3 ms·

My concern is that while doxycycline may be considered by some as a "commodity" the general class of tetracyclines is not. If you reference the linked antibioti

My concern is that while doxycycline may be considered by some as a "commodity" the general class of tetracyclines is not. If you reference the linked antibiotic sensitivity chart, you'll notice that tigecycline is very broadly useful and in some cases one of two drugs that work [1]. Increasing the number of people who are taking doxycycline will expose additional pathogens to tetracyclines and cross resistance is definitely a thing. We are already seeing tigecycline resistant pathogens from agricultural use of doxycycline [2]. I'm sure that the people making these decisions are better informed about such things than I am but I do believe that we are vastly overusing anti-microbial agents in ways that future generations will come to regret. 1.https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Antibiotic_Sensitivity_FINAL_Nov_2019.pdf https://therapeuticseducation.org/sites/therapeuticseducatio... 2.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8557919/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8557919/

notjulianjaynes 3y ago
I hadn't considered that resistance would affect an entire class of antibiotics, but that does seem worth taking into consideration. More broadly speaking, what I'm having difficulty determining is if you wind up with less resistance by having 100 healthy people take 1 potentially unneeded dose of antibiotics if it prevents 10 sick people from needing to take a 10 day course of the same antibiotics. I'd hope that something like this is taken into account when the CDC makes these recommendations and it's not just the STI department trying to hit a certain metric at all costs.
- bioemerl 3y ago
  Resistance doesn't build in the course of days, taking only one pill ensures that bacteria with a mild but not total resistance survive it and then the next time you take the pill there are more of those bacteria hanging around, and one or two of those has yet stronger resistance. This is why every time you take antibiotics the doctor will tell you over and over and over that you have to take the whole bottle
  - metiscus 3y ago
    I agree but I felt like giving a slightly different explanation. It is not guaranteed that you are exposed to only one variant of a pathogen as they are constantly undergoing mutation. By increasing the exposure to an antimicrobial agent, selective pressure is applied against susceptible organism variants which will increase the overall proportion of a global population that are resistant to that agent. The mitigation for this is to take enough of the antibiotic to destroy these variants as well, although this is a somewhat "leaky" containment task as you may spread the pathogen to others while undergoing treatment. This analysis so far neglects that there are other microbes in your system that you are also exposing to the antibiotic even nonpathogenic organisms that we don't normally consider when discussing antibiotic resistance. However, due to horizontal gene transfer, even nonpathogenic organisms can potentially share any developed resistances with pathogenic organisms at a later time. The only real way to protect antimicrobial agents from resistance growth is to use them extremely sparingly. Multi-drug resistant organisms have gotten bad enough that they have brought back the use of Colistin, a very old and fairly toxic drug that had fallen out of use for decades to use in cases where no other drugs work. If the world continues using these drugs at the current rate, we may see things like this become far more common. Fundamentally we are in a war, pitting our multicellular intellect and biotechnology against our single celled brethren. It isn't as lopsided of a battle as it should be. What bacteria etc lack in individual strength, they more than make up for in multitude. I am fairly confident that in the long run we will out-innovate them but the needed systemic incentives are not currently in place to sustain our technological advantage at the present rate of resistance development.

notjulianjaynes 3y ago

I hadn't considered that resistance would affect an entire class of antibiotics, but that does seem worth taking into consideration. More broadly speaking, what I'm having difficulty determining is if you wind up with less resistance by having 100 healthy people take 1 potentially unneeded dose of antibiotics if it prevents 10 sick people from needing to take a 10 day course of the same antibiotics. I'd hope that something like this is taken into account when the CDC makes these recommendations and it's not just the STI department trying to hit a certain metric at all costs.

bioemerl 3y ago
Resistance doesn't build in the course of days, taking only one pill ensures that bacteria with a mild but not total resistance survive it and then the next time you take the pill there are more of those bacteria hanging around, and one or two of those has yet stronger resistance. This is why every time you take antibiotics the doctor will tell you over and over and over that you have to take the whole bottle
- metiscus 3y ago
  I agree but I felt like giving a slightly different explanation. It is not guaranteed that you are exposed to only one variant of a pathogen as they are constantly undergoing mutation. By increasing the exposure to an antimicrobial agent, selective pressure is applied against susceptible organism variants which will increase the overall proportion of a global population that are resistant to that agent. The mitigation for this is to take enough of the antibiotic to destroy these variants as well, although this is a somewhat "leaky" containment task as you may spread the pathogen to others while undergoing treatment. This analysis so far neglects that there are other microbes in your system that you are also exposing to the antibiotic even nonpathogenic organisms that we don't normally consider when discussing antibiotic resistance. However, due to horizontal gene transfer, even nonpathogenic organisms can potentially share any developed resistances with pathogenic organisms at a later time. The only real way to protect antimicrobial agents from resistance growth is to use them extremely sparingly. Multi-drug resistant organisms have gotten bad enough that they have brought back the use of Colistin, a very old and fairly toxic drug that had fallen out of use for decades to use in cases where no other drugs work. If the world continues using these drugs at the current rate, we may see things like this become far more common. Fundamentally we are in a war, pitting our multicellular intellect and biotechnology against our single celled brethren. It isn't as lopsided of a battle as it should be. What bacteria etc lack in individual strength, they more than make up for in multitude. I am fairly confident that in the long run we will out-innovate them but the needed systemic incentives are not currently in place to sustain our technological advantage at the present rate of resistance development.