4 ms·

It's not quite that simple. This popped up on Reddit a few days back and in the comments a physician from India mentioned that a big part of the problem is tha

It's not quite that simple. This popped up on Reddit a few days back and in the comments a physician from India mentioned that a big part of the problem is that a) antibiotics are extremely over-used as they can be gotten over the counter and people do not understand that they do nothing for viral infections like the common cold, and b) his patients rarely finished an entire course even when they were directed to. Both of these factors combine to create a great environment for disease resistant strains of bacteria to emerge.

Swizec 15y ago
As a person who usually doesn't finish the full course of antibiotics if they're feeling healthy: Why does it matter?
- EliRivers 15y ago
  Because some of the bacteria remain. Not enough to make you feel unhealthy. Enough to breed and spread. These survivors are the ones that were most resistant to the antibiotics. Now they have less competition. They will breed more bacteria. More bacteria who inherit their improved resistance to antibiotics. Some of their children will be even more resistant. Some of their children will end up in someone else who, just like you, did not finish the course of antibiotics and, just like you, ended up being an incubator for a hardier, more antibiotic resistant strain. Eventually, the children are completely resistant and they laugh in the face of antibiotics, and then people start dying. People you never met. People who might be generations down the line from you infected with a super-resistant strain that can be traced back to you and others like you.
- shiven 15y ago
  Because you are increasing the likelihood of giving rise to drug resistant variants of the life-form those antibiotics are directed towards. There is a whole field of investigation into this phenomenon. A good (technical) starting point if you are interested in more is: http://www.drug-resistance.org/ http://www.drug-resistance.org/ Please, for the sake of society at large, complete any and all antibiotic/antiviral drug courses you are prescribed by your physician.
- dvdhsu 15y ago
  Just because you feel "healthy" doesn't mean that all the bacteria has been killed. If you stop taking the antibiotics before the bacteria is thoroughly eradicated, the bacteria may develop a resistance to the antibiotics you took. The antibiotics that you took are useless against this new bacteria. You will have to seek other antibiotics. Carry this on with multiple types of antibiotics, and you have a Big Problem. Edit: Amazing that there are four responses to this question, all within a minute of each other!
- celoyd 15y ago
  Because you may have killed most of the bacteria but left a few with some resistance to that type of antibiotic. In classical evolutionary terms, you’ve thinned the herd to the strongest members. These surviving somewhat resistant bacteria, even if they aren’t making you noticeably sick, may then spread those genes into the general population. It’s important not to use antibiotics if you don’t need them, and to complete the course if you do need them. Otherwise you’re selecting for strains of disease that are hard to cure.
- anamax 15y ago
  > As a person who usually doesn't finish the full course of antibiotics if they're feeling healthy: Why does it matter? You can feel healthy before all of the bugs are dead. The ones that remain are more resistant than the ones that died. By lettimg them survive, the baseline next time is "somewhat resistant". Each time, this happens, the survivors are more resistant. You're basically breeding resistant bugs. Either kill them all or leave them alone.
- whimsy 15y ago
  I don't understand why this was downvoted. This is an excellent question.
  - munin 15y ago
    good question, terrible person
    - gommm 15y ago
      Well I wouldn't say terrible person. The problem is that this is not well explained and so most people just do not understand the problems associated with not completing the antibiotic treatment prescribed by the doctor... It's good that he asked and now he will know why it's important and will do it.. It's a failure of education if intelligent and educated people are not aware of the consequences.
      - harshreality 15y ago
        It doesn't have to be well explained. Instructions for antibiotic prescriptions from a licensed doctor/pharmacy tells you to take the full course of antibiotics and not quit part way through. I wonder what other prescription instructions he disregards... drug interaction warnings? You don't get to disregard those just because you're not familiar with the biochemistry involved. Or, what about, "Do not look into 1W laser with remaining good eye?" If you don't know what a laser is or why it might be bad to look into it, you either research the issue, or you follow those instructions blindly (pun intended). You don't blow them off and then ask HN why looking into class 4 lasers is bad after both your eyes are damaged. It's good that they finally asked, though. It should have been asked a long time ago, and not on HN, I think that's the point of the downvotes.
        anon123890 15y ago
        > It doesn't have to be well explained. Instructions for antibiotic prescriptions from a licensed doctor/pharmacy tells you to take the full course of antibiotics and not quit part way through. Why shouldn't it be well explained? It's not like it's rare for doctors to prescribe things people don't really need, especially in this day and age, in the USA.
- carbocation 15y ago
  Take this anecdote as informative, not judgmental: it is most likely (according to the journal article) that these patients developed TDR-TB because they received incomplete treatment with 2nd-line agents.
marvin 15y ago
Unfortunately I'm a bit late to the party on this, but as a case in point, Norway has _very_ tight discipline on penicillin and antibiotics usage for this very reason. This has nothing to do with "medicines being outdated", it has to do with correct and disciplined usage of antibiotics. Norwegian hospitals use forms of penicillin which simply do not work on patients from countries where antibiotics usage is more lax. Treating a patient from Spain with the same penicillin which is used for Norwegian patients would not have any effect and kill the patient. This is _solely_ because poor discipline in drug usage leads to antibiotics-risistant bacteria. What needs to be done, and globally, is to 1) Stop treating livestock with prophylactic antibiotics 2) Stop prescribing antibiotics for conditions where it doesn't work (just because the patient has a cold and is complaining "can't you give me something?") 3) _Force_ patients to take their entire antibiotics course so even the small but drug-resistant minority of bacteria is killed off by the immune system and not transmitted further. If the global community fails to do this, we will in the worst case end up with a world which looks the way it did in the 1800s - a simple bacterial infection will kill you, because it can't be treated. This is a question of disciplined usage of medicines, not researching new and clever ways to kill bacteria. We can't eradicate every dangerous strain of bacteria on earth - it's simply not feasible.
- hartror 15y ago
  Norwegian hospitals use forms of penicillin which simply do not work on patients from countries where antibiotics usage is more lax. Treating a patient from Spain with the same penicillin which is used for Norwegian patients would not have any effect and kill the patient. This is _solely_ because poor discipline in drug usage leads to antibiotics-risistant bacteria. Wait what? The efficacy of an antibiotic is depended on the bacterial strain not the patient. The rest makes perfect sense however and I strongly agree.
  - carbocation 15y ago
    Dependent on the strain and its resistance profile. Staph aureus might be treated fine with some penicillins; or, it might have acquired methicillin resistance. Same staph aureus though, otherwise. On the other hand, yes, pseudomonas infection is quite different from staph infection. But that's not what GP is referring to.

Swizec 15y ago

As a person who usually doesn't finish the full course of antibiotics if they're feeling healthy: Why does it matter?

EliRivers 15y ago
Because some of the bacteria remain. Not enough to make you feel unhealthy. Enough to breed and spread. These survivors are the ones that were most resistant to the antibiotics. Now they have less competition. They will breed more bacteria. More bacteria who inherit their improved resistance to antibiotics. Some of their children will be even more resistant. Some of their children will end up in someone else who, just like you, did not finish the course of antibiotics and, just like you, ended up being an incubator for a hardier, more antibiotic resistant strain. Eventually, the children are completely resistant and they laugh in the face of antibiotics, and then people start dying. People you never met. People who might be generations down the line from you infected with a super-resistant strain that can be traced back to you and others like you.
shiven 15y ago
Because you are increasing the likelihood of giving rise to drug resistant variants of the life-form those antibiotics are directed towards. There is a whole field of investigation into this phenomenon. A good (technical) starting point if you are interested in more is: http://www.drug-resistance.org/ http://www.drug-resistance.org/ Please, for the sake of society at large, complete any and all antibiotic/antiviral drug courses you are prescribed by your physician.
dvdhsu 15y ago
Just because you feel "healthy" doesn't mean that all the bacteria has been killed. If you stop taking the antibiotics before the bacteria is thoroughly eradicated, the bacteria may develop a resistance to the antibiotics you took. The antibiotics that you took are useless against this new bacteria. You will have to seek other antibiotics. Carry this on with multiple types of antibiotics, and you have a Big Problem. Edit: Amazing that there are four responses to this question, all within a minute of each other!
celoyd 15y ago
Because you may have killed most of the bacteria but left a few with some resistance to that type of antibiotic. In classical evolutionary terms, you’ve thinned the herd to the strongest members. These surviving somewhat resistant bacteria, even if they aren’t making you noticeably sick, may then spread those genes into the general population. It’s important not to use antibiotics if you don’t need them, and to complete the course if you do need them. Otherwise you’re selecting for strains of disease that are hard to cure.
anamax 15y ago
> As a person who usually doesn't finish the full course of antibiotics if they're feeling healthy: Why does it matter? You can feel healthy before all of the bugs are dead. The ones that remain are more resistant than the ones that died. By lettimg them survive, the baseline next time is "somewhat resistant". Each time, this happens, the survivors are more resistant. You're basically breeding resistant bugs. Either kill them all or leave them alone.
whimsy 15y ago
I don't understand why this was downvoted. This is an excellent question.
- munin 15y ago
  good question, terrible person
  - gommm 15y ago
    Well I wouldn't say terrible person. The problem is that this is not well explained and so most people just do not understand the problems associated with not completing the antibiotic treatment prescribed by the doctor... It's good that he asked and now he will know why it's important and will do it.. It's a failure of education if intelligent and educated people are not aware of the consequences.
    - harshreality 15y ago
      It doesn't have to be well explained. Instructions for antibiotic prescriptions from a licensed doctor/pharmacy tells you to take the full course of antibiotics and not quit part way through. I wonder what other prescription instructions he disregards... drug interaction warnings? You don't get to disregard those just because you're not familiar with the biochemistry involved. Or, what about, "Do not look into 1W laser with remaining good eye?" If you don't know what a laser is or why it might be bad to look into it, you either research the issue, or you follow those instructions blindly (pun intended). You don't blow them off and then ask HN why looking into class 4 lasers is bad after both your eyes are damaged. It's good that they finally asked, though. It should have been asked a long time ago, and not on HN, I think that's the point of the downvotes.
      - anon123890 15y ago
        > It doesn't have to be well explained. Instructions for antibiotic prescriptions from a licensed doctor/pharmacy tells you to take the full course of antibiotics and not quit part way through. Why shouldn't it be well explained? It's not like it's rare for doctors to prescribe things people don't really need, especially in this day and age, in the USA.
carbocation 15y ago
Take this anecdote as informative, not judgmental: it is most likely (according to the journal article) that these patients developed TDR-TB because they received incomplete treatment with 2nd-line agents.

marvin 15y ago

Unfortunately I'm a bit late to the party on this, but as a case in point, Norway has _very_ tight discipline on penicillin and antibiotics usage for this very reason. This has nothing to do with "medicines being outdated", it has to do with correct and disciplined usage of antibiotics. Norwegian hospitals use forms of penicillin which simply do not work on patients from countries where antibiotics usage is more lax. Treating a patient from Spain with the same penicillin which is used for Norwegian patients would not have any effect and kill the patient. This is _solely_ because poor discipline in drug usage leads to antibiotics-risistant bacteria. What needs to be done, and globally, is to 1) Stop treating livestock with prophylactic antibiotics 2) Stop prescribing antibiotics for conditions where it doesn't work (just because the patient has a cold and is complaining "can't you give me something?") 3) _Force_ patients to take their entire antibiotics course so even the small but drug-resistant minority of bacteria is killed off by the immune system and not transmitted further. If the global community fails to do this, we will in the worst case end up with a world which looks the way it did in the 1800s - a simple bacterial infection will kill you, because it can't be treated. This is a question of disciplined usage of medicines, not researching new and clever ways to kill bacteria. We can't eradicate every dangerous strain of bacteria on earth - it's simply not feasible.

hartror 15y ago
Norwegian hospitals use forms of penicillin which simply do not work on patients from countries where antibiotics usage is more lax. Treating a patient from Spain with the same penicillin which is used for Norwegian patients would not have any effect and kill the patient. This is _solely_ because poor discipline in drug usage leads to antibiotics-risistant bacteria. Wait what? The efficacy of an antibiotic is depended on the bacterial strain not the patient. The rest makes perfect sense however and I strongly agree.
- carbocation 15y ago
  Dependent on the strain and its resistance profile. Staph aureus might be treated fine with some penicillins; or, it might have acquired methicillin resistance. Same staph aureus though, otherwise. On the other hand, yes, pseudomonas infection is quite different from staph infection. But that's not what GP is referring to.