3 ms·

There was recently an interview posted here on HN about the end of antibiotics (http://www.pbs.org/wgbh/pages/frontline/health-science-technology/hunting-the-ni

by mekoka 13y ago

There was recently an interview posted here on HN about the end of antibiotics (http://www.pbs.org/wgbh/pages/frontline/health-science-technology/hunting-the-nightmare-bacteria/dr-arjun-srinivasan-weve-reached-the-end-of-antibiotics-period/ http://www.pbs.org/wgbh/pages/frontline/health-science-techn...). In short, the interviewee Dr. Arjun Srinivasan was pleading for a serious conversation about what to do to further regulate their usage, because some bacteria are developing increased resistance to most, if not all, antibiotics available. What's stunning to me about all these articles is that, after all these alarms have been raised and as all the people responsible seem to be contemplating solutions to regulate antibiotic usage, nobody's mentioning alternative methods to fight bacteria. Following the afore mentioned article one commenter remarked that Dr. Srinivasan did a great job or spooking us, but there was absolutely no mention of bacteriophage during the interview, which got me curious. Turns out phage therapy (http://en.wikipedia.org/wiki/Phage_therapy http://en.wikipedia.org/wiki/Phage_therapy) has been used successfully for close to 100 years in Russia and Georgia. According to this Wikipedia page http://en.wikipedia.org/wiki/Bacteriophage http://en.wikipedia.org/wiki/Bacteriophage Phages were discovered to be antibacterial agents and were used in Georgia and the United States during the 1920s and 1930s for treating bacterial infections. They had widespread use, including treatment of soldiers in the Red Army. However, they were abandoned for general use in the West for several reasons: - Medical trials were carried out, but a basic lack of understanding of phages made these invalid. - Phage therapy was seen as untrustworthy, because many of the trials were conducted on totally unrelated diseases such as allergies and viral infections. - Antibiotics were discovered and marketed widely. They were easier to make, store and to prescribe. - Former Soviet research continued, but publications were mainly in Russian or Georgian languages, and were unavailable internationally for many years. - Clinical trials evaluating the antibacterial efficacy of bacteriophage preparations were conducted without proper controls and were methodologically incomplete preventing the formulation of important conclusions. Their use has continued since the end of the Cold War in Georgia and elsewhere in Central and Eastern Europe. In other words the reason why western countries stopped considering them, and to some extent continue to shun them, is lack of understanding. I am wondering then, if we have to have these "serious conversations" about regulation of antibiotics for the sake of the threat posed by over-consumption, how serious can it really be if we have to wear blinders and continue to pretend that what the Russians and Georgians have been doing is utter sorcery?

Fomite 13y ago
It isn't actually a "lack of understanding" - I was doing research into phage therapy over a decade ago, and the field has progressed since then. There are however a number of problems with phage therapy, and this is from the perspective of someone who likes phage therapy: - Phages are usually very bacteria specific, there isn't really a "broad spectrum" phage. The therapy used in Russia and Georgia is often a bespoke formulation for each individual patient. This is: a. Really, really hard for the FDA to approve. b. Expensive as all hell. c. Involves keeping "banks" of phages around, and creating custom cocktails of them. This is, as mentioned, expensive as hell, and manpower intensive. - Phage therapy is fairly novel in the West, due to some problems in the early days of phage therapy followed swiftly by the discovery of penicillin. It's an entirely different method of treatment, which means all the clinical knowledge doctors currently have is invalid, and has to be relearned. That's tough. - There's no promise a bacteria has a phage associated with it, and synthetic phages are, at this point, a pretty distant prospect. - When bacterial cell walls rupture, they create endotoxins. Endotoxins are bad - indeed, in the early experiments with phage therapy in the West, insufficiently pure phage solutions with endotoxins in them were responsible for some deaths. Right now, phage therapy is most often used in dire cases, where side effects like that are less of a thing. For a bad case of Strep throat? There's some serious clinical trials that need to be done. - It's a hell of a lot harder to give someone a 14 day course of bacteriophages to take home than it is a 14 day course of antibiotics. Phage therapy is a really fascinating field, and I think it has a lot of potential. But to say we shun them due to a lack of understanding, or acting like what the Russians and Georgians do is "utter sorcery" ignores a great deal of the research that takes place here. The real problem is, even while we struggle with resistance, antibiotics are profoundly superior as a general purpose drug. The reasons the Russians used them so heavily is because they had trouble getting antibiotics. But seriously, "What about phages?" isn't exactly a new idea.
- derleth3 13y ago
  > It's a hell of a lot harder to give someone a 14 day course of bacteriophages to take home than it is a 14 day course of antibiotics. As we've seen, this is a good thing. Especially since people insist on only taking part of a course and saving antibiotics for later, when they might or might not work at all.

by mekoka 13y ago

Fomite 13y ago

It isn't actually a "lack of understanding" - I was doing research into phage therapy over a decade ago, and the field has progressed since then. There are however a number of problems with phage therapy, and this is from the perspective of someone who likes phage therapy: - Phages are usually very bacteria specific, there isn't really a "broad spectrum" phage. The therapy used in Russia and Georgia is often a bespoke formulation for each individual patient. This is: a. Really, really hard for the FDA to approve. b. Expensive as all hell. c. Involves keeping "banks" of phages around, and creating custom cocktails of them. This is, as mentioned, expensive as hell, and manpower intensive. - Phage therapy is fairly novel in the West, due to some problems in the early days of phage therapy followed swiftly by the discovery of penicillin. It's an entirely different method of treatment, which means all the clinical knowledge doctors currently have is invalid, and has to be relearned. That's tough. - There's no promise a bacteria has a phage associated with it, and synthetic phages are, at this point, a pretty distant prospect. - When bacterial cell walls rupture, they create endotoxins. Endotoxins are bad - indeed, in the early experiments with phage therapy in the West, insufficiently pure phage solutions with endotoxins in them were responsible for some deaths. Right now, phage therapy is most often used in dire cases, where side effects like that are less of a thing. For a bad case of Strep throat? There's some serious clinical trials that need to be done. - It's a hell of a lot harder to give someone a 14 day course of bacteriophages to take home than it is a 14 day course of antibiotics. Phage therapy is a really fascinating field, and I think it has a lot of potential. But to say we shun them due to a lack of understanding, or acting like what the Russians and Georgians do is "utter sorcery" ignores a great deal of the research that takes place here. The real problem is, even while we struggle with resistance, antibiotics are profoundly superior as a general purpose drug. The reasons the Russians used them so heavily is because they had trouble getting antibiotics. But seriously, "What about phages?" isn't exactly a new idea.

derleth3 13y ago
> It's a hell of a lot harder to give someone a 14 day course of bacteriophages to take home than it is a 14 day course of antibiotics. As we've seen, this is a good thing. Especially since people insist on only taking part of a course and saving antibiotics for later, when they might or might not work at all.