15 ms·

The antimicrobial resistance crisis needs action now

236 points by ikbdsk 4y ago

therusskiy 4y ago
My wife has just got better from a case of pneumonia that developed rapidly within several hours. If not for antibiotics... We are back to medieval times if antibiotics stop working.
- throwaway0x7E6 4y ago
  >if when
- DrJohanson 4y ago
  [dead]
- bell-cot 4y ago
  There anti-pneumonia vaccines, though the effectiveness is iffy. (For starters, many species of bacteria can cause pneumonia. The species not covered by the vaccine she got will not magically avoid infecting her.) If your wife hasn't gotten one recently, and has no contra-indicating medical conditions or... Best wishes to your wife and you in any case.
mustafabisic1 4y ago
I bet all those antibiotics prescribed for covid didn't help as well. That was happening on a massive scale in my country
- eschaton 4y ago
  Why were doctors prescribing antibiotics for COVID?!
  - pram 4y ago
    I think some of those 'kits' countries were distributing to people early-on (before the vaccine) contained stuff like doxycycline.
  - AustinDev 4y ago
    Secondary infections of bacterial pneumonia were common with COVID iirc.
    - dopylitty 4y ago
      A study just came out showing that co-infections weren't common [0] 0: https://academic.oup.com/ofid/article/9/Supplement_2/ofac492.046/6902149 https://academic.oup.com/ofid/article/9/Supplement_2/ofac492...
  - anbende 4y ago
    When I was in Peru, they kind of prescribed antibiotics for everything. Persistent cold? Antibiotics. Like that. Source: lived there with Peruvian partner for 18 months.
    - getoj 4y ago
      Same deal in Japan, every time my kid has a cold her mum takes her to the doctor and comes home with antibiotics. When I get a cold the first thing anyone asks is whether I went to the doctor yet. For what? “Medicine.”
    - friendlyHornet 4y ago
      I'm Jordanian and it's the same in Jordan; it feels like people take antibiotics like candy in Jordan
    - lucb1e 4y ago
      Germany/Netherlands also from my limited experience.
  - eftychis 4y ago
    Death from COVID, and other pneumonic (pulmonary) diseases, can be commonly a result of secondary infection by bacteria. Our bodies are not the best at handling two different types of threats at the same time. See https://www.nature.com/articles/s41598-021-92220-0 https://www.nature.com/articles/s41598-021-92220-0 for instance. P.S. Note that the situation was unclear in 2020-2021 -- for instance from a quick lookup see https://pubmed.ncbi.nlm.nih.gov/34354682/ https://pubmed.ncbi.nlm.nih.gov/34354682/. So patient management was different per region -- as it was a guess.
  - xvilka 4y ago
    Some of the antibiotics have also proven antiviral and/or immunomodulatory effect, e.g. azithromycin [1] or levofloxacin [2]. [1] https://pubmed.ncbi.nlm.nih.gov/34015317/ https://pubmed.ncbi.nlm.nih.gov/34015317/ [2] https://pubmed.ncbi.nlm.nih.gov/32546446/ https://pubmed.ncbi.nlm.nih.gov/32546446/
- silisili 4y ago
  Even in the US, pre COVID, every time I went to to doctor with a bad cold/flu, they'd just give you a Z Pak(antibiotics) and say...if it's bacterial this will kill it, if it's viral it'll work itself out. So I can definitely see how they're overprescribed.
  - seunosewa 4y ago
    They are cheaper than the tests to determine whether they're needed.
    - mschuster91 4y ago
      And yet, people will demand an antibiotic from their doctor even with a test showing it's viral. Partially because school science ed doesn't cover that topic at all, partially because of "folk tales" aka learning from parents who didn't know better, partially because of placebo effect... and ultimately, because people want/need to feel better soon because they can't afford being too sick to work or having to take care for sick children. In the end it dwarfs against antibiotics in agriculture anyway, but if we want to fix the issue of antibiotic overusage on humans, we need to completely re-think our relationship to work and sickness.
  - zw7 4y ago
    Z-pak (azithromycin) is not the recommended antibiotic for bacterial sinus infections nor pneumonia (common bacterial infections associated with upper respiratory infections) per most guidelines. Interestingly though, it does have anti-inflammatory properties in addition to its main antibacterial effect. When I see a clinician prescribe a Z-pak (urgent cares are notorious for having a low threshold for prescribing Z-paks), part of me wonders if it's to avoid overuse and potential resistance to appropriate antibiotics and placate patients who want a quick fix. The downside is that since they feel better from the anti-inflammatory effect, its supports their initial thought they needed antibiotics and in the future will always think they need them, even though they very likely only have a viral infection.
    - christkv 4y ago
- xahrepap 4y ago
  I’m still amazed at how many people are able to get their dr to prescribe them antibiotics just by asking. I knew someone who had a cold and said “but I asked my Dr for some antibiotics and I’m taking DayQuil so I’ll be better in a day or two” Im always left open mouthed gaping at them like… even if YOU don’t know. But at least the Dr should …
  - YLYvYkHeB2NRNT 4y ago
    US doctors have to do everything to keep patients happy. CMS rules their careers with satisfaction metrics. Hospital ADMINS really push it on them. Complaints lead to job loss.
    - ghastmaster 4y ago
      Liability, standard of care, patient happiness, insurance compensation, and stupidity all come to my mind when considering why they do it.
  - samsa 4y ago
    I saw a Dr the other week (to rule out Covid and strep) and despite testing negative for both and telling me I just had a cold she offered me antibiotics. I declined, not wanting to be part of this problem, but was taken aback that she would basically try to push them on me.
  - skeletal88 4y ago
    This is just weird. Not living on the US and people here take taking antibiotics seriously, because they often have nasty side effects like messing around with digestion, making you otherwise feel like shit. People don't ask for strong antibiotics just for a common cold or the flu.
  - ThrowawayR2 4y ago
    The way it was explained to me is that the physicians know it very well but they're exhausted from arguing with patients who demand antibiotics anyway.
- mschuster91 4y ago
  The biggest risk factor when it comes to infection in general is agriculture: - We encroach ever closer and closer to reservoirs of animal illnesses, which is how we got OG SARS, MERS and Covid. - We give farm animals prophylactic antibiotics to promote growth or, worse, keep them alive in completely unsanitary conditions, and the conditions in slaughterhouses are often horrible as well. That is not just plain horrible from an animal welfare aspect, but risks breeding superbugs on one side and severe complications should someone not properly cook their meat and not kill off all the bacteria. - We spread manure from farm animals over produce fields, which regularly causes e.coli / EHEC outbreaks Antibiotic overuse in humans is only a small part of the problem, simply because the agriculture scale is so much bigger, and even people who go vegan/vegetarian because they want to avoid all the issues with meat production still can't avoid their produce being contaminated.
  - salawat 4y ago
    >We spread manure from farm animals over produce fields You do not want to stop this. Topsoil is a damn complicated thing, and bacteria and other decomposers are critical to freeing up and breaking down organic material to keep the nutrient cycle going. Try growing a plant in a sterile soil, and you end up having to maintain it on artificial fertilizers instead of being able to let microbiota do their thing. I've got a hunch part of our degradation in crop nutrition and loss of topsoil quality is probably stemming from overuse of chemical fertilizer, as well as fundamental microbiome depletion from overuse of antibiotics in industrial farming processes. The unfortunate part being there may not be much to be done about it if there is a desire to maintain our current population carry capacity, because replenishing of it would require reversion to less short-term efficient agriculture, but more long term sustainable methods.
- Fomite 4y ago
  Having looked at the data on this, the change in antibiotic prescribing was extremely heterogeneous. It absolutely crashed in some areas, and went up in others.
nextos 4y ago
We need more research in bacteriophages. They can be engineered to avoid any resistance, and they can replace antibiotics in all use cases. Besides, they are much more selective. Getting antibiotics when needed is OK, but they can lead to other health complications down the road.
- rdedev 4y ago
  The problem with phages is that our immune system can recognize them easily and flush them out of the body. It doesn't stick around long enough to do the work. It could work if the dose is massive or if the infection is localized to one specific area. Btw this is what I learnt from reading a blog from someone who has worked with this stuff. I'm not a biologist and it's been a long time since I read that article so I can't seem to find it. So take the above stuff with a grain of salt
  - nextos 4y ago
    This is not necessarily true. Our gut has trillions of bacteriophages. They are actually really useful as they keep bacterial populations under control. Many bacteriophages are not immunogenic, i.e. our immune system will ignore them. Others are very immunogenic, and are actually used as vaccine platforms.
    - rdedev 4y ago
      Bacteriophages in the bloodstream is different from our gut. Our gut has a lot of bacteria too but the immune system rarely bothers with them till they start popping up outside the guy. We've coevolved with phages for a long time. So our immune system knows that they are mostly benign but don't like them hanging around the bloodstream and flush them out pretty quick
  - krisoft 4y ago
    > The problem with phages is that our immune system can recognize them easily and flush them out of the body. The problem with phages is that they are finicky to administer. There is no "get this phage and it will kill all bacteria in and around you" treatment. They are specific. This of course has its own benefits too, but makes the process of administering harder. With antibiotics the doctor comes to the conclusion that it is a bacterial infection. Then they write a prescription. And then you can buy the drug from any drug store. Antibiotics are largely shelf-stable and there is only a handful of different ones, so any drug store can keep all the major ones. With phages the pipeline is more complicated. You need to take a sample from the patient, you need to cultivate it, and then you need to check which phage or phage cocktail gets rid of that specific bacteria the best. That is a lot of lab work. Won't work at scale unless we automate it. And then there are questions like: How do they keep the phages healthy and happy? Are they working with a fixed selection of phages (a phage library if you will) or do they try phages based on the symptoms? Once they know which phage is the right one how does the patient get them? Can we stock them in our existing drug stores? Are they shelf-stable / can they be made shelf-stable? Which phages should the drug stores stock? All of this can be of course answered and the problems ironed out. We put a man on the moon after all. We can do hard things if we want to. It is just a lot of faff.
zosima 4y ago
I am quite sure, that if a sufficient bounty was given out for developing new kinds of antimicrobials, they'd be developed in no time. The problem is that cost and risk of development and trials is too large for the current rewards, and hence there is very little new antimicrobials being developed. There are very many promising leads though, and either making development cheaper (by requiring smaller or fewer clinical trials) or ensuring good prices or bounties for successful development would likely create a plethora of antimicrobials in a quite short time frame.
- lofatdairy 4y ago
  This is actually completely right. I believe there's some policy in the works in the US after talking to a friend who's doing some consulting work to help align the Cost-Benefit side of antimicrobial development. I can't say if there's a plethora of drugs just waiting to be released after CT requirements are lowered, but definitely there is less of an R&D incentive currently because pts who take antimicrobials only take them temporarily and cases where you need an advanced antimicrobial to deal with an AMR case are thankfully uncommon. Edit: I think this is the specific bill: https://www.congress.gov/bill/117th-congress/house-bill/3932/text https://www.congress.gov/bill/117th-congress/house-bill/3932...
  - azinman2 4y ago
    There’s also pharma world wide. Seems the system is broken if only massive economic upside in the US is what leads to drug discovery and successful clinical trials.
    - tormeh 4y ago
      Testing requirements are as high in other rich countries. And existing antibiotics work fine atm. Nobody’s gonna pay to use new ones unless there’s no alternative, both for cost and resistance reasons. So why bother? Might as well postpone development until there’s a real market, right? I actually think this is good since it means we postpone usage of, and thereby resistance to, any new antibiotics.
pazimzadeh 4y ago
There are alternatives to antimicrobials being developed. Instead of directly killing bacteria and therefore putting selective pressure on them, you can prevent their ability to bind to host surfaces and wash them away. The best example is probably mannosides, which are high affinity mannose analogues currently in clinical trial in humans for UTI treatment. https://pubmed.ncbi.nlm.nih.gov/22089451/ https://pubmed.ncbi.nlm.nih.gov/22089451/
- SonOfLilit 4y ago
  How is this putting less selection pressure on them?
  - SQueeeeeL 4y ago
    Not OP, but it's kinda like boiling or alcohol versus poisoning (which is essentially how most drugs work). Certain attack vectors are literally unevolvable, as they would require fundamentally different building blocks to be able to be able to handle, which is too big of a leap for evolution to make.
    - lucb1e 4y ago
      Alcohol resistance is also a thing, though. https://duckduckgo.com/?q=alcohol+resistance+bacteria https://duckduckgo.com/?q=alcohol+resistance+bacteria
    - r3trohack3r 4y ago
      This was a light bulb comment for me, thank you. The challenge is: 1) finding something that kills mostly/only cells we don't want in or around our cells 2) kill them in such a ruthlessly efficient way that there are no survivors As a sibling points out, the vacuum of space does #2 quite well. Actually we have a lot of stuff that handles #2 quite well. But #1, differentiating between "good" and "bad" with our murder machines, is pretty much an unsolved problem.
      - midoridensha 4y ago
Brendinooo 4y ago
At the risk of sounding ignorant… I’ve been hearing stuff like this for twenty years now. And yet the crisis hasn’t happened. Why is that?
- flappyeagle 4y ago
  It’s happening. Like climate change, by the time you notice it in the course of your daily existence it’s far too late.
- Rebelgecko 4y ago
  Supposedly MRSA kills like 100k people per year (although maybe a good chunk of those 100k aren't getting any antibiotics at all, so it's not entirely due to resistance)
- retrac 4y ago
  Like many slow moving disasters, it doesn't feel like one while you live through it. An example: gonorrhea has no golden standard cure anymore. 40 years ago a single large dose of oral antibiotics was an effective cure. It made controlling it relatively easy. In the 90s, resistance to most of the common oral antibiotics became prevalent. Through the 2010s, a single dose of an intramuscular cephalosporin was effective. Now resistance to that is also common. Gonorrhea remains curable in almost all cases, but cultures and strain-specific targeting and second-line antibiotics in combination may be needed. Repeat testing to be sure it worked is necessary. From one pill cure in 99%+ of cases, to something requiring multiple clinic visits and lots of lab work and possibly IV infusion antibiotics. The complications for public health, in terms of patient compliance, containing spread, as well as just the labour hours and case management complexity, are awful.
  - Thorentis 4y ago
    [flagged]
    - magpi3 4y ago
      What about someone who gets it from a partner who is sleeping around?
lofatdairy 4y ago
BTW for anyone who wants to help but thinks this is mostly wetlab/drug development work. There's quite a bit of room in the space for the computer-vision side of things to improve decision-making and time to treat. I think it's mostly based on phenotyping by imaging and identifying low-specimen cultures but I might be totally wrong. Some competitions: - https://longitudeprize.org/ https://longitudeprize.org/ - https://dpcpsi.nih.gov/AMRChallenge/Finalists https://dpcpsi.nih.gov/AMRChallenge/Finalists Some previous work using various ML piplines: - https://phastdiagnostics.com/ https://phastdiagnostics.com/ - https://acceleratediagnostics.com/publications/ https://acceleratediagnostics.com/publications/ - https://talisbio.com/ https://talisbio.com/
- atemerev 4y ago
  I am trying for nearly a year to get a grant for my multi-objective drug combinations therapy optimizer, which seeks to adapt drug combination regimens for long-term robustness against emerging drug resistance. And I am getting one rejection after another. I mean, yes, there is a crisis. We need action now. Many people are offering solutions and new research directions. But money are simply not there.
- Fomite 4y ago
  There is also a ton of room for work in modeling, simulation, data analysis, etc. The field could use computationally inclined people.
hackitup7 4y ago
For both entertainment and awareness purposes, World Antimicrobial Awareness Week and Shark Week probably oughta switch time slots.
christkv 4y ago
Its a topic that comes up again and again. We are getting resistance against modern antibiotics. There are a ton of old antibiotics that have been out of use for decades that should be retested as possible weapons. Evolving resistance comes at a cost for bacteria and over time they might loose resistance against previous antibiotics. https://www.frontiersin.org/articles/10.3389/fmicb.2014.00551/full https://www.frontiersin.org/articles/10.3389/fmicb.2014.0055... The problem is no pharmaceutical wants to spend money on qualifying an out of patent antibiotic that can be copied by any generics manufacturer. We need a joint governmental founding initiative across the eu and us and any other countries to fund qualification of old antibiotics as well as developing new ones.
- oa335 4y ago
  > Evolving resistance comes at a cost for bacteria and over time they might loose resistance against previous antibiotics. This is known as the "ecological fallacy". > reversion to sensitivity is neither an immediate nor necessary outcome of selection simply because a resistant pathogen is no longer in an antibiotic-laden environment [1] [1] "Why Do Antibiotics Exist" - https://journals.asm.org/doi/10.1128/mBio.01966-21 https://journals.asm.org/doi/10.1128/mBio.01966-21
  - oa335 4y ago
    My mistake, this is not an example of “ecological fallacy”, but instead a line of reasoning that explains the assumptions that led to an “ecological fallacy” type of error.
  - Fomite 4y ago
    ...that is not how I've ever heard "the ecological fallacy" used, and this is what I do for a living.
    - oa335 4y ago
      What is your line of work and how is concept of “the ecological fallacy” used there?
emmelaich 4y ago
Another way to slow the pace is to not get infected in the first place. When I was a kid, cleaning oneself and your environment was emphasised. Scrub your nails, use hot water snd soap. You would smell lysol/dettol often. And bleach. Also, iodine and phisohex. Now, not so much. Even the phisohex you buy today has no hexachlorophene in it. It's triclosan like ever other damn thing - due to a California law I believe. I just don't believe these new green clothes and dishwashing liquids are as effective either. I suppose I'm saying "an ounce of protection is worth a pound of cure" and get off my lawn
yawnxyz 4y ago
I could rant on all day about this. AMR is actually a SOLVED problem at this point. If we threw money at it like we threw them at Patriot missiles, we wouldn't run out. But... here we are. Rant on why things are why they are: 1. Making antibiotics is hard and expensive. The "low-hanging fruit" are all gone, and in the last few decades we've just been rehashing different variations of the same classes of antibiotics. We're seeing bacteria become resistant to entire variations within classes so quickly that, it doesn't make sense to develop those variations anymore. 2. Making antibiotics is harder, and more expensive than it needs to be. This is because of regulations, and mostly it's a good thing. It protects us from getting sick(er), and from scams and grifts. Clinical trials are expensive: https://news.ycombinator.com/item?id=33545209 https://news.ycombinator.com/item?id=33545209 3. We expect antibiotics to be cheap to buy. We expect them to be cheap, and if the price gets jacked up, people (doctors, patients, ppl on social media) complain. Because it's a pill we think it should be free (and it should; gov't should subsidize) but it's not free to make. If we required iPhones to sell for $5 each by law, they wouldn't be around either. 4. New antibiotics are "not allowed" to be sold. This is because we're afraid of resistance developing against them, which makes sense! But this means no company is allowed to recuperate the hundreds of millions of dollars of up-front development costs it takes to new versions of these things. 5. No one expects to make profit. Few expect to recuperate costs in antibiotics, at this point. It's not profitable (or cost-recoverable). If we treated bacteria like the Russian invasion of Ukraine, and we called antibiotics "Patriot" then we'd get more funding. Yes there's GARD-P and CARB-X etc. but look... the total amount of money raised in antibiotics funding is like less than half what Bird scooters raised before getting acquired by their Canadian subsidy. 6. Gov't has "more important things to do": new funding for AMR didn't pass congress, and Pasteur Act in general has been in a holding pattern. Basically it introduces more funding and allows for new ways to sell antibiotics. (Higher ups call it a "Netflix model" but it really is a "Doordash model" because Netflix has near-zero distribution costs. But it didn't matter bc it didn't pass) 7. It's not a real crisis yet. It's not really anyone's problem. Since we're not staring down the barrel of a real crisis. It's like going to the gym or eating healthy — yes we should probably do it, but let's put it off til next year, and make a resolution for it. Kick the ball down the road. Ending on a slightly happier note: 1. Old school antibiotics development take many years to develop. Hopefully with AI, ML, genome sequencing, we might be able to find new classes! 2. Phages definitely work. We work with them! We've been treating some very hard-to-treat patients at Phage Australia, as a five person team, out of Westmead Institute. 3. Does phage therapy work at scale? We're shifting our answer from "is this crazy? Will it even work?" to "will this be sustainable?" It costs around $70k+ AUD per patient (time, labor, equipment, for labs and paperwork) but we have no systems in place. Lots of room to bring it down. 4. Does it work at scale, with good unit economics (and to Western standards)? We TGA to figure out regulations, and we're figuring out how to get them reimbursed for the long run. Ideas include using them as compounding pharmacy ingredients (like "Magistral Phage" out of Belgium) 5. There's no money in phages - even with our success, it's hard, and we're always scrambling for money to keep the lights on. But hopefully the Aussie gov't will keep the project running for long enough that we can get a better understanding of running this with "lifestyle business" unit economics (it's probably not venture scale). 6. Going to market is very tricky. Phages are a service, not a drug. Each person's phage treatment is different than the other, so this doesn't fit the clinical trial pathways currently available. It's also different in each country, and we're open to ideas. Final note: What we REALLY want is to provide a "concierge service" to wealthy clients and hospital systems that always want "insurance" to treat some of the worst pathogens lurking around the hospital or their region. AMR infections can strike quickly, but usually it's strains that we've seen before — especially in hospitals. It's always the "most wanted" strains that have previously caused problems. We're able to create "countermeasures" for any bacterial threats using phages. Pretty much like Patriot missiles (and with similar costs). This would also follow the Tesla playbook for ("a rich people toy" before releasing a cheaper version). This would really help us fund us to find ways to lower our production and get it into more hands. We need help on that front! If you're able to help, or have ideas, please find me on my twitter (same as my handle here) or on the Phage Australia website) Thanks everyone and merry xmas!
yarg 4y ago
Phage therapy seems like it's gonna become increasingly important (we've been using static munitions against increasingly dynamic enemies for far too long). Keyhole and robotic surgeries (already advancing rapidly) are going to be significant and useful. We also need to investigate, understand and classify symbiotic organisms with the same zeal with which we've approached pathogens. We've spent so long glaring at the invisible enemy that we've completely ignored the invisible allies (who we regularly nuke with broad spectrum soaps, gels and other microbicides). All we're really doing is creating monopolies for pathogens. Maybe it's me, but a lot of these article seem to advocate for magical solutions; when there's both enhancements to current technologies and unexploited low-hanging fruit that they aren't even bothering to consider.
- apples_oranges 4y ago
  It's time to break up the monopoly of harmful pathogens and start exploring all the options at our disposal.
  - rogerkirkness 4y ago
    Time to drag them before congress to hold them to account.
    - deleted 4y ago
      [deleted]
- manmal 4y ago
  Phages are great when they work, but they too are yet another tool that bacteria can evolve to survive. I can’t find the article right now but there are bacterial strains that evolve so quickly that you can’t usually subdue them with just one strain of phage - you need to go at them with multiple strains at once.
- Fomite 4y ago
  My phage boilerplate: Phage comes up a lot here - it seems to be on of HN's favorite biology topics. I have a deep and abiding fondness for phage, but they're not quite as awesome as they seem at first glance. From the perspective of an infectious disease epidemiologist who has been super-interested in phage for my whole career (literally tried to get a job out of undergrad with a phage therapeutics startup): 1) There's no such thing as a "broad spectrum" phage. They're organism specific, and that means not only would you need to keep a phage library on hand, but you'd have to do a lot of diagnostic tests. That's going to be both expensive and tricky. There are treatment guidelines for things like sepsis right now that are basically un-doable with phage therapy because of the time it takes to tune a phage library. 2) Phages are living things. Not only is that a weird regulatory framework to be in for a drug, but it also means that you need to be able to keep phage alive. In contrast, antibiotics are inert. 3) Phage therapy is also relatively new in the West (after being abandoned for some very real, very serious safety concerns back in the day), which means there's just less of a R&D infrastructure behind it. There have been people working on commercializing phage therapy since I was in undergrad (I'm now a tenured professor). The problem is it's hard, and antibiotics are so much better as a treatment that there's kind of a ceiling on the excitement that they can generate, especially when trying to treat at scale. Some of the most interesting applications are currently combination antibiotic and phage therapy - it's much harder for bacteria to maintain resistance mechanisms for both simultaneously.
bandyaboot 4y ago
Well we better deal with it now. If the threat becomes too dire we’ll reach the critical level above which people begin to believe the threat is fake news.
cratermoon 4y ago
I was hospitalized to have an operation recently and before they admitted me they tested my nose for MRSA. Apparently pretty common but not a concern as long as they are aware of it
Animats 4y ago
An antibiotic is something that kills something you don't like while not killing things you do like. The survival strategy for hostile bacteria is to evolve towards not having vulnerabilities to things which have that antibiotic property. A century of antibiotics has pushed evolution in that direction. Antibiotics thus get harder to find. There may be a fundamental limit here. The golden age of simple, broad-spectrum antibiotics is behind us.
- Salgat 4y ago
  On the plus side, this forces bacteria to compromise in other ways in order to incorporate antibiotic resistance.
adolph 4y ago
An offering of ill-informed conjecture/prediction from afar: no progress in future antibiotics—things shift to understanding human biome, at least in significant parts of not whole. Antibiotics are an Industrial Age approach that got humanity across some hurdles, similar to hydrocarbons, but are a dead end.
Proven 4y ago
[dead]
mmcgaha 4y ago
Last Wednesday night, I drove a torx bit right through the first knuckle on my left index finger. Since I type all day this seemed serious enough to go to the emergency room. When I see the doctor, I am sure I sounded like a fiend looking for a hit but in this case for antibiotics. He tells me that he does not want to give them to me because if I didn't really need them that it could make it so they don't work for me later in life when I have a real need. Instead he gave me an xray, a tetanus shot and sends me on my way. Since then the swelling has gone down and my finger looks nasty but healthy and I am so far glad that I did not get the antibiotics.
- jjcon 4y ago
  Does it work that way? I didn’t think so. Or did he mean in the proverbial, if we overuse them we won’t have them for anyone in 30 years?
  - mmcgaha 4y ago
    I will not say that there is no possibility that I misunderstood him but if I understood him correctly the act of taking the antibiotic will make it less likely to work for me personally in the future. In hindsight I wish I had ask him to clarify if he was talking about not working for me or in general. If he was talking about in general, I would have pushed harder for my drugs.
- ip26 4y ago
  You drove a bit all the way through the finger? Through the joint/bone? And all you got was a tetanus shot?
  - mmcgaha 4y ago
    Yeah it went through the joint and I got a call the next day telling me it was broken. The PA told me to get splint and to give it a rest for a week.
    - ip26 4y ago
Llamamoe 4y ago
Just like global warming, ridiculous wealth inequality and housing crises, outdated primary education systems, air and water pollution, diabetes and obesity crises, increasing prevalence of autism, and still ongoing COVID need action. I think the pandemic gave us a good reality check about how much is going to actually get done about an urgent crisis: not much.
- landemva 4y ago
  Describing everything you identify with as a crisis seems overdone. A crisis that extends over years is hardly an emergency. There may be better language to attract people to get involved in your projects.
  - sattoshi 4y ago
    What an excellent strategy to deal with any emergent crisis — do nothing! After enough time passes, it is no longer an emergency.

236 points by ikbdsk 4y ago

My wife has just got better from a case of pneumonia that developed rapidly within several hours. If not for antibiotics... We are back to medieval times if antibiotics stop working.

throwaway0x7E6 4y ago
>if when
DrJohanson 4y ago
[dead]
bell-cot 4y ago
There anti-pneumonia vaccines, though the effectiveness is iffy. (For starters, many species of bacteria can cause pneumonia. The species not covered by the vaccine she got will not magically avoid infecting her.) If your wife hasn't gotten one recently, and has no contra-indicating medical conditions or... Best wishes to your wife and you in any case.

mustafabisic1 4y ago

I bet all those antibiotics prescribed for covid didn't help as well. That was happening on a massive scale in my country

eschaton 4y ago
Why were doctors prescribing antibiotics for COVID?!
- pram 4y ago
  I think some of those 'kits' countries were distributing to people early-on (before the vaccine) contained stuff like doxycycline.
- AustinDev 4y ago
  Secondary infections of bacterial pneumonia were common with COVID iirc.
  - dopylitty 4y ago
    A study just came out showing that co-infections weren't common [0] 0: https://academic.oup.com/ofid/article/9/Supplement_2/ofac492.046/6902149 https://academic.oup.com/ofid/article/9/Supplement_2/ofac492...
- anbende 4y ago
  When I was in Peru, they kind of prescribed antibiotics for everything. Persistent cold? Antibiotics. Like that. Source: lived there with Peruvian partner for 18 months.
  - getoj 4y ago
    Same deal in Japan, every time my kid has a cold her mum takes her to the doctor and comes home with antibiotics. When I get a cold the first thing anyone asks is whether I went to the doctor yet. For what? “Medicine.”
  - friendlyHornet 4y ago
    I'm Jordanian and it's the same in Jordan; it feels like people take antibiotics like candy in Jordan
  - lucb1e 4y ago
    Germany/Netherlands also from my limited experience.
- eftychis 4y ago
  Death from COVID, and other pneumonic (pulmonary) diseases, can be commonly a result of secondary infection by bacteria. Our bodies are not the best at handling two different types of threats at the same time. See https://www.nature.com/articles/s41598-021-92220-0 https://www.nature.com/articles/s41598-021-92220-0 for instance. P.S. Note that the situation was unclear in 2020-2021 -- for instance from a quick lookup see https://pubmed.ncbi.nlm.nih.gov/34354682/ https://pubmed.ncbi.nlm.nih.gov/34354682/. So patient management was different per region -- as it was a guess.
- xvilka 4y ago
  Some of the antibiotics have also proven antiviral and/or immunomodulatory effect, e.g. azithromycin [1] or levofloxacin [2]. [1] https://pubmed.ncbi.nlm.nih.gov/34015317/ https://pubmed.ncbi.nlm.nih.gov/34015317/ [2] https://pubmed.ncbi.nlm.nih.gov/32546446/ https://pubmed.ncbi.nlm.nih.gov/32546446/
silisili 4y ago
Even in the US, pre COVID, every time I went to to doctor with a bad cold/flu, they'd just give you a Z Pak(antibiotics) and say...if it's bacterial this will kill it, if it's viral it'll work itself out. So I can definitely see how they're overprescribed.
- seunosewa 4y ago
  They are cheaper than the tests to determine whether they're needed.
  - mschuster91 4y ago
    And yet, people will demand an antibiotic from their doctor even with a test showing it's viral. Partially because school science ed doesn't cover that topic at all, partially because of "folk tales" aka learning from parents who didn't know better, partially because of placebo effect... and ultimately, because people want/need to feel better soon because they can't afford being too sick to work or having to take care for sick children. In the end it dwarfs against antibiotics in agriculture anyway, but if we want to fix the issue of antibiotic overusage on humans, we need to completely re-think our relationship to work and sickness.
- zw7 4y ago
  Z-pak (azithromycin) is not the recommended antibiotic for bacterial sinus infections nor pneumonia (common bacterial infections associated with upper respiratory infections) per most guidelines. Interestingly though, it does have anti-inflammatory properties in addition to its main antibacterial effect. When I see a clinician prescribe a Z-pak (urgent cares are notorious for having a low threshold for prescribing Z-paks), part of me wonders if it's to avoid overuse and potential resistance to appropriate antibiotics and placate patients who want a quick fix. The downside is that since they feel better from the anti-inflammatory effect, its supports their initial thought they needed antibiotics and in the future will always think they need them, even though they very likely only have a viral infection.
  - christkv 4y ago
xahrepap 4y ago
I’m still amazed at how many people are able to get their dr to prescribe them antibiotics just by asking. I knew someone who had a cold and said “but I asked my Dr for some antibiotics and I’m taking DayQuil so I’ll be better in a day or two” Im always left open mouthed gaping at them like… even if YOU don’t know. But at least the Dr should …
- YLYvYkHeB2NRNT 4y ago
  US doctors have to do everything to keep patients happy. CMS rules their careers with satisfaction metrics. Hospital ADMINS really push it on them. Complaints lead to job loss.
  - ghastmaster 4y ago
    Liability, standard of care, patient happiness, insurance compensation, and stupidity all come to my mind when considering why they do it.
- samsa 4y ago
  I saw a Dr the other week (to rule out Covid and strep) and despite testing negative for both and telling me I just had a cold she offered me antibiotics. I declined, not wanting to be part of this problem, but was taken aback that she would basically try to push them on me.
- skeletal88 4y ago
  This is just weird. Not living on the US and people here take taking antibiotics seriously, because they often have nasty side effects like messing around with digestion, making you otherwise feel like shit. People don't ask for strong antibiotics just for a common cold or the flu.
- ThrowawayR2 4y ago
  The way it was explained to me is that the physicians know it very well but they're exhausted from arguing with patients who demand antibiotics anyway.
mschuster91 4y ago
The biggest risk factor when it comes to infection in general is agriculture: - We encroach ever closer and closer to reservoirs of animal illnesses, which is how we got OG SARS, MERS and Covid. - We give farm animals prophylactic antibiotics to promote growth or, worse, keep them alive in completely unsanitary conditions, and the conditions in slaughterhouses are often horrible as well. That is not just plain horrible from an animal welfare aspect, but risks breeding superbugs on one side and severe complications should someone not properly cook their meat and not kill off all the bacteria. - We spread manure from farm animals over produce fields, which regularly causes e.coli / EHEC outbreaks Antibiotic overuse in humans is only a small part of the problem, simply because the agriculture scale is so much bigger, and even people who go vegan/vegetarian because they want to avoid all the issues with meat production still can't avoid their produce being contaminated.
- salawat 4y ago
  >We spread manure from farm animals over produce fields You do not want to stop this. Topsoil is a damn complicated thing, and bacteria and other decomposers are critical to freeing up and breaking down organic material to keep the nutrient cycle going. Try growing a plant in a sterile soil, and you end up having to maintain it on artificial fertilizers instead of being able to let microbiota do their thing. I've got a hunch part of our degradation in crop nutrition and loss of topsoil quality is probably stemming from overuse of chemical fertilizer, as well as fundamental microbiome depletion from overuse of antibiotics in industrial farming processes. The unfortunate part being there may not be much to be done about it if there is a desire to maintain our current population carry capacity, because replenishing of it would require reversion to less short-term efficient agriculture, but more long term sustainable methods.
Fomite 4y ago
Having looked at the data on this, the change in antibiotic prescribing was extremely heterogeneous. It absolutely crashed in some areas, and went up in others.

nextos 4y ago

We need more research in bacteriophages. They can be engineered to avoid any resistance, and they can replace antibiotics in all use cases. Besides, they are much more selective. Getting antibiotics when needed is OK, but they can lead to other health complications down the road.

rdedev 4y ago
The problem with phages is that our immune system can recognize them easily and flush them out of the body. It doesn't stick around long enough to do the work. It could work if the dose is massive or if the infection is localized to one specific area. Btw this is what I learnt from reading a blog from someone who has worked with this stuff. I'm not a biologist and it's been a long time since I read that article so I can't seem to find it. So take the above stuff with a grain of salt
- nextos 4y ago
  This is not necessarily true. Our gut has trillions of bacteriophages. They are actually really useful as they keep bacterial populations under control. Many bacteriophages are not immunogenic, i.e. our immune system will ignore them. Others are very immunogenic, and are actually used as vaccine platforms.
  - rdedev 4y ago
    Bacteriophages in the bloodstream is different from our gut. Our gut has a lot of bacteria too but the immune system rarely bothers with them till they start popping up outside the guy. We've coevolved with phages for a long time. So our immune system knows that they are mostly benign but don't like them hanging around the bloodstream and flush them out pretty quick
- krisoft 4y ago
  > The problem with phages is that our immune system can recognize them easily and flush them out of the body. The problem with phages is that they are finicky to administer. There is no "get this phage and it will kill all bacteria in and around you" treatment. They are specific. This of course has its own benefits too, but makes the process of administering harder. With antibiotics the doctor comes to the conclusion that it is a bacterial infection. Then they write a prescription. And then you can buy the drug from any drug store. Antibiotics are largely shelf-stable and there is only a handful of different ones, so any drug store can keep all the major ones. With phages the pipeline is more complicated. You need to take a sample from the patient, you need to cultivate it, and then you need to check which phage or phage cocktail gets rid of that specific bacteria the best. That is a lot of lab work. Won't work at scale unless we automate it. And then there are questions like: How do they keep the phages healthy and happy? Are they working with a fixed selection of phages (a phage library if you will) or do they try phages based on the symptoms? Once they know which phage is the right one how does the patient get them? Can we stock them in our existing drug stores? Are they shelf-stable / can they be made shelf-stable? Which phages should the drug stores stock? All of this can be of course answered and the problems ironed out. We put a man on the moon after all. We can do hard things if we want to. It is just a lot of faff.

zosima 4y ago

I am quite sure, that if a sufficient bounty was given out for developing new kinds of antimicrobials, they'd be developed in no time. The problem is that cost and risk of development and trials is too large for the current rewards, and hence there is very little new antimicrobials being developed. There are very many promising leads though, and either making development cheaper (by requiring smaller or fewer clinical trials) or ensuring good prices or bounties for successful development would likely create a plethora of antimicrobials in a quite short time frame.

lofatdairy 4y ago
This is actually completely right. I believe there's some policy in the works in the US after talking to a friend who's doing some consulting work to help align the Cost-Benefit side of antimicrobial development. I can't say if there's a plethora of drugs just waiting to be released after CT requirements are lowered, but definitely there is less of an R&D incentive currently because pts who take antimicrobials only take them temporarily and cases where you need an advanced antimicrobial to deal with an AMR case are thankfully uncommon. Edit: I think this is the specific bill: https://www.congress.gov/bill/117th-congress/house-bill/3932/text https://www.congress.gov/bill/117th-congress/house-bill/3932...
- azinman2 4y ago
  There’s also pharma world wide. Seems the system is broken if only massive economic upside in the US is what leads to drug discovery and successful clinical trials.
  - tormeh 4y ago
    Testing requirements are as high in other rich countries. And existing antibiotics work fine atm. Nobody’s gonna pay to use new ones unless there’s no alternative, both for cost and resistance reasons. So why bother? Might as well postpone development until there’s a real market, right? I actually think this is good since it means we postpone usage of, and thereby resistance to, any new antibiotics.

pazimzadeh 4y ago

There are alternatives to antimicrobials being developed. Instead of directly killing bacteria and therefore putting selective pressure on them, you can prevent their ability to bind to host surfaces and wash them away. The best example is probably mannosides, which are high affinity mannose analogues currently in clinical trial in humans for UTI treatment. https://pubmed.ncbi.nlm.nih.gov/22089451/ https://pubmed.ncbi.nlm.nih.gov/22089451/

SonOfLilit 4y ago
How is this putting less selection pressure on them?
- SQueeeeeL 4y ago
  Not OP, but it's kinda like boiling or alcohol versus poisoning (which is essentially how most drugs work). Certain attack vectors are literally unevolvable, as they would require fundamentally different building blocks to be able to be able to handle, which is too big of a leap for evolution to make.
  - lucb1e 4y ago
    Alcohol resistance is also a thing, though. https://duckduckgo.com/?q=alcohol+resistance+bacteria https://duckduckgo.com/?q=alcohol+resistance+bacteria
  - r3trohack3r 4y ago
    This was a light bulb comment for me, thank you. The challenge is: 1) finding something that kills mostly/only cells we don't want in or around our cells 2) kill them in such a ruthlessly efficient way that there are no survivors As a sibling points out, the vacuum of space does #2 quite well. Actually we have a lot of stuff that handles #2 quite well. But #1, differentiating between "good" and "bad" with our murder machines, is pretty much an unsolved problem.
    - midoridensha 4y ago

Brendinooo 4y ago

At the risk of sounding ignorant… I’ve been hearing stuff like this for twenty years now. And yet the crisis hasn’t happened. Why is that?

flappyeagle 4y ago
It’s happening. Like climate change, by the time you notice it in the course of your daily existence it’s far too late.
Rebelgecko 4y ago
Supposedly MRSA kills like 100k people per year (although maybe a good chunk of those 100k aren't getting any antibiotics at all, so it's not entirely due to resistance)
retrac 4y ago
Like many slow moving disasters, it doesn't feel like one while you live through it. An example: gonorrhea has no golden standard cure anymore. 40 years ago a single large dose of oral antibiotics was an effective cure. It made controlling it relatively easy. In the 90s, resistance to most of the common oral antibiotics became prevalent. Through the 2010s, a single dose of an intramuscular cephalosporin was effective. Now resistance to that is also common. Gonorrhea remains curable in almost all cases, but cultures and strain-specific targeting and second-line antibiotics in combination may be needed. Repeat testing to be sure it worked is necessary. From one pill cure in 99%+ of cases, to something requiring multiple clinic visits and lots of lab work and possibly IV infusion antibiotics. The complications for public health, in terms of patient compliance, containing spread, as well as just the labour hours and case management complexity, are awful.
- Thorentis 4y ago
  [flagged]
  - magpi3 4y ago
    What about someone who gets it from a partner who is sleeping around?

lofatdairy 4y ago

BTW for anyone who wants to help but thinks this is mostly wetlab/drug development work. There's quite a bit of room in the space for the computer-vision side of things to improve decision-making and time to treat. I think it's mostly based on phenotyping by imaging and identifying low-specimen cultures but I might be totally wrong. Some competitions: - https://longitudeprize.org/ https://longitudeprize.org/ - https://dpcpsi.nih.gov/AMRChallenge/Finalists https://dpcpsi.nih.gov/AMRChallenge/Finalists Some previous work using various ML piplines: - https://phastdiagnostics.com/ https://phastdiagnostics.com/ - https://acceleratediagnostics.com/publications/ https://acceleratediagnostics.com/publications/ - https://talisbio.com/ https://talisbio.com/

atemerev 4y ago
I am trying for nearly a year to get a grant for my multi-objective drug combinations therapy optimizer, which seeks to adapt drug combination regimens for long-term robustness against emerging drug resistance. And I am getting one rejection after another. I mean, yes, there is a crisis. We need action now. Many people are offering solutions and new research directions. But money are simply not there.
Fomite 4y ago
There is also a ton of room for work in modeling, simulation, data analysis, etc. The field could use computationally inclined people.

hackitup7 4y ago

For both entertainment and awareness purposes, World Antimicrobial Awareness Week and Shark Week probably oughta switch time slots.

christkv 4y ago

Its a topic that comes up again and again. We are getting resistance against modern antibiotics. There are a ton of old antibiotics that have been out of use for decades that should be retested as possible weapons. Evolving resistance comes at a cost for bacteria and over time they might loose resistance against previous antibiotics. https://www.frontiersin.org/articles/10.3389/fmicb.2014.00551/full https://www.frontiersin.org/articles/10.3389/fmicb.2014.0055... The problem is no pharmaceutical wants to spend money on qualifying an out of patent antibiotic that can be copied by any generics manufacturer. We need a joint governmental founding initiative across the eu and us and any other countries to fund qualification of old antibiotics as well as developing new ones.

oa335 4y ago
> Evolving resistance comes at a cost for bacteria and over time they might loose resistance against previous antibiotics. This is known as the "ecological fallacy". > reversion to sensitivity is neither an immediate nor necessary outcome of selection simply because a resistant pathogen is no longer in an antibiotic-laden environment [1] [1] "Why Do Antibiotics Exist" - https://journals.asm.org/doi/10.1128/mBio.01966-21 https://journals.asm.org/doi/10.1128/mBio.01966-21
- oa335 4y ago
  My mistake, this is not an example of “ecological fallacy”, but instead a line of reasoning that explains the assumptions that led to an “ecological fallacy” type of error.
- Fomite 4y ago
  ...that is not how I've ever heard "the ecological fallacy" used, and this is what I do for a living.
  - oa335 4y ago
    What is your line of work and how is concept of “the ecological fallacy” used there?

emmelaich 4y ago

Another way to slow the pace is to not get infected in the first place. When I was a kid, cleaning oneself and your environment was emphasised. Scrub your nails, use hot water snd soap. You would smell lysol/dettol often. And bleach. Also, iodine and phisohex. Now, not so much. Even the phisohex you buy today has no hexachlorophene in it. It's triclosan like ever other damn thing - due to a California law I believe. I just don't believe these new green clothes and dishwashing liquids are as effective either. I suppose I'm saying "an ounce of protection is worth a pound of cure" and get off my lawn

yawnxyz 4y ago

I could rant on all day about this. AMR is actually a SOLVED problem at this point. If we threw money at it like we threw them at Patriot missiles, we wouldn't run out. But... here we are. Rant on why things are why they are: 1. Making antibiotics is hard and expensive. The "low-hanging fruit" are all gone, and in the last few decades we've just been rehashing different variations of the same classes of antibiotics. We're seeing bacteria become resistant to entire variations within classes so quickly that, it doesn't make sense to develop those variations anymore. 2. Making antibiotics is harder, and more expensive than it needs to be. This is because of regulations, and mostly it's a good thing. It protects us from getting sick(er), and from scams and grifts. Clinical trials are expensive: https://news.ycombinator.com/item?id=33545209 https://news.ycombinator.com/item?id=33545209 3. We expect antibiotics to be cheap to buy. We expect them to be cheap, and if the price gets jacked up, people (doctors, patients, ppl on social media) complain. Because it's a pill we think it should be free (and it should; gov't should subsidize) but it's not free to make. If we required iPhones to sell for $5 each by law, they wouldn't be around either. 4. New antibiotics are "not allowed" to be sold. This is because we're afraid of resistance developing against them, which makes sense! But this means no company is allowed to recuperate the hundreds of millions of dollars of up-front development costs it takes to new versions of these things. 5. No one expects to make profit. Few expect to recuperate costs in antibiotics, at this point. It's not profitable (or cost-recoverable). If we treated bacteria like the Russian invasion of Ukraine, and we called antibiotics "Patriot" then we'd get more funding. Yes there's GARD-P and CARB-X etc. but look... the total amount of money raised in antibiotics funding is like less than half what Bird scooters raised before getting acquired by their Canadian subsidy. 6. Gov't has "more important things to do": new funding for AMR didn't pass congress, and Pasteur Act in general has been in a holding pattern. Basically it introduces more funding and allows for new ways to sell antibiotics. (Higher ups call it a "Netflix model" but it really is a "Doordash model" because Netflix has near-zero distribution costs. But it didn't matter bc it didn't pass) 7. It's not a real crisis yet. It's not really anyone's problem. Since we're not staring down the barrel of a real crisis. It's like going to the gym or eating healthy — yes we should probably do it, but let's put it off til next year, and make a resolution for it. Kick the ball down the road. Ending on a slightly happier note: 1. Old school antibiotics development take many years to develop. Hopefully with AI, ML, genome sequencing, we might be able to find new classes! 2. Phages definitely work. We work with them! We've been treating some very hard-to-treat patients at Phage Australia, as a five person team, out of Westmead Institute. 3. Does phage therapy work at scale? We're shifting our answer from "is this crazy? Will it even work?" to "will this be sustainable?" It costs around $70k+ AUD per patient (time, labor, equipment, for labs and paperwork) but we have no systems in place. Lots of room to bring it down. 4. Does it work at scale, with good unit economics (and to Western standards)? We TGA to figure out regulations, and we're figuring out how to get them reimbursed for the long run. Ideas include using them as compounding pharmacy ingredients (like "Magistral Phage" out of Belgium) 5. There's no money in phages - even with our success, it's hard, and we're always scrambling for money to keep the lights on. But hopefully the Aussie gov't will keep the project running for long enough that we can get a better understanding of running this with "lifestyle business" unit economics (it's probably not venture scale). 6. Going to market is very tricky. Phages are a service, not a drug. Each person's phage treatment is different than the other, so this doesn't fit the clinical trial pathways currently available. It's also different in each country, and we're open to ideas. Final note: What we REALLY want is to provide a "concierge service" to wealthy clients and hospital systems that always want "insurance" to treat some of the worst pathogens lurking around the hospital or their region. AMR infections can strike quickly, but usually it's strains that we've seen before — especially in hospitals. It's always the "most wanted" strains that have previously caused problems. We're able to create "countermeasures" for any bacterial threats using phages. Pretty much like Patriot missiles (and with similar costs). This would also follow the Tesla playbook for ("a rich people toy" before releasing a cheaper version). This would really help us fund us to find ways to lower our production and get it into more hands. We need help on that front! If you're able to help, or have ideas, please find me on my twitter (same as my handle here) or on the Phage Australia website) Thanks everyone and merry xmas!

yarg 4y ago

Phage therapy seems like it's gonna become increasingly important (we've been using static munitions against increasingly dynamic enemies for far too long). Keyhole and robotic surgeries (already advancing rapidly) are going to be significant and useful. We also need to investigate, understand and classify symbiotic organisms with the same zeal with which we've approached pathogens. We've spent so long glaring at the invisible enemy that we've completely ignored the invisible allies (who we regularly nuke with broad spectrum soaps, gels and other microbicides). All we're really doing is creating monopolies for pathogens. Maybe it's me, but a lot of these article seem to advocate for magical solutions; when there's both enhancements to current technologies and unexploited low-hanging fruit that they aren't even bothering to consider.

apples_oranges 4y ago
It's time to break up the monopoly of harmful pathogens and start exploring all the options at our disposal.
- rogerkirkness 4y ago
  Time to drag them before congress to hold them to account.
  - deleted 4y ago
    [deleted]
manmal 4y ago
Phages are great when they work, but they too are yet another tool that bacteria can evolve to survive. I can’t find the article right now but there are bacterial strains that evolve so quickly that you can’t usually subdue them with just one strain of phage - you need to go at them with multiple strains at once.
Fomite 4y ago
My phage boilerplate: Phage comes up a lot here - it seems to be on of HN's favorite biology topics. I have a deep and abiding fondness for phage, but they're not quite as awesome as they seem at first glance. From the perspective of an infectious disease epidemiologist who has been super-interested in phage for my whole career (literally tried to get a job out of undergrad with a phage therapeutics startup): 1) There's no such thing as a "broad spectrum" phage. They're organism specific, and that means not only would you need to keep a phage library on hand, but you'd have to do a lot of diagnostic tests. That's going to be both expensive and tricky. There are treatment guidelines for things like sepsis right now that are basically un-doable with phage therapy because of the time it takes to tune a phage library. 2) Phages are living things. Not only is that a weird regulatory framework to be in for a drug, but it also means that you need to be able to keep phage alive. In contrast, antibiotics are inert. 3) Phage therapy is also relatively new in the West (after being abandoned for some very real, very serious safety concerns back in the day), which means there's just less of a R&D infrastructure behind it. There have been people working on commercializing phage therapy since I was in undergrad (I'm now a tenured professor). The problem is it's hard, and antibiotics are so much better as a treatment that there's kind of a ceiling on the excitement that they can generate, especially when trying to treat at scale. Some of the most interesting applications are currently combination antibiotic and phage therapy - it's much harder for bacteria to maintain resistance mechanisms for both simultaneously.

bandyaboot 4y ago

Well we better deal with it now. If the threat becomes too dire we’ll reach the critical level above which people begin to believe the threat is fake news.

cratermoon 4y ago

I was hospitalized to have an operation recently and before they admitted me they tested my nose for MRSA. Apparently pretty common but not a concern as long as they are aware of it

Animats 4y ago

An antibiotic is something that kills something you don't like while not killing things you do like. The survival strategy for hostile bacteria is to evolve towards not having vulnerabilities to things which have that antibiotic property. A century of antibiotics has pushed evolution in that direction. Antibiotics thus get harder to find. There may be a fundamental limit here. The golden age of simple, broad-spectrum antibiotics is behind us.

Salgat 4y ago
On the plus side, this forces bacteria to compromise in other ways in order to incorporate antibiotic resistance.

adolph 4y ago

An offering of ill-informed conjecture/prediction from afar: no progress in future antibiotics—things shift to understanding human biome, at least in significant parts of not whole. Antibiotics are an Industrial Age approach that got humanity across some hurdles, similar to hydrocarbons, but are a dead end.

Proven 4y ago

[dead]

mmcgaha 4y ago

Last Wednesday night, I drove a torx bit right through the first knuckle on my left index finger. Since I type all day this seemed serious enough to go to the emergency room. When I see the doctor, I am sure I sounded like a fiend looking for a hit but in this case for antibiotics. He tells me that he does not want to give them to me because if I didn't really need them that it could make it so they don't work for me later in life when I have a real need. Instead he gave me an xray, a tetanus shot and sends me on my way. Since then the swelling has gone down and my finger looks nasty but healthy and I am so far glad that I did not get the antibiotics.

jjcon 4y ago
Does it work that way? I didn’t think so. Or did he mean in the proverbial, if we overuse them we won’t have them for anyone in 30 years?
- mmcgaha 4y ago
  I will not say that there is no possibility that I misunderstood him but if I understood him correctly the act of taking the antibiotic will make it less likely to work for me personally in the future. In hindsight I wish I had ask him to clarify if he was talking about not working for me or in general. If he was talking about in general, I would have pushed harder for my drugs.
ip26 4y ago
You drove a bit all the way through the finger? Through the joint/bone? And all you got was a tetanus shot?
- mmcgaha 4y ago
  Yeah it went through the joint and I got a call the next day telling me it was broken. The PA told me to get splint and to give it a rest for a week.
  - ip26 4y ago

Llamamoe 4y ago

Just like global warming, ridiculous wealth inequality and housing crises, outdated primary education systems, air and water pollution, diabetes and obesity crises, increasing prevalence of autism, and still ongoing COVID need action. I think the pandemic gave us a good reality check about how much is going to actually get done about an urgent crisis: not much.

landemva 4y ago
Describing everything you identify with as a crisis seems overdone. A crisis that extends over years is hardly an emergency. There may be better language to attract people to get involved in your projects.
- sattoshi 4y ago
  What an excellent strategy to deal with any emergent crisis — do nothing! After enough time passes, it is no longer an emergency.