat from the others (I would guess it's easy to test).
    - nradov 5y ago
      The FDA has already been working to reduce antibiotic use in agriculture. https://www.fda.gov/animal-veterinary/safety-health/antimicrobial-resistance https://www.fda.gov/animal-veterinary/safety-health/antimicr...
    - culi 5y ago
      I wouldn't call it low-hanging fruit considering just how dependent large-scale animal agriculture is dependent on antibiotics
    - mdavis6890 5y ago
      This would mean either that we would have a lot less food, or we would have to divert a lot of effort from other productive activities to make it up. Maybe that's okay, but still this idea is not free, and not low-hanging fruit.
mrtweetyhack 5y ago
for the same reason biotics exists
DantesKite 5y ago
What's interesting is that the same principle doesn't seem to apply for viral infections. The smallpox vaccine is just as effective today as it was a couple decades ago. Then again the flu is constantly mutating so maybe it's just contingent on the type of disease.
- not2b 5y ago
  Depends on which virus. Flu shots have to be changed every year, but measles shots appear to give lifetime immunity.
  - roywiggins 5y ago
    Flu doesn't evolve to resist each vaccine, it's just a different strain becoming prevalent each year. I'm not sure what the mechanism behind that is, but it was happening before the flu vaccine existed.
    - bink 5y ago
      Is there much difference conceptually between a virus mutating in a body and then finding ready hosts amongst the vaccinated if there is a large vaccinated population and a bacteria that has a resistance to an antibiotic spreading in a host that is receiving that antibiotic? Sorry for probably not using the right terminology here but they seem closely related to me.
      - exyi 5y ago
        Antibiotic resistance is usually on plazmids which can be exchanged between different bacteria (often even between different bacterial species). So only one bacteria needs to find the right gene and it starts spreading. Viruses have really small genomes and simply adding a gene for bypassing immunity does not work. It would need to restructure it's surface proteins so that the immune cells can't recognize it anymore, but this restructure often breaks the virus. Also there is the thing that antibiotics are present at low concentrations everywhere which makes small but constant pressure for the resistance genes. > On a larger scale, since 1940, antibiotics have become an omnipresent pollutant in environments of all types (55). Even in places largely untouched by humans, we can find antibiotic compounds and, with them, ARGs (56–59). In recent years, we have learned that even low levels of antibiotic pollution select for high levels of resistance (60–62). Additionally, regardless of the biome or their ability to clear pollutants, humanity’s worldwide industrial-level use of antibiotics has resulted in a steady stream of antibiotics into the environment, without ever allowing natural systems to return to baseline levels (63). Immunity does not come in this constant small pressure. You either have it and then the virus is dead quickly, so it does not have much time for finding mutations. Or you don't have it, so there is no pressure for the mutations.
User23 5y ago
I'm a little disappointed that this isn't an article about how fungi became the world heavyweight champions of cellular level biological warfare. I've often wondered if we could let the fungi do the work for us, and maintain colonies that are periodically challenged with organisms of interest, such as ones that have broad resistance, and see what they come up with as a way to create new antibiotics.
alan-crowe 5y ago
The article makes much of the pairing of antibiotic production genes and antibiotic resistance genes. They often occur on a single plasmid and are passed around together. But there must be different facets to antibiotic resistance genes, because a bacterium that is producing an antibiotic needs to avoid being poisoned by it. Perhaps some genes produce antibiotic resistance by coding for proteins that metabolize the antibiotic. Such genes are not helpful when paired with antibiotic production because they are destroying the antibiotic as fast as the other genes produce it. By contrast, some antibiotics work by destroying the cell walls of bacteria. Presumably some antibiotic resistance genes work by coding for resistant cell walls. And a bacterium that is producing such an antibiotic had better have such resistance genes or it will end up destroying its own cell walls. The article is silent on the differences between antibiotic resistance genes that a producer needs, to survive its own antibiotics, and antibiotic resistance genes that a producer mustn't have, to avoid sabotaging its own production. The article raises the issue of mutualism between different species of bacteria, with shared resistance and production genes letting the diverse community resist outsiders. Perhaps that is already a complicated story without adding in different kinds of resistance genes.
- dotancohen 5y ago
  > But there must be different facets to antibiotic resistance genes, because > a bacterium that is producing an antibiotic needs to avoid being poisoned by it. Excuse the analogy, but this looks like looking at the problem under a microscope but not looking at the bigger ecosystem. Every living thing produces materials that would poison it. We exhale carbon dioxide, our solid excrement is often toxic in addition to a biohazard. Even the skin cells we shed and sweat would be problematic if left to accumulate.
nyanpasu64 5y ago
> If the secret society system was a dominant selective force in evolving and maintaining antibiotics in the preantibiotic era, then changes in the magnitude, frequency, and diversity of antibiotics after 1940 would likely have caused a consequent shift away from a production-resistance balance in favor of a resistance-dominated evolutionary strategy. So if bacteria in nature use antibiotics for signalling and to filter surrounding bacteria, rather than for warfare, it's not reasonable to expect humans to stop using antibiotics as warfare against dangerous pathogens (though using it to make animals grow faster is another story). What's the takeaway from this hypothesis?
JoeCoo7 5y ago
Bacteria are microorganisms, meaning that they are life forms. The word ‘antibiotic’ breaks down into: ‘anti’ (against) and ‘biotic’ (life). Antibiotics act to inhibit the growth of, or kill, microorganisms, preventing their spread and multiplication. The first – and still most common – antibiotics come from fungi (e.g., penicillin) and specifically fight bacteria. Before the development of antibiotics for widespread use, about 70 years ago, there was a high mortality rate from bacterial infections, such as tuberculosis, pneumonia, and sexually transmitted contagions. Today, many forms of antibiotics exist to treat several different types of infections, including parasitic infections and some fungal infections. However, antibiotics do not work on viruses because viruses are not living organisms and so are ‘not alive’. Unlike living organisms with their own cells, viruses are segments of DNA (or RNA) that inject themselves into living cells, forcing those cells to do the work of reproducing more of the viral DNA. This is why your physician will not prescribe an antibiotic for the common cold or flu. When we are sick, we often don’t know the full nature of the infection that is attacking our bodies. We just feel bad. This can be confusing because, for example, while a cold virus attacks our body, our immune system is working extra hard and we become vulnerable to developing other types of infections, such as pneumonia or strep throat, which are bacterial infections and usually treated with antibiotics.
rpaddock 5y ago
Why are Fluoroquinolone Antibiotics (FQs) such as Cipro, Levaquin etc. even still on the market, from the many life long devastating side effects they cause many? The FDA itself has said that this class of Antibiotics should be reserved until ALL other options have been exhausted. Yet doctors are giving this crap out like candy. Usually for things that they don't even work for such as UTIs see FDA July 26 2016: "Limits use for acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis and uncomplicated urinary tract infections." See link below. Because for those items they don't work any better than a placebo, as the FDA itself documented in this 617 page report: https://web.archive.org/web/20170113234645/http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/Anti-InfectiveDrugsAdvisoryCommittee/UCM467383.pdf https://web.archive.org/web/20170113234645/http://www.fda.go... On page 17 of that report they even give a name to the problem these antibiotics cause: '"fluoroqunolone-associated disability" (FQAD)'. I have gathers all of the FDA warnings, and a few from the EU that say don't use them at all, about FQs at my late wife's website: https://www.kpaddock.com/fq https://www.kpaddock.com/fq In large part she is my late wife because of Levaquin causing her systemic tendentious. After several years she killed herself to stop the pain from that and CSF Leaks. For that whole saga see the documentary Pain Warriors that is free to watch on Amazon Prime and TubiTV: https://www.kpaddock.com/pw https://www.kpaddock.com/pw For me because of all of that it comes down to don't trust Big Pharam and the Medical Establishment with your health. Study EVERYTHING and make an informed decision before taking anything a doctor offers you. Ask them "Is my problem being caused by a pill deficiency?" and watch their stunned looks... On a possible upside there is some work coming around on using Phages as a type of antibiotic. The founder of this company experienced her own antibiotic resistant infection. [Full disclosure I have communicated with her about the above FQ issues, I receive nothing from them.] https://www.felixbt.com/new-page https://www.felixbt.com/new-page
amriksohata 5y ago
None of this covers the new need for antibiotics, driven by industrialisation, the rise of disease due to poor santisation and squalid housing and living conditions caused by the industrial revolution as people moved towards cities.

143 points by maxerickson 5y ago

From conversations with medical professionals: Antibiotic “misuse” is one of the most frustrating things in the field. They’re taught about antibiotic resistance in school, but then contribute to the problem by overprescribing it. The y describe the circumstances that patients (and parents) just want “a pill” to solve “a problem”, and that while the doctors know that it’s a viral infection, they still prescribe the antibiotics to placate the patient/parent. Further compounding the problem. They’d be better just prescribing placebos or “drink some ginger garlic tea and rest”

cortesoft 5y ago
Isn’t this paper actually debunking that argument (That overuse of antibiotics has increased antibiotic resistance)? The paper says that resistance didn’t diminish when antibiotic use was decreased. It seems that our common understanding of how resistance develops was incorrect, at least partially.
- commiefornian 5y ago
  If there is selective pressure to increase resistance, resistance increases over time. If there is not selective pressure to increase resistance... nothing. There is no pressure to change anything relating to resistance. It could increase. It could decrease. It could stay the same. There is no reason to expect anything in particular about it.
fennecfoxen 5y ago
Well, that’s not covered by my health plan!
snarf21 5y ago
Of course, but the US fee-for-service model is aligned elsewhere. I think a lot of them think that as long as they are not prescribing a z-pack every month, it won't be that big of a deal. Also, customer acquisition is hard. Patients will just find another primary or go to an urgent care and get the meds there. For primary care, being seen as "not helpful" won't just lose one patient, but a whole household of them. As you quote above, people want a quick fix. The person consuming 3000 calories of carbs per day wants a magic pill to fix their type 2 diabetes without them having to make any changes. I don't envy them.
- nradov 5y ago
  SGLT2 inhibitors pretty much are magic pills for type 2 diabetes. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/sodium-glucose-cotransporter-2-sglt2-inhibitors https://www.fda.gov/drugs/postmarket-drug-safety-information... But of course it's better to prevent the condition in the first place.
  - tsol 5y ago
    Wait until people find out the side effects, then you'll get another thread exactly like this one but about SGLT2 inhibitors instead of antibiotics
  - orangepurple 5y ago
    Autophagy is the real silver bullet for T2DM treatment but you won't get that from a pill especially if you continue to ingest sugar.
  - snarf21 5y ago
    Another very promising treatment for type 2 is DMR. We need to do a lot more research on the duodenum as it is clear it is a major linchpin in type 2. [https://gut.bmj.com/content/69/2/295 https://gut.bmj.com/content/69/2/295]
avgDev 5y ago
I do not understand why there is a huge gap between scientific knowledge and physicians. I had a problem with an allergic reaction to an antibiotic. This resulted in me actually paying attention to drug labels, side effects and what a drug is being prescribed for. It has quite literally ruined my trust in doctors. Last year I had stomach pain, I thought it was appendix. So, I went to an urgent care because my physician could not see me. They had access to my medical records. Quickly, I receive a diagnosis of "Diverticulitis". 2 minutes later I'm given a prescription for Cipro, which I'm deadly allergic to. New guidelines suggest not using antibiotics in uncomplicated diverticulitis. I didn't take the meds, and I'm pretty sure I just pulled an abdomen muscle as it healed over the next few weeks. I have many stories from sports injuries and doctors offering steroid injections as first line treatment, which is no longer recommended. NSAIDs are also not recommended for tendon injuries and it is the first thing the doctor will offer. I don't get it. The information is easily available. Saying I read a study or a updated recommendation gets most doctors visibly upset. Not sure if it is the long working hours and trying to move as many patients as possible or just lack of giving a fuck.
- bserge 5y ago
  It's both. On the one hand, I hate the fuckers who don't give a shit, I've met way too many of them. On the other hand, too many times they are overworked and/or underpaid. At some point anyone will stop giving a fuck. Surgeons, dentists, EMTs deserve respect though. Yeah they fuck up, but nowhere near as often or bad as those responsible for gatekeeping useful medicine.
- peakaboo 5y ago
  It's about money and they just want to get rid of you, because they are understaffed, overworked and not happy people.
- nradov 5y ago
  I don't have the citation handy but the Institute of Medicine researched this and found it takes about 17 years in average to get all physicians to adopt new clinical practice guidelines. For physicians with a wide scope of practice it's just tough to keep up with all the chances. There might be some opportunities to use technology in clinical decision support systems that warn about potentially inappropriate treatments, but those have to be handled carefully so as to not slow down patient care unnecessarily.
beached_whale 5y ago
There was talk to the placebos on SBM at one point, the gist of it being that it would be far worse for them to do so for a few reasons. It erodes trust is the big point. But, I assume, there would be issues with informed consent too. How does one prescribe a placebo where the user can lookup the drug by name online. Not a medical professional, but I think the issue comes down to doctors saying no as a group and being ok if they shop another doctor. If enough do that, the issue goes away.
cogman10 5y ago
I have to wonder, though, if it's human prescribed antibiotics that source these super-bugs. It's pretty common practice in the cattle industry, for example, to just pump cows with antibiotics because studies have shown cows constantly on antibiotics grow fatter than cows not on antibiotics. (Likely, because they don't ever really get sick). [1] That makes me wonder how many of our super bugs have origins in the livestock industries where common practice is literally a recipe to bread superbugs. [1] https://www.cidrap.umn.edu/news-perspective/2020/06/report-slams-beef-industry-overuse-antibiotics https://www.cidrap.umn.edu/news-perspective/2020/06/report-s...
- hyperman1 5y ago
  This is one of the contentious points in trade between the USA and the EU: The EU does not allow preventive antibiotic use, but the USA does. Same for growth hormones. As a result, USA meat can not be imported in the EU. USA claims this is foul play, protectionism, against WTO rules. Now the EU does allow curative antibiotic usage on animals, so I wonder if this is actually such a big difference. If a vet prescribes antibiotics for the slightest reason, there might not be much changed in reality.
  - Fomite 5y ago
    This is certainly a problem when banning antibiotics for growth promotion, but allowing the prophylactic use of antibiotics. Any animal in the type of farm looking for growth promotion is at risk for a bacterial infection basically all the time.
- Fomite 5y ago
  It's been funny working at the intersection of human and animal health. The medical types all want to blame agriculture. The agriculture types all respond that they're not using major frontline human antibiotics (outside some stuff for companion animals). It's sort of a complex mix - there's a lot of bulk use in agriculture, but the drug-microorganism pairings in human medicine are somewhat more acute.
MaxBarraclough 5y ago
It seems odd to me that doctors are even allowed to prescribe antibiotics when they know they aren't necessary. Why shouldn't that be grounds for disciplinary action?
- deleted 5y ago
  [deleted]
- cycomanic 5y ago
  That's one of the interesting experiences when moving to Sweden. One is highly unlikely to be prescribed antibiotics here, and one gets prescribed very "old" antibiotics, that my partner who was trained in France said are hardly used anymore in France due to resistances. When she started working as a GP here she found out that it's very hard for doctors to prescribe antibiotics, i.e. the conditions under which doctors are allowed to prescribe them are very strict. There's a lot of things that are frustrating about the medical system here, but the restrictions on antibiotics is one of the very good things.
  - MaxBarraclough 5y ago
    Sounds sensible, but I imagine it won't do much good if it's just Sweden doing it.
    - Zircom 5y ago
      You're right it won't do much good, but it is nice to see a country take a principled stand and actually practice what they preach and be the change they want to see.
nostromo 5y ago
I don't buy that the primary issue is with human antibiotic use. Doctors have become increasingly stingy with antibiotics, sometimes at the expense of human well-being -- meanwhile 80% of antibiotics are used in livestock production. We could reduce the need for antibiotics in livestock if we treated animals better. Giving animals a bit of breathing room and fresh air would reduce the need to jack them up on antibiotics from day one. Reducing use in humans seems like banning straws to take on plastic waste -- a feel good policy that won't actually fix much.
johnisgood 5y ago
Why prescribe it if we know it is viral? First, the doctor should determine whether or not it is viral or bacterial. If it turns out that it is viral, then DO NOT PRESCRIBE ANTIBIOTICS. Is it because of placebo? Because if so, the costs are too high. Tell them to take zinc or whatever for a week.

sattoshi 5y ago

> In reaction to the antibiotic resistance problem and with treatment options dwindling, public health officials attempted to control antibiotic usage as a means of controlling resistance (20). The expectation was that rates of resistance would diminish as antibiotic usage dropped. However, resistance persisted even in the face of such drug management practices on both small and large scales (20–23). This makes perfect sense to me. Why did this not work? The article continues with an explanation of "the ecological fallacy" but I don't understand how the two are supposed to be connected.

christkv 5y ago
There are so many exiting old antibiotics that might be possible to repurpose however no money or willingness to qualify them https://www.sciencedirect.com/science/article/pii/S1198743X15006205 https://www.sciencedirect.com/science/article/pii/S1198743X1... I guess there is no money in requalifying an out of patent antibiotic.
Fomite 5y ago
The problem is that there was a very compelling "just so" story that antibiotic-resistant bacteria are inherently at a competitive disadvantage vs. susceptible bacteria absent selective pressure. Take the antibiotics away, and the resistant bacteria will follow. Unfortunately, microbial ecology is much more complex than that, and it hasn't panned out that way. Often because resistance plasmids also carry other helpful genes. For example, I'm currently working on a study where there's high levels of antibiotic resistance to an antibiotic that isn't used in that population because there's other things hanging out on the same plasmid. Also note: That's not what most people mean when they say "ecological fallacy", which is a statistics term.
- jessriedel 5y ago
  Not all proposed evolutionary mechaniams that turn out to be false, much less merely incomplete, are just-so stories. The fact that the hypothesis was simple makes it more reasonable.
  - 5y ago

Gunax 5y ago

Does antibiotic overuse really contribute a large portion of antibiotic use? I ask because it seems like misuse is blamed for antibiotic resistance: but it seems to me that bacteria don't care whether youre using it legitimately or not: either way has a chance of contributing to resistance.

jurassic 5y ago
One thing I hear cited often is the way antibiotics are widely used in animal agriculture to boost margins by helping keep more animals alive in the lowest cost living conditions (often squalid and unhealthy for the animal). This is antibiotic abuse on a massive scale, for the profit of private individuals. :facepalm:
- vkk8 5y ago
  This feels like a pretty low hanging fruit to regulate away. Ban antibiotics use in agriculture in civilized countries and ban importing antibiotics grown meat from the others (I would guess it's easy to test).
  - nradov 5y ago
    The FDA has already been working to reduce antibiotic use in agriculture. https://www.fda.gov/animal-veterinary/safety-health/antimicrobial-resistance https://www.fda.gov/animal-veterinary/safety-health/antimicr...
  - culi 5y ago
    I wouldn't call it low-hanging fruit considering just how dependent large-scale animal agriculture is dependent on antibiotics
  - mdavis6890 5y ago
    This would mean either that we would have a lot less food, or we would have to divert a lot of effort from other productive activities to make it up. Maybe that's okay, but still this idea is not free, and not low-hanging fruit.

mrtweetyhack 5y ago

for the same reason biotics exists

DantesKite 5y ago

What's interesting is that the same principle doesn't seem to apply for viral infections. The smallpox vaccine is just as effective today as it was a couple decades ago. Then again the flu is constantly mutating so maybe it's just contingent on the type of disease.

not2b 5y ago
Depends on which virus. Flu shots have to be changed every year, but measles shots appear to give lifetime immunity.
- roywiggins 5y ago
  Flu doesn't evolve to resist each vaccine, it's just a different strain becoming prevalent each year. I'm not sure what the mechanism behind that is, but it was happening before the flu vaccine existed.
  - bink 5y ago
    Is there much difference conceptually between a virus mutating in a body and then finding ready hosts amongst the vaccinated if there is a large vaccinated population and a bacteria that has a resistance to an antibiotic spreading in a host that is receiving that antibiotic? Sorry for probably not using the right terminology here but they seem closely related to me.
    - exyi 5y ago
      Antibiotic resistance is usually on plazmids which can be exchanged between different bacteria (often even between different bacterial species). So only one bacteria needs to find the right gene and it starts spreading. Viruses have really small genomes and simply adding a gene for bypassing immunity does not work. It would need to restructure it's surface proteins so that the immune cells can't recognize it anymore, but this restructure often breaks the virus. Also there is the thing that antibiotics are present at low concentrations everywhere which makes small but constant pressure for the resistance genes. > On a larger scale, since 1940, antibiotics have become an omnipresent pollutant in environments of all types (55). Even in places largely untouched by humans, we can find antibiotic compounds and, with them, ARGs (56–59). In recent years, we have learned that even low levels of antibiotic pollution select for high levels of resistance (60–62). Additionally, regardless of the biome or their ability to clear pollutants, humanity’s worldwide industrial-level use of antibiotics has resulted in a steady stream of antibiotics into the environment, without ever allowing natural systems to return to baseline levels (63). Immunity does not come in this constant small pressure. You either have it and then the virus is dead quickly, so it does not have much time for finding mutations. Or you don't have it, so there is no pressure for the mutations.

User23 5y ago

I'm a little disappointed that this isn't an article about how fungi became the world heavyweight champions of cellular level biological warfare. I've often wondered if we could let the fungi do the work for us, and maintain colonies that are periodically challenged with organisms of interest, such as ones that have broad resistance, and see what they come up with as a way to create new antibiotics.

alan-crowe 5y ago

The article makes much of the pairing of antibiotic production genes and antibiotic resistance genes. They often occur on a single plasmid and are passed around together. But there must be different facets to antibiotic resistance genes, because a bacterium that is producing an antibiotic needs to avoid being poisoned by it. Perhaps some genes produce antibiotic resistance by coding for proteins that metabolize the antibiotic. Such genes are not helpful when paired with antibiotic production because they are destroying the antibiotic as fast as the other genes produce it. By contrast, some antibiotics work by destroying the cell walls of bacteria. Presumably some antibiotic resistance genes work by coding for resistant cell walls. And a bacterium that is producing such an antibiotic had better have such resistance genes or it will end up destroying its own cell walls. The article is silent on the differences between antibiotic resistance genes that a producer needs, to survive its own antibiotics, and antibiotic resistance genes that a producer mustn't have, to avoid sabotaging its own production. The article raises the issue of mutualism between different species of bacteria, with shared resistance and production genes letting the diverse community resist outsiders. Perhaps that is already a complicated story without adding in different kinds of resistance genes.

dotancohen 5y ago
> But there must be different facets to antibiotic resistance genes, because > a bacterium that is producing an antibiotic needs to avoid being poisoned by it. Excuse the analogy, but this looks like looking at the problem under a microscope but not looking at the bigger ecosystem. Every living thing produces materials that would poison it. We exhale carbon dioxide, our solid excrement is often toxic in addition to a biohazard. Even the skin cells we shed and sweat would be problematic if left to accumulate.

nyanpasu64 5y ago

> If the secret society system was a dominant selective force in evolving and maintaining antibiotics in the preantibiotic era, then changes in the magnitude, frequency, and diversity of antibiotics after 1940 would likely have caused a consequent shift away from a production-resistance balance in favor of a resistance-dominated evolutionary strategy. So if bacteria in nature use antibiotics for signalling and to filter surrounding bacteria, rather than for warfare, it's not reasonable to expect humans to stop using antibiotics as warfare against dangerous pathogens (though using it to make animals grow faster is another story). What's the takeaway from this hypothesis?

JoeCoo7 5y ago

Bacteria are microorganisms, meaning that they are life forms. The word ‘antibiotic’ breaks down into: ‘anti’ (against) and ‘biotic’ (life). Antibiotics act to inhibit the growth of, or kill, microorganisms, preventing their spread and multiplication. The first – and still most common – antibiotics come from fungi (e.g., penicillin) and specifically fight bacteria. Before the development of antibiotics for widespread use, about 70 years ago, there was a high mortality rate from bacterial infections, such as tuberculosis, pneumonia, and sexually transmitted contagions. Today, many forms of antibiotics exist to treat several different types of infections, including parasitic infections and some fungal infections. However, antibiotics do not work on viruses because viruses are not living organisms and so are ‘not alive’. Unlike living organisms with their own cells, viruses are segments of DNA (or RNA) that inject themselves into living cells, forcing those cells to do the work of reproducing more of the viral DNA. This is why your physician will not prescribe an antibiotic for the common cold or flu. When we are sick, we often don’t know the full nature of the infection that is attacking our bodies. We just feel bad. This can be confusing because, for example, while a cold virus attacks our body, our immune system is working extra hard and we become vulnerable to developing other types of infections, such as pneumonia or strep throat, which are bacterial infections and usually treated with antibiotics.

rpaddock 5y ago

Why are Fluoroquinolone Antibiotics (FQs) such as Cipro, Levaquin etc. even still on the market, from the many life long devastating side effects they cause many? The FDA itself has said that this class of Antibiotics should be reserved until ALL other options have been exhausted. Yet doctors are giving this crap out like candy. Usually for things that they don't even work for such as UTIs see FDA July 26 2016: "Limits use for acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis and uncomplicated urinary tract infections." See link below. Because for those items they don't work any better than a placebo, as the FDA itself documented in this 617 page report: https://web.archive.org/web/20170113234645/http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/Anti-InfectiveDrugsAdvisoryCommittee/UCM467383.pdf https://web.archive.org/web/20170113234645/http://www.fda.go... On page 17 of that report they even give a name to the problem these antibiotics cause: '"fluoroqunolone-associated disability" (FQAD)'. I have gathers all of the FDA warnings, and a few from the EU that say don't use them at all, about FQs at my late wife's website: https://www.kpaddock.com/fq https://www.kpaddock.com/fq In large part she is my late wife because of Levaquin causing her systemic tendentious. After several years she killed herself to stop the pain from that and CSF Leaks. For that whole saga see the documentary Pain Warriors that is free to watch on Amazon Prime and TubiTV: https://www.kpaddock.com/pw https://www.kpaddock.com/pw For me because of all of that it comes down to don't trust Big Pharam and the Medical Establishment with your health. Study EVERYTHING and make an informed decision before taking anything a doctor offers you. Ask them "Is my problem being caused by a pill deficiency?" and watch their stunned looks... On a possible upside there is some work coming around on using Phages as a type of antibiotic. The founder of this company experienced her own antibiotic resistant infection. [Full disclosure I have communicated with her about the above FQ issues, I receive nothing from them.] https://www.felixbt.com/new-page https://www.felixbt.com/new-page

amriksohata 5y ago

None of this covers the new need for antibiotics, driven by industrialisation, the rise of disease due to poor santisation and squalid housing and living conditions caused by the industrial revolution as people moved towards cities.