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Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”

• selmnoo 13y ago
  Watch the full FRONTLINE documentary here: http://www.pbs.org/wgbh/pages/frontline/hunting-the-nightmare-bacteria/ http://www.pbs.org/wgbh/pages/frontline/hunting-the-nightmar...
• benmarks 13y ago
  Really don't like the anthropomorphism.
  • jmcgough 13y ago
    Same - he's trying to dumb it down but really misrepresenting some things by doing so (like how evolution works).
    • kubiiii 13y ago
      Dumbing it down on purpose might be the key to political action.
  • ddlatham 13y ago
    The bacteria hate it too.
• sailfast 13y ago
  This resistance scares me a great deal, especially as a new dad. I'm hopeful that in the coming years we'll be able to target bacteria and viruses more specifically using nano-technology and other tools at a cost effective level (admittedly I don't have a lot of knowledge in this area but I'm hopeful.) If all else fails, I guess we'll depend on the cycles of nature's adaptations and break out a new set of antibacterials every 50 years or so depending on the resistance trends we see crop up and hope we don't lose too many humans in the process. At any rate, I'm glad lots of smart people are working on this problem.
  • mesaaz 13y ago
    There is reason for guarded optimism if we can eliminate, or at least drastically reduce, irresponsible use of antibiotics: The capacity to resist antibiotics extracts a small metabolic/competitive "tax" on bacteria. In the presence of antibiotics, the costs of this tax are outweighed by the obvious benefits of antibiotic resistance. In an environment without antibiotics, the costs of the tax outweigh their benefits, so these antibiotic-resistant bacteria will eventually be outgrown by "normal" bacteria. If we can discipline ourselves to use antibiotics only when necessary, gradually antibiotic-resistant bacteria should become less common. Unfortunately, I doubt this will happen until the antibiotic-resistance problem becomes much more serious.
    • gibwell 13y ago
      We can't discipline ourselves because there are giant vested interests in selling antibiotics and none in resisting buying them.
      • penguindev 13y ago
        I don't know why you were down voted; you had a logical argument. There's no greed like short term greed.
• eranation 13y ago
  What about Linezolid? http://en.wikipedia.org/wiki/Linezolid http://en.wikipedia.org/wiki/Linezolid
  • w4 13y ago
    The Wiki article you linked specifically mentions Linezolid isn't necessarily effective against many Gram-negatives (the resistant bacteria): Linezolid has no clinically significant effect on most Gram-negative bacteria. Pseudomonas and the Enterobacteriaceae, for instance, are not susceptible.[90] In vitro, it is active against Pasteurella multocida,[2][91] Fusobacterium, Moraxella catarrhalis, Legionella, Bordetella, and Elizabethkingia meningoseptica, and moderately active (having a minimum inhibitory concentration for 90% of strains of 8 mg/L) against Haemophilus influenzae.[87][90] It has also been used to great effect as a second-line treatment for Capnocytophaga infections.[43][92]
    • eranation 13y ago
      Oh, thanks, missed that.
  • carbocation 13y ago
    You basically have polymixins (colistin) and, depending on resistance profile, fosfomycin and tigecycline. Colistin is avoided if possible because of nephrotoxicity, but as usual, medicine is a field heavily involved in balancing risks and benefits.
    • eranation 13y ago
      I wish I haven't skipped Biology in school...
• AaronFriel 13y ago
  For the past half century, we should have been treating our antibiotics like weapons of mass destruction - tools of last resort only to be used in emergencies, with great hesitation, and only when absolutely necessary. The industry and the doctors responded: antibiotics were too profitable and the risk seemed too distant. Now we have no weapons; we're helpless and the world is again going to be a scary place where a cut or a scrape can land you in a hospital or in a mortuary. For the first time in the memory of anyone alive today, we're going to see medical science step backwards. We're going to be more vulnerable tomorrow than we are today, and we did it to ourselves.
  • erichurkman 13y ago
    > Now we have no weapons; we're helpless and the world is again going to be a scary place where a cut or a scrape can land you in a hospital or in a mortuary. Perhaps most terrifying is that the mere act of hospitalization will likely be the highest vector of transmission of nearly untreatable infections. Go in for a routine procedure and end up in the isolation ward due to some highly infectious, deadly disease.
    • legitsource 13y ago
      The return of the sanitarium and things like leper colonies could be in our futures.
      • nate_meurer 13y ago
        And they'll be absolutely necessary. The infrastructure exists now. As an example, if you contract XDR tuberculosis you will be quarantined under orders from the CDC, by force if necessary, until the infection is cleared, which can currently be done reliably only with surgery.
    • w4 13y ago
      This, right here, is the biggest issue. Routine, minor surgery? No longer a risk free proposition. This sort of antibiotic resistance will have, and is having, enormously deleterious effects on the kind of basic health care and medical science we take for granted.
• mmoche 13y ago
  I remember hearing about Soviet research into phage therapy, where bacteriophages are cultured to consume particular strains of bacteria. I believe the treatment is only in use in a couple ex-Soviet states. Is this a reasonable avenue once we're essentially dealing with only MRSA-like infections?
  • frakkingcylons 13y ago
    I believe the MRSA-like infections you're thinking of are the Gram-negative bacteria [1] mentioned in the article. Based on the Wikipedia page for phage therapy [2], it should be an effective treatment option where the bacteria have polysacharride layer in the cell envelope, which most antibiotics cannot penetrate. There's more in the treatment section [3], which doesn't mention phage therapy however. [1]: http://en.wikipedia.org/wiki/Gram-negative_bacteria http://en.wikipedia.org/wiki/Gram-negative_bacteria [2]: http://en.wikipedia.org/wiki/Phage_therapy http://en.wikipedia.org/wiki/Phage_therapy [3]: http://en.wikipedia.org/wiki/Gram-negative_bacteria#Medical_treatment http://en.wikipedia.org/wiki/Gram-negative_bacteria#Medical_...
  • mjn 13y ago
    This is a decent, accessibly written survey article as of 2004, from Nature Biotechnology: http://seahorse.louisiana.edu/biol224/Pdfs/From%202010/Thiel2004.pdf http://seahorse.louisiana.edu/biol224/Pdfs/From%202010/Thiel...
• the_watcher 13y ago
  I'm hopeful this leads to new default treatments, since I have had allergic reactions to the last 3 antibiotics I have been prescribed. They do a great job fighting what they were designed to fight (for me), but then I get a week of a really itchy rash, cortisone shots, and cortico steroids.
• bronbron 13y ago
  > Another reality is there’s not much money to be made in making new antibiotics, so we saw a lot of drug companies who left the field of antibiotic development because of this combination of factors, that it was getting really hard to discover, to develop new antibiotics, and you don’t make a lot of money in selling these drugs, so the market really wasn’t there. To me this seems like the big problem here. Antibiotic resistance is an inevitability regardless of our usage rates - there's too much selective pressure for it not to. To co-opt the Red Queen hypothesis slightly, we have to constantly be developing new antibiotics just to keep pace. I suspect this problem will self-correct eventually, with the unfortunate side-effect that the cost of effective antibiotics will skyrocket for awhile. That being said, we're obviously not doing ourselves any favors by dispensing them like candy, especially to the agricultural industry. It definitely encourages cycles - Effective antibiotics are rare and therefore profitable so tons of $$ goes into R&D -> Lots of new antibiotics are created -> price goes down because there's so many options/patents expire -> Overuse -> Resistance develops quickly and we're left with few effective options.
• kubiiii 13y ago
  I was wondering if resistant bacterial strain would drop resistances against one antibiotic if we stop using it for long enough. Maintaining a resistance comes at a cost for a living organism (synthesizing an enzyme), so the bacteria that would drop it would be promoted.
  • roc 13y ago
    It seems like a plausible approach, if you could coordinate antibiotic use. But if we were capable of coordinating antibiotic use, we could correct the practices that got us to this point in the first place.
• ronaldx 13y ago
  > Eventually bacteria will evolve, and they’ll adapt ways around that to overcome that obstacle. I am more optimistic than that. Sure: as long as antibiotic resistance is crucial for bacterial survival, bacteria have a natural need to evolve it. And, they will. But, this will come with a genetic cost to the bacteria. The reason that antibiotics work is because they are attacking some function that has deliberately evolved, through natural selection, to be like that. Antibiotic resistance must literally cost bacteria some efficiency in some of their other functions. This cost was originally such that the bacteria would die. Fantastic. But note: we wouldn't actually benefit from all bacteria dying at the mention of the word antibiotic, and some bacterial resistance is good for us. Under normal circumstances, bacteria that don't need to carry around antibiotic resistance with them will most likely have a lower genetic cost and thrive better. This may be why we have seen MRSA predominantly in hospitals and rarely in the 'wild'. (If MRSA was necessary or not costly, all SA would be MR all the time). This gives me some hope - that antibiotic resistance is balanced, genetically forcing bacteria to be less effective in other ways and less competitive in other circumstances. We humans are not out yet.
  • mjt0229 13y ago
    >The reason that antibiotics work is because they are attacking some function that has deliberately evolved, through natural selection, to be like that. Antibiotic resistance must literally cost bacteria some efficiency in some of their other functions. I'm not convinced that there must be a cost; furthermore, I think it's unlikely that if there is a cost, it is high enough to be significant. Bugs evolve, but they do not necessarily evolve optimally all of the time. It is possible that an evolutionary step towards resistance might also improve the fitness of the germ overall (for example, by further optimizing the efficiency of a metabolic pathway). That evolutionary step might have been inevitable, but required additional selective pressure or the presence of a more active mutagen to actually occur. Your claim is sort of assuming that each bug is already optimal for its environment, and any change must therefore be deleterious in some regard, but I hold that neither fact is necessarily true.
    • ronaldx 13y ago
      I appreciate your point and I don't disagree with you (+1). However, the issue is complicated and I wanted to present another side to the original post. I think it's likely that those two claims are mostly true in bacteria. Since bacteria evolve quickly and have experienced a lot of evolution, I believe they are likely near-optimum and therefore the second claim (IMHO) follows from that: changes would typically be deleterious. On the other hand, even allowing for that, it's possible we could be allowing them to escape a local maximum and reach a more-optimal state. And, there is a more significant criticism you could make: Even if I am right on both points, a population that evolved to be heterogeneous (with some small percentage of wildtype being resistant) could likely have the best of both worlds ;)
• dekhn 13y ago
  I'm not going to watch the documentary to see the full quote, but taken on its face, this is a false statement. There continue to be many infections which will still be treatable by antibiotics for the foreseeable future.
  • refurb 13y ago
    I have to agree. There are many antibiotics in the pipeline right now as well. The recent GAIN legislation and other FDA initiatives have spurred the development of new antibiotics. Antibiotic resistance will continue to be a problem (obviously), but we're going to have effective antibiotics available to us for the coming decades.
• warcher 13y ago
  I wish he mentioned the massive dumping of antibiotics into our food supply via feedlots, et cetera. You think the fact that all the meat we eat is swimming in antibiotics for its entire life has something to do with this antibiotic resistant bacteria in our stomachs? It'd be a damn shame to undo one of the miracles of the twentieth century so your chicken sandwich is fifty cents cheaper.
  • bronbron 13y ago
    There's an entire section on the use of antibiotics in agriculture.
• felxh 13y ago
  I know the article tries to explain things in a way a layman can understand, but the wording when it comes to evolution is quite poorly chosen IMO. Saying thinks like 'Bacteria, like any living organism, want to survive' and 'bacteria will always change in order to survive', are just incorrect and will result in big misconceptions. To my knowledge, bacteria don't have an agenda, they don't want to survive and they certainly don't change in order to survive. Instead, they change at random, which sometimes helps an individual to survive and sometimes not.
  • leephillips 13y ago
    I wouldn't be so hard on him. Teaching physics, we often find ourselves saying things like "the ball wants to roll down the hill". It seems to be natural to talk in terms of agency when trying to make concepts intelligible to the relative layman.
    • flatline 13y ago
      Yes, but the ball rolling down the hill is not very contentious, whereas evolution is (at least in the US), and wrongness explaining it makes dismissing it easier.
  • bad_user 13y ago
    It's very hard to get the phrasing right. There's always a certain amount of random mutation going on, which can lead to better fitness (or not). However individuals with better fitness end up reproducing more, so mutations that lead to such better outcomes end up surviving. This coupled with multiple ways that bacterias can use to protect themselves against antibiotics, like enzymes, better shielding, or even pumping the antibiotics out, also increases the chance for successful mutations. And they've also developed this mechanism for spreading their DNA around to other bacterias. The result is almost the same as if bacterias would have an agenda. Although it can happen for mutations to lead to worse fitness in contact with older and forgotten antibiotics. And it can also happen for these random mutations to drive a whole population to extinction. But these two outcomes have a much lower probability than bacterias becoming highly resistant to all antibiotics.
  • 13y ago
• sphericalgames 13y ago
  It wasn't long ago that thread appeared about silver making antibiotics thousands of times more effective. Not sure where the thread is but the story here: http://www.nature.com/news/silver-makes-antibiotics-thousands-of-times-more-effective-1.13232 http://www.nature.com/news/silver-makes-antibiotics-thousand...
  • euroclydon 13y ago
    I used to see, in Sky Mall magazine, a colloidal silver injector that would spray through the skin to treat dermal infections.
• dsschnau 13y ago
  Okay, I'm sold, as a citizen, that this is an issue I and my child's generation will have to face. How can I help?
  • TsiCClawOfLight 13y ago
    Refuse behaving like the average (ahem, mostly american) and don't ask for medicine for benign illnesses.
    • ssmoot 13y ago
      I think as a rule people aren't as stupid as "common knowledge" would like to pretend. My 18mo daughter has had a half dozen ear infections and two staph infections. Antibiotics each time. Would it be better to leave a staph infection untreated with antibiotics? How? Lance and clean the infection site... and then what? Or ear infections? I had frequent undiagnosed ear infections as a small child and now have reduced hearing to thank for it. My entire life I've had people annoyed with me asking them to repeat themselves. Some ear infections may clear up on their own. The ENT has told us this is unlikely in 12mo or younger ages since cranial structures aren't in place that allows excess fluid to drain. We can let her have a fever for a day or two, and give Tylenol, but all that's going to do is delay the necessary antibiotics. We could also have tubes inserted in her ears, but it's not like those are without risks or downsides either. Since people don't have to play the lottery with their hearing or their lives anymore because they have access to antibiotics now sure, maybe that has some scary consequences. But it's not like people are popping them for a headache or skinned knee. And insulting people may make some feel superior, but it doesn't actually solve anything or even hint at a possible solution. You don't just "ride these things (staph) out" and hope for the best. There are consequences to going all granola "nature will take care of itself".
      • dragonwriter 13y ago
        The thing with Tragedy of the Commons -- which is exactly what the antibiotic situation is -- is that the decisions which are optimum for each individual actor in isolation are suboptimal on the whole.
• DonPellegrino 13y ago
  I'd like to know what this will do for bacteriophage therapy. Georgia has been the center of phage research since the 20s and has a massive bank of phages for all sorts of infections. Can someone more knowledgeable of this topic explain why the end of antibiotics is such a problem if there's already a decent alternative? What are the downsides to phage therapy? http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2805%2966759-1/fulltext http://www.thelancet.com/journals/lancet/article/PIIS0140-67...
• javajosh 13y ago
  This is very serious. But consider the worst-case outcome: No more anti-biotics, for anyone. That is, we go back to the era before anti-biotics, life in the 1920's. Maybe mortality rates will go back to that era, and maybe higher. But thankfully we aren't talking about a plague. At least not yet. Recently I had a wisdom tooth extracted. The dentist prescribed anti-biotics, but (unknown to him) I didn't take them. I healed fine. And so it was in the 20's and before that. Plenty of people survived and thrived before anti-biotics. And life will go on when we don't have them anymore. No doubt these super bugs have had to give up certain advantages to attain what is (for their species) a very specialized survival mechanism. Which means that if we ease off of the drugs for a while, the bacterial populations will compete, and the less drug resistant ones will thrive. Then we can use our drugs again. Or that's the idea. What I'd really like to see are the internal assessments of big pharma of these gram neg bugs. Why isn't it economically feasible to create new drugs for them? This article makes it sound like there is a large and growing market of suffering people who'd be more than willing to spend every last cent for a pill to make the pain go away. And if the prospect of people willingly bankrupting themselves for drugs doesn't perk big pharma's interest, I don't know what would.
  • roc 13y ago
    > "Why isn't it economically feasible to create new drugs for them? " It's not that you couldn't make a profit off them. It's that the opportunity costs can't be justified (today). There's a finite amount of R&D funds available to any firm. And if I'm maximizing profit, I'm not going to spend my money on difficult research, seeking and developing a drug useful to a handful of patients in 4% of hospitals, that's taken for a few weeks by each patient. Not if I can instead spend it tweaking known drugs, useful to 30-50% of the entire population, that they'll take for the rest of their lives. (e.g. blood pressure medicine) And particularly not when CDC, WHO, et al are actively campaigning for changes to antibiotic handling/prescription/use which may well mean your potential future market for "a better antibiotic" is actually smaller than today's.
  • klmr 13y ago
    I think you seriously underestimate just how many lives antibiotics save. Sure, for your tooth extraction they were completely unnecessary and your doctor is either a bit of an idiot or there were other compelling reasons to suspect that antibiotics might be beneficial. But healthcare-wise I would not want to go back to the 1920, no sir. Without antibiotics, medical routine procedures will become life-threatening again (that said, I don’t share the article’s pessimism; yes, it’s bad – but there will be solutions).
• tezza 13y ago
  My doctor friends have been warning about this for 15 years, and the situation has continued to worsen. MRSA was a bit of a wakeup here in the UK, but the main 'solution' was concentration on cleaning hospitals rather than developing new anitbiotics. It is my opinion that unfortunately it will require high profile people to start dying before support is galvanised. It would seem from the outside that HIV/AIDs started to be addressed when superstars like Freddie Mercury started succumbing.
• uptown 13y ago
  One of the best ways to combat the problem is to speed-up detection speeds of bacteria. Lots of companies are tackling this problem. One of them I've been following has made enormous progress in reducing these detection times. They've reduced MRSA from 18-24 hours down to 6 hours. Salmonella from 24 hours to a 30 minutes. Mycobacterium tuberculosis from 21 days to 1.5 hours. Etc. http://nanologix.com/test_results.html http://nanologix.com/test_results.html Stopping these problems before they get the chance to spread is how I believe these infections will be slowed, as antibiotics become less effective.
• Tjmac73 13y ago
  This is a really big deal, and should be getting more visibility. I think the good news here is it opens the door for a more targeted approach. Current antibiotics are a nuclear option, they wipe out the good with the bad. Thats very bad when a majority of the cells in our body are good bacteria that play a role in our immunity and health. You can see how this leads to a reliance on the nuclear option. If this is the end of the Age of Antibiotics, I hope its the beginning of the Age of Probiotics. Working with the good bacteria and developing more targeted strategies of taking out the bad. Snipers, not nukes. (Im no scientist but perhaps learning from how good bacteria fight off bad bacteria is a good place to start) http://www.sciencedaily.com/releases/2010/03/100324094717.htm http://www.sciencedaily.com/releases/2010/03/100324094717.ht...
• tzakrajs 13y ago
  Do doctors over-use antibiotics to save from being sued by patients in the case of an infection?
  • dragonwriter 13y ago
    Doctors overprescribe antibiotics (among other things) to get patients out of the office.
  • Fomite 13y ago
    There are a number of reasons to over-use antibiotics: 1. Patients ask for them. For a long time, the thinking went 'What's the harm?' in giving Mr. Jones some penicillin for what's probably a viral infection. 2. There is the potential for lawsuits, and the desire to have 'done something' to cover your ass, but I think this is widely exaggerated as a threat. 3. It's hard to diagnose many conditions. Like juries think all crimes get the full CSI treatment, patients often think doctors can just pop down to the lab and find out what you have, like in House. The answer is that's often hard, expensive, and failure prone. So they give antibiotics, especially broad spectrum ones, because of the subset of things you might have, antibiotics can treat some of them. 4. This is really 3b, but it's also possible, when you have no clue what your patient has, to try different antibiotics to try to get a handle on things. This...ends up using a lot of antibiotics. 5. Doctors, at their core, want to treat their patients. To make them better. They're trained to deal at the individual level - antibiotic resistance is a population level concern.
• darkarmani 13y ago
  Meanwhile tons of antibiotics are used in factory farming. I'm not sure why it has ever been legal to use massive amounts of antibiotics on animals that aren't sick yet.
  • wglb 13y ago
    Feeding corn to cows, who are natural grass eaters, keeps them in a perpetual state of sickness, some say.
  • sliverstorm 13y ago
    A thought occurs to me- do we know it to be true, that a constant life-long supply of antibiotics results in the development of greater numbers of resistant strains of bacteria? Think about it. We always say humans who don't finish their prescription are allowing some of the most resistant strains to survive, when taking the full prescription would generally finish off everything (even the moderately resistant strains) preventing selection. Farm animals that never stop taking antibiotics never provide that window of opportunity for unresistant strains to take hold and then undergo selection due to antibiotic regimes that are ended too soon. Maybe I've got the wrong idea here, but is this particularly different from, say, a petri dish full of sulfuric acid, and a petri dish that periodically has some acid introduced for a short period of time? Drop a culture in the first dish, and they all die. Drop a culture in the second dish, and they have time to develop resistance.
  • deleted 13y ago
    [deleted]
• nostromo 13y ago
  80% of the antibiotics we use are given to animals.[1] That seems like a good place to cut back. [1] http://www.nytimes.com/2012/09/04/health/use-of-antibiotics-in-animals-raised-for-food-defies-scrutiny.html http://www.nytimes.com/2012/09/04/health/use-of-antibiotics-...
  • route66 13y ago
    And not to cure diseases: http://www.ucsusa.org/food_and_agriculture/our-failing-food-system/industrial-agriculture/prescription-for-trouble.html http://www.ucsusa.org/food_and_agriculture/our-failing-food-... (slow site warning)
  • stcredzero 13y ago
    In Denmark, they prevent infections in chicken houses by thoroughly cleaning them, then using techniques developed for clean rooms to prevent infections. In the US, we let them wade in their own filth and pump them full of antibiotics. We should just make it flat out illegal to use antibiotics across entire herds of livestock. We should also fine doctors for prescribing antibiotics to patients with a viral infection and no sign of bacteria in their systems, unless they are severely immune compromised.
    • carbocation 13y ago
      As you can imagine, doctors initially got into trouble with this because there is no test that you can use in clinic that says "this patient just has a viral infection". Nevertheless, there are clinical criteria that we can use to come to the same conclusion, and the tide changed years ago with regards to inappropriate antibiotic use for routine viral illnesses. It gets much dicier in-hospital when someone has a SIRS response and you need to presumptively treat them for sepsis. I would be curious to know: of the antibiotic resistance burden that comes from human antibiotic use (specifically in countries where abx are physician-prescribed and not available over the counter), how much of this burden comes from broad treatment of presumed serious infections, and how much comes from treatment of presumed non-serious infections or even postsurgical prophylaxis?
• schoper 13y ago
  Antibiotic resistance shows up among the unhealthiest communities first. They act as the necessary incubators that resistance needs to develop. In a person with a working immune system, the time frame of antibiotic and pathogen contact is very small compared to the time frame of antibiotic and pathogen contact in an immunocompromised patient. To put the above into simple English: Our problem isn't that we give antibiotics out like candy, it's that we give them to the elderly, people with AIDS, the poor, etc. This massively increases the chance of antibiotic resistance developing. What can we do about it? To start with, run the numbers, make some cost-benefit calculations, and think about the problem. There may be technical as well as social solutions. Not thinking about the problem, making it harder for the healthiest people to get antibiotics, and pretending that you are doing something is also a viable option. It's what we're doing now.
  • bad_user 13y ago
    > Our problem isn't that we give antibiotics out like candy, it's that we give them to the elderly, people with AIDS, the poor, etc. Do you realize what you've just said? Are you arguing that we shouldn't have had given antibiotics to people that needed antibiotics? Also, I don't know how your society is or does, but in our country the poor have a better immune system.
    • schoper 13y ago
      I correctly described the situation. I think it's ugly too. Do you have a fix? Because that's what we need, a fix, not cheap moralizing. Moralizing doesn't save anyone from gangrene and sepsis and a slow death. It doesn't prevent the diarrhea to dehydration to death sequence. It doesn't do an ounce of good for anyone. Immunocompromise (poor, sick, elderly, AIDS, etc.) + long-term antibiotic use = Antibiotic resistance. That equation is death, and we need fixes, not the crap in your comment above. "Also, I don't know how your society is or does, but in our country the poor have a better immune system." No doubt you live on Mars or Venus.
      • kamaal 13y ago
        I don't know how that works, God forbid say your dad is sick- Will you go and tell him- 'Dad, you better die for the sake humanity and than take these antibiotics and have you pain reduced'. If you are poor, will you tell your kid- 'Sorry son, I have to sacrifice you for the sake of humanity, no more antibiotics for you' The parent comment to yours is correct. Poor have better immune systems, because theirs is trained to handle such situations from their birth than yours and mine which live well sanitized environments and have never been exposed to them before. That's at least true in a country like India. I'm not sure where you live, poor people dying out of fatal infections is one thing. But its also a fact, some that requires me or you take a sick leave doesn't even bother them.
• DanBC 13y ago
  I've posted this before, but some people may have missed it. "Defeating the superbugs" (http://www.bbc.co.uk/programmes/b01ms5c6 http://www.bbc.co.uk/programmes/b01ms5c6) has a segment showing bacteria developing resistance to antibiotics. (http://v6.tinypic.com/player.swf?file=24goih4&s=6 http://v6.tinypic.com/player.swf?file=24goih4&s=6) (Sorry about the lousy host; YouTube's content sniffing detects this as BBC property and blocks it.) They have a slab of nutrient jelly. The jelly has sections of differing strength of antibiotic. There's a section with no antibiotic, then 10x, then 100x then 1000x. (They cannot dissolve any more antibiotic into the jelly at that point, they've reached the limits of solubility) They drop a bit of bacteria on the zero antibiotic section. A time lapse camera shows the bacteria growing, and developing resistance to each section. After two weeks the entire slab, all sections, are covered. The bacteria has developed resistance to the antibiotic, and is resistant to antibiotics at a strength that could not be used in humans. It's an excellent, scary, bit of video.
  • tokenadult 13y ago
    A good illustration. Your phrasing "The bacteria has developed resistance to the antibiotic" is of course better understood as "the descendant bacterial cells have been ruthlessly selected for resistance to this antibiotic." But that is not an invariant characteristic of bacteria. It is perfectly possible to completely wipe out a population of bacteria in a particular place so that the bacteria have NO descendants.
    • DanBC 13y ago
      Thank you! I'll tweak the wording if I ever post this again.
  • rblatz 13y ago
    I've always been under the impression that bacteria pay a heavy evolutionary tax for their resistance. So what would happen if you then took a sample from the 1000x section of jelly and then another sample of your initial bacteria and put them on opposite sides of nutrient jelly slab. Would the new bacteria be completely overwhelmed? Would infecting someone with a non resistant strain, letting it sit for a while and then hitting them with antibiotics knock the infection low enough that your immune system could wipe up the rest?
• tocomment 13y ago
  I submitted this a few days ago about future alternatives to antibiotics. Maybe it's more interesting now? https://news.ycombinator.com/item?id=6559134 https://news.ycombinator.com/item?id=6559134
  • tocomment 13y ago
    Wow, harsh downvote. Sorry for submitting something related to antibiotics I thought you guys would find interesting.
• joshuahedlund 13y ago
  I've been hearing about the coming Antibiotics Apocalypse for some time now, and while it sounds very dangerous I'm wondering what signs to look for about how bad it's getting. Articles like these point to limited things like an increase in MSRA outbreaks or vague statements about increasing infections from hospitals, but it's not like average people are dying in the streets or anything. How do we tell how much we're moving on the long continuum from here to there while keeping isolated stories in the larger context of overall antibiotic resistance?
  • Fomite 13y ago
    Yes, average people are dying in the streets. Hospital infections, many of which are caused by resistant organisms, are a major cause of death in the United States. Beyond that, you now have things like extensively resistant Gonorrhea, which has taken a disease that is fairly common, but easy to treat if caught and thus embarrassing without being dangerous, and turned it into a serious problem, especially for women. The answer for "How do we tell" is that epidemiologists (like me) do a lot of surveillance for antibiotic resistance. We ask why hospital patients died, and what organism killed them - and what is was susceptible to. And the answer is this is a rather serious problem.
• tocomment 13y ago
  I heard the author on NPR yesterday. I think it's all very true, but it seem disingenuous to blame antibacterial soaps. I haven't ever heard of human antibiotics being added to soaps. And I don't think a triclosan resistant bacteria would be of much risk to us. The only argument I can think of against antibacterial cleaning products would be that our bodies get less exposure or "practice" against ordinary bacteria?
• tokenadult 13y ago
  The interviewed expert has very good credentials and clinical experience to be talking about what he is talking about, and his warnings should be taken seriously. But even at that, the fallacious teleological language he uses about biological evolution by natural selection suggests a way out of this problem. When he says, "Bacteria, like any living organism, want to survive," and "So anything that we do to try and kill bacteria, or anything the environment does to try and kill bacteria, bacteria will eventually discover ways or find ways around those" he is making factual statements that are plainly incorrect on their face. Bacteria don't desire anything, and they don't seek out anything or plan anything. Moreover, it is perfectly possible for lineages of bacteria to go completely extinct, and that has undoubtedly happened more times than human beings are aware. Current antiobiotics are themselves mostly derived from "natural" chemicals emitted by microorganisms so that those microorganisms survive natural selection to go on reproducing in a world full of bacteria. Many of the early antiobiotics, for example penicillin, are derived from mycotoxins produced by fungi. Human medicine can use chemicals from fungi for protection against bacteria because human beings and all animals are more closely related to fungi than either fungi or animals are related to bacteria,[1] so fungi have a biochemical similarity to animals that makes it likely (although not certain) that a mycotoxin that is lethal to bacteria will be relatively harmless to human beings. And this is the way forward to developing new antibiotics. As we reach a deeper biochemical understanding of the basis of all life, we will eventually understand the differences, which are biochemical differences at bottom, between human beings and bacteria, between human beings and protists, between human beings and fungi (yes, there are some systematic differences between animals and fungi) and between human beings and all other harmful microorganisms. Only human beings have science labs and clinical research studies to come up with new defenses against the thoughtless, largely immobile threats from other living things. We can form hypotheses, test those hypotheses rigorously, and perhaps make some lineages of harmful microorganisms as extinct in the wild as the smallpox virus and rinderpest virus now are. The intelligence that the hominid lineage has evolved gives human beings advantages that bacteria will never possess. [1] http://ucjeps.berkeley.edu/DeepGreen/NYTimes.html http://ucjeps.berkeley.edu/DeepGreen/NYTimes.html http://www.nytimes.com/1993/04/16/us/animals-and-fungi-evolutionary-tie.html http://www.nytimes.com/1993/04/16/us/animals-and-fungi-evolu...
  • 13y ago
• gibwell 13y ago
  How are we going to use fewer antibiotics when they are a profit making venture?
• Futurebot 13y ago
  Norway came up with their own solution to this issue, and it has apparently been working very well for them: http://www.spokesman.com/stories/2010/jan/03/norways-mrsa-solution/ http://www.spokesman.com/stories/2010/jan/03/norways-mrsa-so...
• api 13y ago
  ... and the judicious use of antibiotics requires some kind of regulatory agency or system to make sure the users follow through. This seems like another area where libertarianism is crashing against the rocks of reality-- as socialism, communism, and all other political ideologies have already done. I have a profound sense that all political ideologies are failed, and that we're entering a post-ideological age of pragmatism driven by either populism, oligarchy, or technocracy... take your pick.
  • stcredzero 13y ago
    > This seems like another area where libertarianism is crashing against the rocks of reality Antibiotics use fits the "Tragedy of the Commons" scenario to a T.
• bradleyjg 13y ago
  It's an insane world we live in where all the measures that should be used to control the distribution of antibiotics exist, but they are used instead for opiates. I'm not saying opiates addiction isn't a genuine problem, but it's a largely individual one. There's no widespread negative externalities to prescribing opiates to a patient. Antibiotics on the other hand, present a classic limited pool resource allocation problem (the same species of problem as the tragedy of the commons). It's antibiotics that should require a three part pad, with one copy sent off to the federal government and investigations into over-prescribers -- not painkillers. It's antibiotics that should be subject to intentional treaties governing their distribution and use -- not painkillers. It's antibioatics that should have criminal penalties for misuse -- not painkillers.
  • Timothee 13y ago
    Antibiotics on the other hand, present a classic limited pool resource allocation problem While reading the article, that's what I was thinking: even if I limit my antibiotics use, it won't help me since this affects everyone, not just people who abuse antibiotics…
  • Fomite 13y ago
    Many hospitals have rather elaborate approval mechanisms for the use of "the good stuff" in terms of antibiotics. Just FYI.
• hodder 13y ago
  The anthropomorphism of bacterial evolution makes the article hard to follow for the layman (me). Can someone familiar with bacterial evolution please explain to me how the use of antibiotics leads to superbugs? I am clearly misunderstanding something. I was under the impression that in a population of bacteria, genes express themselves in any number of random ways. If we expose the bacterial culture to antibiotics, the bacteria susceptible to the antibiotic dies, while the resistant bacteria lives on free to reproduce, leaving the descendant bacteria with resistive characteristics... My question to the HN scientists is, doesn't this just destroy some subset of bacteria? Is new genetic information produced that did not exist before? Taking this trimming tree down the line, wouldn't the "superbug" antibiotic resistant bacteria have been created/survived and thrived anway? Or does the antibiotic exposure actually cause, "the bacteria to want to survive", in the sense that exposing them to antibiotics leads to more rapid mutation of descendants? Why wouldnt the antibiotic resistant bacteria be created with or without overuse of antibiotics? Isn't the spectrum of the genetic tree just trimmed?
  • dragandj 13y ago
    Let's suppose that in an antibiotic-resistant future some, very small, number of people develop a mutation that produces 2 effects: antibiotic resistance and VERY ugly nose warts. Since other people live for 25 years and the uglies for 100 years, I suppose they would be desirable mates with lots of offspring despite the ugliness. In a few centuries, they would be the majority. Now, if there weren't the antibiotic resistance, do such mutations have the same chance to appear? Yes, but they'd have hard trouble finding mates. Their mutation has only drawbacks, and no advantages. As soon as the advantage appears, the mutation has more chance to spread through offspring. The same with bacteria. It is not necessary that they mutate more, it is just that those mutations that help the bacteria survive spread quickly. But if the danger is not present, the mutation is not significant.
  • deleted 13y ago
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  • Timothee 13y ago
    That's a good question. I have no credentials or background to know the answer, but I wonder if this is something where the use of antibiotics decimates most the bacteria population so that it's easier for the resistant ones to thrive, as opposed to cohabitate and possibly be overtaken by the non-resistant ones. I'm thinking of it like Conway's Game of Life where a cell dies if surrounded by more than 3 cells. With antibiotics, you limit the number of living cells around and are more likely to keep others living. Or maybe the non-resistant ones would have another trait that make them thrive more than the resistant ones if both are mixed?
• lgleason 13y ago
  My mother died from a MRSA infection. This is VERY serious stuff.
• hooande 13y ago
  One thing I learned from watching this episode of Frontline was that we aren't doing a lot of research into new antibiotics. Companies like Pfizer (the original makers of penicillin) would rather create drugs like Lipitor or Prozac, things that customers will take everyday for the rest of their lives. Antibiotics are intended to be used as sparingly as possible, which doesn't leave room for a lot of profit. Even the National Institute of Health has but antibiotic research on the back burner to pursue more pressing concerns. The other big problem we face is that certain antibiotics are like steroids for farm animals. I believe that they kill the bacteria in the gut of a cow or big that signals when they should stop eating, resulting in larger stock (or something like that). This increases the exposure of bacteria to the antibiotics, making things less safe for all of us. But drug companies and farmers aren't to blame for our antibiotic situation. Capitalism encourages profit and doesn't ask questions about how it's made. Corporations have a fiduciary responsibility. And doctors can't be faulted for overprrscribing antibiotics either. A sick person is the ultimate debugging task and most doctors will try anything that could help the patient. I don't know if this problem has a good solution. If we research new antibiotics then bacteria will eventually evolve to resist them (kicking the can down the road). If we stop using antibiotics then more people will suffer, potentially unnecessarily (destroying the village to save the village). Trying to fight evolution is a losing game. I am, however, confident that someone somewhere will come up with a break through in the next few decades that will allow us to temporarily solve this problem once again.
  • j_baker 13y ago
    It makes me think that the government will have to take some of the responsibility from the drug companies. If capitalism isn't working (which frequently happens in medical fields), we need another mechanism to make new antibiotics available.
    • refurb 13y ago
      It's not capitalism that's the problem, it's the current regulations surrounding drug research. The FDA has set out hurdles for drug approval that make it very unattractive to discover new antibiotics. They are currently changing the way these drugs are reviewed to try and alleviate that (new endpoints, etc).
• alan_cx 13y ago
  This is not my thing at all, so this might be a really silly question, but... Are people who have avoided prescribed antibiotics in a better position than those who haven't? Then, what is the effect on such people of the antibiotics taken in by eating meat from animals which have been give antibiotics? Have the people who have been avoiding completely wasted their time?
  • axaxs 13y ago
    The problem as I understand it is not with human immunity, but rather that we will not be able to kill or control the bacteria when it's bad enough to warrant treatment. I'm not a biologist, but I'd wager the answer is that they are not any better off.
  • chrisamiller 13y ago
    Even if you've never taken antibiotics, you're in the same boat as everyone else. The resistant bacteria are in the environment. If your immune system works fine, there's less to worry about. The most urgent danger is to the very young, old, or immunocompromised because of illness or therapy. (That said, MRSA infections do happen in otherwise healthy people from time to time) If you've been avoiding meat raised with antibiotics, you're part of the solution, because you're pushing the market away from the cheap short-term fix (antibiotics) towards more sustainable solutions without the societal consequences.
  • ronaldx 13y ago
    It's hard to know the answer to this question. Yes, antibiotic resistant bacteria pose a new threat to everyone (likely still less of a threat than non resistant bacteria did in 1950), but maybe not equally. it's possible that antibiotic-resistant bacteria have more chance to take hold (asymptomatically/latently) in people who are regularly exposed to antibiotics. You could be carrying around MRSA but you wouldn't observe symptoms unless/until you are otherwise in a critical state - wounded or immune-suppressed. It's not currently obvious how antibiotic-resistance spreads in the wild and so it's still plausible that avoiding antibiotics gives you some degree of protection.
  • alan_cx 13y ago
• patrickg_zill 13y ago
  While most view colloidal silver as quackery, the fact is that using silver in colloidal form along with other medicine administered at the same time, was standard practice 80 years ago. Perhaps silver in nanoparticle form will make a comeback, as bacteria don't seem to be as able to survive the cell wall disruption that silver can cause.
  • TaffeyLewis 13y ago
    There are actually studies being done around implementing exactly that with antibiotics... However there is also the fun danger of your skin turning incurably silvery blue thanks to the silver component in the antibiotics... No really.
  • yuhong 13y ago
    I am thinking the term "quackery" is for example probably a bit too broad.
• jasonkolb 13y ago
  Well let's start doing something about this. I created a whitehouse.gov petition, let's start spreading it around: https://petitions.whitehouse.gov/petition/make-antibiotic-use-illegal-except-treating-bacterial-infections-humans/gtGrwQ6K https://petitions.whitehouse.gov/petition/make-antibiotic-us... Hopefully we'll be able to create some alternatives, but let's stop the bleeding if we can.
• thewarrior 13y ago
  Reading this really scared me. Is there any hope against this.
• JumpCrisscross 13y ago
  "These are companies that are for-profit companies, and like you said, they have to answer to people. They have to develop drugs that will make money, and that’s not an antibiotic." The profit motive is almost as blind a watchmaker as natural selection. We've built an environment which encourages bacteria to develop antibiotic resistance. Let's structure a pharmaceutical industry in which antibiotics are profitable. The problem appears to be myopia. Antibiotics make money for a few weeks, chronic diseases for a lifetime. Fortunately, finance long ago solved the temporal shifting of incentives and payoffs. We need smooth the lumpy, often in-the-future, demand for antibiotics. The government could tax the pharmaceutical industry, medical insureres, or the public. The proceeds would fund tax credits for the developers and/or producers of antibiotics. Alternatively, a more elaborate system by which health and life insurers incentivise antibiotic research, perhaps by issuing credit default swaps on pools of their reinsurance liabilities to antibiotic developers, could be structured.
  • protomyth 13y ago
    I'm pretty sure an X-Prize-style $10 Billion tax free for the next antibiotic from the government[1] would probably get something done. Given our needs, the $10B would be cheap. Heck, buy the next 3 or 4 discovered. 1) assuming said government exempts the company from court claims on the approved drug
    • refurb 13y ago
      The gov't is already looking at something similar. If an antibiotic is approved by the FDA, the company would be guaranteed at least $100M in revenue per year, going up to $350M in the fifth and final year.
      • protomyth 13y ago
        The big one would be the immunity from court action. Look at all the crap going on with the Lyme Disease Vaccine and flu shots.
  • mturmon 13y ago
• robomartin 13y ago
  > Bacteria, like any living organism, want to survive. > bacteria will always change in order to survive. Excellent article. Everyone should read it from top to bottom twice. Forward it to your entire network. This is a serious matter. However. I really cringe when I see scientists get loose with language like this. I know he knows perfectly well how evolution works. This is an attempt to make it simpler to swallow for those who might not be up to speed and, perhaps, come to the discussion lacking a minimal scientific background to be able to rationalize it. I get it. Among that population the misrepresentation of the driving mechanisms behind evolution can actually do more harm than good. Taken far enough you end up with? "Oh, so you mean to say that a monkey WANTED to survive and CHANGE in order to become a human". Which makes you sound like an insane lunatic, of course. The mechanism is dead simple: Out of a pool of organisms exposed to an environment some die and some survive. This "environment" can be anything, from an antibiotic at the bacterial level to a flood in a canyon. Of those who survived some did so due to blind chance. Others because they might possess a characteristic that helped them survive the environment. Survivors mate and reproduce. Some mutations occur. The cycle repeats with the new population. If the environmental "attack" (antibiotics, the flood, whatever) remains the same, over time populations will develop that will have better and better resistance to their particular challenges. This is the brutally simple result of the demise of those who simply could not handle whatever was dished out. Over time either the entire population is killed off and game over or those who were resistant, for whatever reason, will --without intent, goals or knowledge-- help evolve populations equipped with increased resistance to what is trying to kill them. In evolution there is no "wanting" to do anything. There isn't even the idea of wanting to survive. There is no struggle for survival. There is no conscious desire to change or to become something else. It is brutal and simple. Some die. Some don't. Those who survive repeat the cycle. Eventually either all die or you end-up with one or more new species/variants that got past the killing spree and emerge resistant to whatever ailed them. And it goes on. Challenge after challenge. Part of me wishes people would have a better handle on this very simple scientific fact so we could move on to more important topics. We went to see Richard Dawkins at Caltech this weekend. He mentioned that in the US some 40% of the population think the earth is 6,000 years old and reject evolution. What they reject might very well be what ends-up killing them. This issue of bacteria evolving past our ability to concoct antibiotics is a very serious one. I've always believed we are all going to be killed-off by something microscopic that nobody is going to see coming. The potential is there for hundreds of millions of people to die over a short period of time. Airplanes will contribute to that greatly, helping take bacteria all over the world before we even realize what's happening. That's why I don't understand why we don't get behind this --as a planet, not just a nation-- with great force. I see virtually no use for our military and that of other nations. Can't we lobby for the elimination of the horrible waste that is the maintenance of massive military forces and, instead, devote those funds to more worthy causes? Imagine if we, as a nation, devoted half our current military budget to honest medical research. I am not one for huge government programs, but there would be ways to do such a thing without having government bureaucracies devolve the thing into a cash burning furnace. The point isn't the details but rather the idea that something like this should be priority one. We are looking at the possibility that within the next 25 to 50 years there could be a massive antibiotic resistant bacteria outbreak that takes out a huge chunk of the human race. We need to be ahead of that event, not behind it. And it is far wiser to throw billions of dollars into medical research of almost any kind rather than into making the latest wiz-bank how-to-kill-more-people-per-round machine. Utopia. I know. Sad. EDIT: I neglected to add how I would explain evolution to a general audience without resorting to "want" and "desire" type analogies. In other words, don't be critical without offering a solution. Well, I think it's simple, I sort of did: When faced with challenges organisms either excel or die. Those who excel go on to reproduce. In reproduction there is mutation. Small changes to each and every new organism. Reproduction does not produce clones. Reproduction results in a population of new and distinct individuals with some of the traits of their parents and some new ones. Their offsprings, if faced with the same challenges will, just the same, survive or die. If none survive the population goes extinct. Otherwise, over time, the only organisms who will continue to survive are those who continue to carry the traits that made their ancestors survive. This repeats over time and across challenges. That's not the elevator pitch, of course. So here is that one, applied to bacteria in particular: When attacked by antibiotics some bacteria survive. These reproduce and produce new bacteria that might carry-on some of the traits that allowed the parents to survive. Random mutations might also make some members of the new population even more resistant to the same antibiotics. The process repeats over many generations. Over time new populations emerge with immunity to the antibiotics that killed so many of their ancestors. The more we expose bacterial populations to wide ranges of antibiotic challenges the greater the effect can be. Over time populations will evolve that will be resistant to anything we have on the shelves to throw at them.
• polskibus 13y ago
  What about chemiotics? Do the usual warnings about antibiotics abuse refer to chemiotics in the same way?
• deleted 13y ago
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• moocowduckquack 13y ago
  With the development of generic anti-virals like DRACO ^1 - http://web.mit.edu/newsoffice/2011/antiviral-0810.html http://web.mit.edu/newsoffice/2011/antiviral-0810.html - I wonder if we might see viruses become largely treatable even while bacterial infections are becoming less so. ^1 who names these things and are they purposely trolling conspiracy theorists?
• rrtyyyy 13y ago
  Evolution always wins
• _pmf_ 13y ago
  Aw, shucks! At least some people made a quick buck fattening up animals to fatten up Westerners. That surely justifies a few million deaths in the future.
• T3RMINATED 13y ago
  Sounds like the guy from the Patent Office that said they should shut it down everything has been invented.
• dailo10 13y ago
  Interesting that in a non-antibiotic environment, the antibiotic resistant bacteria are actually less fit because that resistance comes at a cost.
• g8oz 13y ago
  The antibiotic overuse that caused this problem will not be solved with out action in 2 area. 1) Antibiotic overuse in poultry and livestock farming to compensate for overcrowded and stressful conditions and 2) Antibiotic overuse in the developing world.
• eliben 13y ago
  I'm always confused by these articles. If the issue was really so serious, wouldn't governments be concerned by it at this point? What does it mean that they aren't, in fact, concerned? Does it mean that the amount of people currently affected by these bacteria is negligible? Something else? That there are opposite experts who say this is no a real problem? Lobbying?
• SmokyBourbon 13y ago
  > Bacteria, like any living organism, want to survive. They are adapted that way, and any successful bacteria is the bacteria that’s most able to survive in the environment. So bacterial resistance is largely inevitable, because bacteria will always change in order to survive. That's not how evolution works.
• cstigler 13y ago
  Modal stacked above another modal when I opened the page. Neither relevant. gags The article's cool though.
• robot 13y ago
  I've been hearing about MRSA since 2000s. What's new? I mean, what has changed now since 2000 that this is now more important?
  • Fomite 13y ago
    It's more prevalent, and has gone from a weird bug mostly in hospitals to something you can pick up in the community. Beyond that, it's no longer just MRSA. There's all manner of resistance mechanisms, for a very, very wide set of diseases, including some dirt common ones. "Resistant" isn't an on/off switch. How resistant? Where are the resistant bugs? How many of them are there compared to non-resistant competitors, etc.
• gurtwo 13y ago
  I wonder, what should we do as individuals? Shall we refuse to take prescribed antibiotics for "minor" things, and let the body heal itself at the cost of some extra discomfort? Would that make any difference in the long run? Does the resistance apply to any kind of antibiotics?
• triplesec 13y ago
  Can anybody outline what possible justification there is for the continued use of antibiotics not as disease cure, but as prophylaxis and growth promoters in intensive farming? I heard about the stupidity of this as a child, from competent medical professionals, and decades on, nothing has changed. Rather than such socially rapacious short-sighted practices, we ought to be legislating better farming practices and tighter controls on these precious medicines. I believe this is quite likely a worse issue than the other problem: the blatant overprescription of antibiotics by weak and obsequious family doctors looking to defend themselves from lawsuits and approbation from wealthy and stupid patients with colds and coughs, which has also accelerated resistance.
• memracom 13y ago
  Technology is the answer. All citizens will be required to carry a smartphone or other GPS tracking device that reports their location every 5 mins to a central database run by the National Security Agency. When a new infected person is discovered, National Bureau of Health agents will contact everyone who was close enough to the infected person to have possibly transmitted (given or received) the infection over the previous two months. Those people will be tested and infected people will be incarcerated in National Health Concentration Centers for healing. They will stay their for life, or until no longer infected. Will it come to this? What about mandatory death penalty (plus confiscation of all family assets) for anyone who gives antibiotics to an animal or who supplies antibiotics to a farmer?
• tpainton 13y ago
  antibiotics do not cause resistance to form. resistance occurs due to natural mutations. these are going to occur regardless of exposure to antibiotics or not. The antibiotics simply select out the resistant organisms from the auger. It was shear panic when S. aureas developed penicillin resistance decades ago. methicillin was the solution. Now we have methicillin resistant staph aureas. This is nothing to panic over. it simply means the battle is never won and we'll require ongoing research on new antibiotics. To say we have lost is just not true. This is the way life works. he also ignores the possibility of human evolution. We can develop resistance to bacteria as well.
• tpainton 13y ago
  This person reminds me of a lot of people I went to medical school with. Very smart, and yet, not very realistic. He outlines a scenario that is endgame.. when in fact, we are seeing cyclical events. We saw the emergence of penicillin resistence in S. Aureas, then methicillin resistance. we moved to quinalones, and sulfa and we see resisance develop there.. OF COURSE it does. The antibiotics don't cause resistance.. Natural selection is the process going on here. There are random mutations that occur regardless of antibiotic exposure. We do see antibiotics cause resistance such as in inducible extended beta lactamase resistance.. (I have a patient currently with E coli resistant to everything but Colistin) but the overwhelming process..it's still good old fashion natural selection that Darwin made us all aware of. We really don't need to panic.. we just need to keep fighting the fight..because it won't ever end, unless we give up. Relax. When I hear people claim it was wanton use of antibiotics that caused all of this.. I wonder if they ever read a word about biologic evolution. Right now, there are organisms out there that are already resistant to antibiotics that haven't been developed yet. How can we blame humans for that?
  • shabble 13y ago
    > * We saw the emergence of penicillin resistence in S. Aureas, then methicillin resistance. we moved to quinalones, and sulfa and we see resisance develop there.. OF COURSE it does. The antibiotics don't cause resistance.. Natural selection is the process going on here.* [...] > When I hear people claim it was wanton use of antibiotics that caused all of this.. I wonder if they ever read a word about biologic evolution Natural selection describes the shift in characteristics of a population due to some environmental pressure which favours individuals with specific characteristics. How they acquire those characteristics is largely immaterial, be it through random mutation, sexual reproduction, viral transduction, etc. So yes, natural selection is the process by which the resistant bacteria outcompete the vulnerable ones, and thus become the dominant population. But the reason that occurs in the first place is because of the environmental pressure induced by the antibiotic. Or am I missing something here?
• robomartin 13y ago
  I'm out of my depth here, but it seems to me one idea could be to help bacteria evolve rather than aim to kill them all. What I mean by this is that perhaps using bacteria against themselves could be an interesting approach. Much like over decades people bred dogs to encourage certain traits perhaps we can coax bacteria into developing traits that help us rather than help them when they come into our bodies. Maybe your run a fever for five or ten days and feel crummy but rather than have bacteria trying to destroy you they are, effectively, fighting and destroying themselves. In other words, Aikido not Karate. Use their own energy against them. Just a thought. Probably nonsense. Not a biologist.
• elangoc 13y ago
  I'm genuinely interested to know whether garlic can be safe and effective replacement. I ask in all seriousness since garlic is said to have antibacterial properties (and was used topically as an antiseptic for wounds in WW 1 & WW 2). The thing about garlic is that our body never develops a tolerance for it. Is it true that bacteria can never develop resistance to the active compounds in garlic (ex: allicin) ?
• j2d3 13y ago
  What seems missing from this HUGE discussion about "the end of antibiotics" is vaccination. There is work in progress toward a MRSA vaccine[1,2,3], though it won't be easy. Nevertheless, the way I see it, vaccines are a strategic approach, while antibiotics are tactical. Obviously we need to continue to pursue both, but I just think it's important to consider and even maybe refocus our efforts to deal with MRSA and other tricky fast evolving bacteria that become widespread and problematic in our communities by pushing hard for vaccine development. [1] http://www.trefis.com/stock/pfe/articles/205872/pfizers-vaccination-business-antibiotic-resistant-staph-mrsa-opportunity/2013-09-17 http://www.trefis.com/stock/pfe/articles/205872/pfizers-vacc... [2] http://www.huffingtonpost.co.uk/2012/02/15/scientists-create-mrsa-vaccine_n_1279160.html http://www.huffingtonpost.co.uk/2012/02/15/scientists-create... [3] http://www.fiercevaccines.com/story/pfizer-glaxo-and-novadigm-race-develop-mrsa-vaccine/2012-09-17 http://www.fiercevaccines.com/story/pfizer-glaxo-and-novadig... (did you know there was a website called "fiercevaccines.com"???)
• ericb 13y ago
  I wonder if we should have been prescribing 3 antibiotics at a time. This would be for the same reason we use redundant disk drives--the odds of one disk write failing might be one in 100. But the odds of 3 disk writes failing simultaneously should be 1 / million. If some bugs need to survive to develop resistance, this seems like it would reduce the chances.