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Antibiotic resistance now 'global threat', WHO warns

359 points by k-mcgrady 13y ago

swombat 13y ago
Whilst I totally appreciate the seriousness of this, I still don't get what exactly I can do about this. Most likely, nothing. Therefore, much like the potentially developing WW3 in Ukraine, or Ebola outbreak in Africa, or rape culture in India, this kind of news is fairly useless. It just creates negative feelings with no positive outcome. I'm happy to be convinced otherwise - what can I do about this?
- luckyno13 13y ago
  The best thing you can do is keep informed, and keep others around you informed. Many people don't realize this is such a rapidly progressing issue. In fact, many people may not even know that they are improperly taking their Antibiotics and what the side effects are to doing so. If more informed I feel like the public could do a bit better at turning down Antibiotics when they aren't necessary, and using them properly when they are. Just that action would go a long way. Edit- I would also like to add that a lot of people don't realize just how easy it is to get an infection, and education could go a long way in keeping it from happening in the first place. It reminds me of that guy on reddit with the horrible case of necrotizing fasciitis that he ended up with after retrieving a football from a koi pond. His day by day imgur chronicle was both interesting and horrifying.
  - midas007 13y ago
    It doesn't have to be that way, and waiting around for "someone else to handle it" will likely lead to a Tragedy of the Commons. Call your representatives [US: 0,1] or regional government representative (I just called my senator, and on hold for house rep now), tell them we need an emergency crash program to develop new, tightly-regulated antibiotics so that infection doesn't become the leading cause of deaths in 2025. Because it takes years and billions to develop new antibiotics, this is something companies will not pursue on their own initiative. If not, it'll be a return to the 19th century. Good luck with that. [0] http://www.house.gov/representatives/find/ http://www.house.gov/representatives/find/ [1] http://www.senate.gov/general/contact_information/senators_cfm.cfm?OrderBy=state&Sort=ASC http://www.senate.gov/general/contact_information/senators_c...
    - refurb 13y ago
      You're not going to have new antibiotics without biotech or pharmaceutical companies helping. The government needs to provide incentive for antibiotic research, right now regulatory and reimbursement issues are making the therapeutic area very unattractive.
- goldenkey 13y ago
  Antibiotics work on a specific mechanism of action. See here: http://en.wikipedia.org/wiki/List_of_antibiotics http://en.wikipedia.org/wiki/List_of_antibiotics New mechanisms of action are needed, more specifically, mechanisms that evolution cannot biologically defeat. Consider an agent like bleach, 99.99% effective because the makeup of a cell does not really permit it to protect against such a caustic agent. Clearly bleach can't be used as an antiobitic but I use it to illustrate the point that a evolutionary-unlikely antibiotic mechanism would be worldly profound.
  - timr 13y ago
    You're right, but here's the problem: things that are robust to evolutionary change tend to kill everything (e.g. chlorine). There's a tension between finding targets that are specific to an organism, but well conserved, so that the organism can't simply evolve away from the specific threat. This is really the alpha and the omega of antibiotics and antiviral research: finding the specific lethal target that can't easily be changed. It's damned hard, and it's why most of our antibiotics have been generated by nature, not by rational design.
    - mikeash 13y ago
      As usual, there's a relevant xkcd: https://xkcd.com/1217/ https://xkcd.com/1217/ It's easy to kill bacteria, viruses, cancer, you name it. We have lots of tools that can kill them, from guns to flame throwers to acid. The trick is killing them without also killing the patient, as you say.
    - Already__Taken 13y ago
      So we need to make it another 50-100 year range so we can just replace it with robots?
      - timr 13y ago
        Hehe...the future is now, sort of. We already have robots that can screen large libraries of chemicals against bacteria for antibiotic effectiveness.
- k-mcgrady 13y ago
  >> "Whilst I totally appreciate the seriousness of this, I still don't get what exactly I can do about this. Most likely, nothing." I think you can help by informing others. If you know a family member not completing their course of antibiotics for example explain to them why it's so important.
- dfxm12 13y ago
  If your doctor is prescribing you an antibiotic, you can ask them what the pros and cons are of taking it. If you are willing to deal with the cons, then maybe don't take the antibiotic. Usually, the con will be that you feel sick for a bit longer. Note though, that you might need them to get over whatever it is you have.
  - swalkergibson 13y ago
    This is absolutely accurate. "People were generally aware of the link between overuse of antibiotics and increased resistance. Only 8% of respondents did not agree that if antibiotics are taken too often they are less likely to work in the future. But many people (43%) incorrectly believed that antibiotics were effective in viral conditions." http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1934431/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1934431/
- artmageddon 13y ago
  I will echo lucky's sentiment - staying educated, and educating others around you, goes a big way. I know people very close to me who still believe it's okay to stop taking antibiotics the moment they feel better, rather than finishing out the entire prescription. I'd like to believe that buying meat / other foods that aren't treated with antibiotics could make a difference as well, but I'm not sure how much impact that would have.
- FooBarWidget 13y ago
  Not sure why swombat got downvoted, he makes good points. Heck, once in a while, an HN submission for along the lines of "Why reading news is harmful and why you shouldn't read it" goes by, and it gets upvoted a lot. What can the general public do about this? It's not like I can go to my family physician and tell him to use less antibiotics (he already doesn't; I'm in the Netherlands), and expect to make any kind of meaningful difference. This is one of those "tragedy of the commons" kind of problems that can only be solved if everybody cooperates.
- pessimizer 13y ago
  Be educated about it, and educate others. Eventually, you will be called on to vote on something, and some intrenched interest will try to convince you that it is an encroachment of big government on the sovereignty of job creators. Good luck trying to teach them then.
- exratione 13y ago
  Donate to research groups that are working on ways of controlling bacterial and viral infections that are a step beyond the present status quo. Things like DRACO [1] spring to mind. Present day fundamental (as opposed to translational) biomedical research is very cheap in comparison to the state of things even a decade or two ago. Small fundraising groups can make a big impact now. [1]: https://en.wikipedia.org/wiki/DRACO_(antiviral) https://en.wikipedia.org/wiki/DRACO_(antiviral)
- coenhyde 13y ago
  Pressure your government (where ever you may be) to make responsible use of antibiotics a priority. The misuse that terrifies me the most are antibiotics used on livestock. Particularly the antibiotics that are also used on humans. In my opinion antibiotics should not be used as a growth promoter and only used to help sick animals.
  - sgk284 13y ago
    > should not be used as a growth promoter and only used to help sick animals The issue is that a lot of animals get sick from being crammed together in small areas, unable to move, while living in their own feces and urine. If we regulated animal treatment better and required certain living conditions for animals they wouldn't get sick nearly as often and wouldn't need nearly as many antibiotics. As it stands, regulating antibiotics to be used only on sick animals wouldn't change much since an incredibly large percentage of livestock are often sick (as a consequence of living conditions).
    - midas007 13y ago
      I don't eat meat or consume animal-derived products for this reason. This is where the next pandemic is mostly likely to originate, and it's completely preventable.
      - tomp 13y ago
        Unless you also avoid meat for other reasons, wouldn't it be better to eat meat, but only from those farmers that raise livestock in humane, sustainable conditions (organic/free range/...)? That would increase competition and support their business models.
    - coenhyde 13y ago
      You're right. This needs to change as well.
  - midas007 13y ago
    That's one side, the other side would be a crash program to develop a spectrum of closely-guarded, last-resort antibiotics.
- Slackwise 13y ago
  The primary source of antibiotic abuse is in farm animals. Do you really want to help? Start eating less meat, and tell others to also do so. Tell them why. Tell them to also tell others. When there is less demand for meat, then there will be less land devoted to animal feed/grazing, and more to food crops. Less animals that can be infected, less antibiotics used, etc, etc. Want to really help solve it? Don't eat meat. Get others to stop eating meat. Invest in faux/lab-grown meat companies. Disease free meat can be grown. We just need to make it profitable. Honestly, this is the future. Farming like this is unsustainable, not only for the antibiotic reasons. (I'll spare everyone the ethical/transhumanist discussion.)
  - azth 13y ago
    > Want to really help solve it? Don't eat meat. Get others to stop eating meat. Why not just get meat from farms that treat their animals properly (no cramming, free-range, etc)? I don't think it should be this extreme.
  - pound 13y ago
    red meat is high in iron and anemia is not nice. of course there are other sources of iron, i'm just saying that stopping eating meat should go with balancing diet.
- Houshalter 13y ago
  That's true for pretty much all significant news. And it's not like we are helpless, it's still possible to invest in new antibiotics and strictly control the ones that still work.
- vacri 13y ago
  If given the option, you can decline antibiotics for minor ailments.
doktrin 13y ago
> Last year, the chief medical officer for England, Prof Dame Sally Davies, said the rise in drug-resistant infections was comparable to the threat of global warming. Perhaps I lack proper context, but drug-resistance terrifies me significantly more than global warming. Primarily, I think, because we are still speculating about the consequences of climate change - if not so much its causes. In contrast, we know what a world without antibiotics looks like, and it's pretty horrifying.
- _dark_matter_ 13y ago
  I completely agree with you. Maybe this was a subtle way to get the public to understand the catastrophe that is global warming as well...
- luckyno13 13y ago
  My concern with this line being drawn is the risk of people drawing a line between them and then transferring the overwhelming amount of skepticism of climate change to such a serious topic as this. All we need is to give the anti-vaccine nuts another reason to shit all over herd immunity.
  - chc 13y ago
    Both are pretty serious topics.
  - ams6110 13y ago
    I get what your're saying (I think) but vaccine != antibiotic. We're not (that I've heard) seeing the emergence of vaccine-resistant polio for example.
    - luckyno13 13y ago
      Right, I get that, but this article mentions vaccinations as part of preventive care.
    - akiselev 13y ago
      Polio? Maybe not yet, but "vaccine resistance" isn't the same thing as antibacterial resistance. Antibiotic resistance is generally created through contact with the antibiotic but stuff like polio, measles, mumps, and rubella just need an unvaccinated host coming into contact with vaccinated people long enough. Once the unvaccinated host's disease mutates enough (and it never stops mutating), it will start jumping to vaccinated hosts whose immune systems no longer recognize the threat as one it has prepared for by the vaccine [1][2]. [1] http://www.nejm.org/doi/full/10.1056/NEJMoa060775 http://www.nejm.org/doi/full/10.1056/NEJMoa060775 [2] http://www.sciencedirect.com/science/article/pii/S0264410X02006278 http://www.sciencedirect.com/science/article/pii/S0264410X02...
luckyno13 13y ago
The threat we now are facing with these resistant strains of bacteria are the main reason I got interested in the Public Health field. I am only in my second semester, going part time, but look forward to trying to address the growing need for infectious treatment "reform."
- dopkew 13y ago
  We may eventually need to have a compulsory hospital stay (or something else) for antibiotic treatment so that a patient treated with an antibiotic does not have any leftover resistant pathogens to transfer to the public.
  - Fomite 13y ago
    Given the amount of antibiotic resistant bugs that live in hospitals, I'm highly skeptical that longer hospital stays will result in decreased colonization with resistant species.
mullingitover 13y ago
Oddly enough, I can't find a single reference to farms using antibiotics as a growth enhancer in this article. Isn't that the single biggest source of antibiotic-resistant bacteria?
- luckyno13 13y ago
  From what I understand, it isn't usually used as a growth enhancer (I may be wrong) but used because of the way livestock is maintained. When you have cows being kept standing in one place to maintain lean meat, they develop infections more so than being able to walk somewhere other than their own feces. So to keep production up and infections down, the livestock gets pumped full of antibiotics.
  - maxerickson 13y ago
    Huge amounts of ionophores [1] are used as feed additives. That class of drugs is not used therapeutically in humans. I think other antibiotics are also used quite extensively as feed additives, but I'm less clear on them. If you search on 'vancomycin feed additive', you see discussion about replacing it with other drugs. There are health benefits to the animals (the drugs prevent 'bloat'), but they also increase the weight gain per pound of feed, which the farmer (rancher? lot manager?) is going to take into account. [1]http://en.wikipedia.org/wiki/Ionophore http://en.wikipedia.org/wiki/Ionophore
- CapitalistCartr 13y ago
  Yup. "The isolation of antibiotic-resistant Salmonella from Retail Ground Meats" in The New England Journal of Medicine. http://www.foodpoisonjournal.com/uploads/file/retailmeat.pdf http://www.foodpoisonjournal.com/uploads/file/retailmeat.pdf
- anigbrowl 13y ago
  Agricultural use of antibiotics has definitely been an issue, but perhaps they're trying to state narrow conclusions in the name of scientific rigor. Fortunately, in the US at least, the practice is being discontinued. http://www.fda.gov/animalveterinary/guidancecomplianceenforcement/guidanceforindustry/ucm216939.htm http://www.fda.gov/animalveterinary/guidancecomplianceenforc...
melling 13y ago
Isn't this caused because some countries make antibiotics easily accessible without a doctor?
- cstross 13y ago
  Yes; there are perverse disincentives built into the profit mechanism underpinning the commercial pharmaceutical industry. Patents on antibiotics last no longer than on any other type of medicine (20 years, minus the substantial time taken to test it, jump through regulatory hoops, and bring it to market -- typically 8-14 years). The cost of meeting those regulatory prerequisites is measured in the hundreds of millions of dollars in the USA alone -- more if you want to get a product license everywhere worldwide. So you need to earn back several hundred million bucks in profit in a single-digit period of years ... But antibiotics are unprofitable. A typical AB course lasts 5-14 days after which the patient is completely cured. Compare with antidepressants or ADHD drugs -- where you get a customer for life! Which would you invest in, if you were in that business -- a product 10% of the population will use annually for a week, or a product 10% of the population will be hooked on for life? It's not a coincidence that research into new antibiotics ground to a halt in the 1970s around the time that the regulatory barriers to entry rose so high that small and medium scale pharmaceutical companies were frozen out of the business and the surviving operators were the large conglomerates. (Disclaimer: wearing my ex-pharmacist hat here.)
  - dopkew 13y ago
    I saw a documentary in which it was said that another disincentive to antibiotic research is that its very use causes its effectiveness (for the general population) to reduce, due to antibiotic resistance. So that it would eventually stop selling. It is not so in the case of medicines for BP, diabetes etc. We may eventually need to have a compulsory hospital stay (or something else) for antibiotic treatment so that a patient treated with an antibiotic does not have any leftover resistant pathogens to transfer to the public.
- regoldste 13y ago
  I think it's also occurring in part because of doctors who are prescribing aggressive and often unnecessary courses of antibiotics. I expect this is at least one explanation for why (as the article notes) antibiotics are ineffective at treating more than half of urinary tract infections caused by E. Coli. One standard treatment for persistent, recurrent UTIs in women is to prescribe a prophylactic antibiotic to be taken post-coitally, which typically means that a woman takes a pill irregularly--either every time after she has sex or once a week. This can last for years, without the doctor reevaluating the necessity of the treatment. While this is completely necessary for truly severe, recurring cases, I've seen several doctors prescribe this casually to women who don't have recurring UTIs but request it anyway. This is detrimental for the community and the patient, who has a higher risk of developing drug-resistant infections. I think one way to address this problem is making doctors more aware of the community-wide effects of aggressive courses of treatment, informing them about alternative treatments that don't involve antibiotics, and encouraging them to use aggressive courses of antibiotics (such as prophylacticly for recurrent UTIs) as a treatment of last-resort.
denzil_correa 13y ago
Isn't (one of the reasons) this due to excessive use of antibiotics?
- luckyno13 13y ago
  Yes, excessive use in not only humans, but in livestock.
  - majkinetor 13y ago
    You are wrong. Excessive use in livestock contributes a lot given that 40% of worlds AB's are used for growth promotion and we eat that junk.
    - skj 13y ago
      When you say "You are wrong.", that indicates that you disagree. But the rest of your comment indicates that you agree. Could you clarify?
      - majkinetor 13y ago
        Ah, I misread that, didn't see that tiny "not". Yes, he is right :)
Orangeair 13y ago
Is there any particular reason we can't just create new antibiotics? Is there something inherent in the current design of antibiotics that prevents creating new versions of what we have? If so, is there an 'upper limit' of how many we can create, and have we reached it already?
- pygy_ 13y ago
  It's an active research topic, and little progress has been made recently. You'd have to find a new class of drugs that is safe for humans at the toxic dose for bacteria.
- FooBarWidget 13y ago
  The reason is that creating antibiotics is not profitable enough, and so 15 years ago pharmas stopped most research on them.
  - refurb 13y ago
    Not sure why this was down voted because it's true. Only a few big pharma have R&D programs in the antibacterial space. As a reply above states, the current system penalizes new antibiotics by reserving them for only the most severe cases. With the cost of a new antibiotic approval in the hundreds of millions of dollars, companies put their R&D dollars into areas with better returns. That being said, a few new legislative changes have happened and will happens (GAIN Act approved, DISARM Act being considered) that will change the economics of antibiotic research and have already prompted drug companies to get back into the field.
- majc2 13y ago
  Apparently not. This article (http://www.telegraph.co.uk/finance/newsbysector/pharmaceuticalsandchemicals/9010738/The-battle-to-discover-new-antibiotics.html http://www.telegraph.co.uk/finance/newsbysector/pharmaceutic...) suggests its a case of economics. That is new antibiotics would be kept back as a last line of defence only; therefore not as profitable.
  - 13y ago
kayoone 13y ago
So every few weeks we get these news but this isn't reversible anyway i guess. Does this basically mean a lot more people will die from simple infections starting 1-2 years from now ? How likely is it that new antibiotics will be developed ? By reading articles like these it sounds like we are facing a massive increase in deaths from illnesses, yet the general public doesn't seem to care much. Genuinely curious.
- refurb 13y ago
  Does this basically mean a lot more people will die from simple infections starting 1-2 years from now ? No, the problem is not that severe right now. In fact, some of the antibiotic resistant infections have decreased over the last few years. This is something we need to worry about 5-10+ years from now. It is inevitable that bacteria will become resistant to current antibiotics. The only way to keep ahead of them is to create new antibiotics.
  - midas007 13y ago
    Exactly. But because of the difficulty, time and capital requirements, this is something that can't be left to the market economics. It will be too late by the time we need them because of the years it takes to develop a single new drug. This is a "going to the moon" type thing that needs to happen if we intend to survive. Because that's what's at stake.
    - alexeisadeski3 13y ago
      >But because of the difficulty, time and capital requirements, this is something that can't be left to the market economics. It will be too late by the time we need them because of the years it takes to develop a single new drug. Isn't this exactly what people used to say about the food supply?
      - midas007 13y ago
        Nope. It is what it is: capital-intensive research that is hard and it takes a long time to come up with a molecule that will stop an infection without killing or disabling the patient. That can't be done last minute like in the movies. FYI: One of the last-ditch antibiotics (I forget the name) has a side-effect of permanently damaging hearing. I have to basically yell at 95 yo grandmother for her to hear me. :)
ams6110 13y ago
I have long thought that humans (at least those living in the first world) had developed civilization to a point where natural selection was not really operating anymore. We can shelter ourselves, feed ourselves, and cure illnesses and injuries so well that almost all of us live to reproduce and raise our children to the point where they can take care of themselves. We haven't even had a large-scale war in the time that most of us have been alive. But on evolutionary timescales, we've really lived this way for only the blink of an eye. So maybe I'm wrong. This is a reminder that we live in a larger ecosystem that we really have a lot less control over than we might think. Nature has a way of keeping things in balance, and it's never pretty.
tokenadult 13y ago
Here is a link to the World Health Organization media release[1] about the new WHO report, which links to a fact sheet summary[2] of the findings, and to the full report.[3] What's new here is the comparative data from different countries. It has been known for a while that multidrug-resistant tuberculosis is a grave problem in India,[4] for example, but the new report makes clear that antibiotic-resistant microorganisms that cause major human disease are present all over the world. Some of the other comments posted here ask, well, what can we do about this? A submission to Hacker News from 189 days ago linked to a PBS report about the views of a Centers for Disease Control and Prevention epidemiologist in the United States[5] who advocated specific policy changes, some of which have been adopted since then. The discussion of that submission (including one of my highest-karma-ever comments[6]) provides more perspective on some biological evolution issues that are being brought up again in today's discussion here. [1] http://www.who.int/mediacentre/news/releases/2014/amr-report/en/ http://www.who.int/mediacentre/news/releases/2014/amr-report... [2] http://www.who.int/mediacentre/factsheets/fs194/en/ http://www.who.int/mediacentre/factsheets/fs194/en/ [3] http://www.who.int/drugresistance/documents/surveillancereport/en/ http://www.who.int/drugresistance/documents/surveillancerepo... [4] http://online.wsj.com/news/articles/SB10001424052702303444204577460734274201756 http://online.wsj.com/news/articles/SB1000142405270230344420... http://articles.economictimes.indiatimes.com/2013-06-23/news/40134749_1_stop-tb-department-mario-raviglione-jmm-meeting http://articles.economictimes.indiatimes.com/2013-06-23/news... http://www.iom.edu/Reports/2012/Facing-the-Reality-of-Drug-Resistant-Tuberculosis-Challenges-and-Potential-Solutions-in-India.aspx http://www.iom.edu/Reports/2012/Facing-the-Reality-of-Drug-R... http://www.tbcindia.nic.in/pdfs/RNTCP%20Response%20DR%20TB%20in%20India%20-%20Jan%202012%20update.pdf http://www.tbcindia.nic.in/pdfs/RNTCP%20Response%20DR%20TB%2... [5] https://news.ycombinator.com/item?id=6599040 https://news.ycombinator.com/item?id=6599040 [6] https://news.ycombinator.com/item?id=6599795 https://news.ycombinator.com/item?id=6599795
- chez17 13y ago
  In America, the number one thing you can do is stop eating factory farmed meat. That is a huge contributor to antibiotics resistance. Either eat mainly vegan or spend the few extra dollars to buy meat that isn't gross. Remember, it is MORE EXPENSIVE in the long run to buy that cheap meat. When you have a routine infection that can't be cured with antibiotics, the hospital bills will be far more then the few dollars you saved. Eat less meat. Oh, and you'll massively reduce your carbon footprint as well, and you'll use less land and water, and you'll be healthier (if you cut out red meat). It really is a no brainer.
volune 13y ago
time to buy an auto-clave
- MichaelGG 13y ago
  Sterilizing things you own is unlikely to help. You'd reduce any naturally acquired resistance, yet still remain vulnerable to getting infected from the entire world you cannot sanitize.
ScotterC 13y ago
What are the limiters to creating new, stronger antibiotics to beat the resistant strains?
- WalterSear 13y ago
  Same as everything else: money and attention.
- jacquesm 13y ago
  The one limit seems to be that even if we did that the bacteria will evolve to become resistant against those as well. This is a game of leap-frog, we've been ahead for a while, now we'll be behind for a while and so on. Think of it as a very slow arms race where on the one side there is intelligence and design and on the other there is the lottery driven mechanism of evolution that rewards the solver of the newly posed problem with a very large number of offspring. The sides are surprisingly well matched and short of total eradication this is likely going to be the game for the next foreseeable future. The bigger challenge will be to restrain ourselves to consume much more limited amounts if and when we do find antibiotics that work again in order to lengthen the time that we're 'on top'.
  - midas007 13y ago
    That's part of it, but this is something governments have to take leadership on right now. That will only happen with direct pressure. Waiting until it's the leading cause of death will be too late, because of drug development pipeline timeframes.
  - ScotterC 13y ago
    You'd think the companies behind creating this technology would welcome the never-ending arms race. They get to keep releasing products while their old ones get cannibalized for them.
- DanBC 13y ago
  Stuff that kills bacteria has to also not kill people. I saw a TV programme where scientists had a big tray of nutrient gel. They divided the tray into sections. The fist section was normal nutrient gel. The next contained a normal dose of antibiotic. The next section was 10x, the next section was 100x and the final section was 1000x a regular dose. This was far more than humans could tolerate. They stopped at 1000x because that was the limits of solubility - they couldn't disolve more antibiotic into the gel. Scientists then dropped a bit of e.coli on the normal gel and set their time lapse cameras. In just a few weeks the bacteria had evolved to live on all sections of the gel. (This was a BBC 'Horizon' programme called "defeatng the superbugs")
majkinetor 13y ago
Antibiotic resistance is a fact, what else can you expect given the game rules. What is less well known is that majority of people do not need antibiotics anyway and that majority of those who were taking them probably didn't need them too. Advice that recommended AB's before for stuff like otitis, helicobacter infection or even common cold (given for this disease because of opportunistic infections) is now changing without any problems, if anything, for the better. AB's should be saved for those few moments in life where you really need them and is not something you want to do every few months like majority of people, particularly kids. There are far better ways to strengthen your body and immune system without risks that are overwhelming with AB's (which are way better known today after we have some bits of microbiome) - nutrition and supplements. Even measures like using viruses as antibiotics are probably better then popping AB's like candies. This news is probably beginning of the "next big big pharma thingy" that will come to rescue and will typically, yet again, use inappropriate tool for the job. The only good that will come out of it are probably not going to be, however, lives saved but science advancement.
midas007 13y ago
On a personal note, my mom is still under the weather, having stuck to three different courses of antibiotics for a simple nasal infection. It's frightening when this becomes the norm, not the exception because we're basically running out of options by natural selection moving faster than research. We need a crash program to develop antibiotics before it's too late.
k-mcgrady 13y ago
Are there any potential alternatives to antibiotics? For example could nanotechnology be used?
- majkinetor 13y ago
  Yes, bunch of alternatives: - bacteriophages (viruses that kill bacteria) - vitamin C for some bacteria, vitamin D, other supplements like MSM. Most must be used in megadoses for this effect. - plant AB's (onion, black pepper, curcumin, the list is enormous and probably infinite)
  - jmpe 13y ago
    There's a very good documentary about bacteriophages: http://www.youtube.com/watch?v=U6sZ7E9Hh-Y http://www.youtube.com/watch?v=U6sZ7E9Hh-Y It's history is muddied, mainly because of money & politics.
    - majkinetor 13y ago
      Apart from 'sacred rivers' the best known example is probably your mouth - viruses do kill majority bacteria there until you start to adopt non-natural cleaning systems (i.e. toothpaste) and carb overflowing you are actually making thing worse.
  - Fomite 13y ago
    Bacteriophages, while fun, and something I once wanted to work in, are nowhere near as "point and click" efficacious as antibiotics are, even under the most optimistic scenarios.
RV86 13y ago
Best case scenario is that we find a way to get back in front of the mutations, but even that would just be buying time before the bacteria adapted again. On a long time scale, it's hubris to think we can stay in front indefinitely. We'd be better off improving our relationship with/attitude toward death on the whole.
patrickdavey 13y ago
Yip, this is definitely a serious threat, one that will affect the rich in ways that climate change won't so immediately do. Probably a good thing in terms of finding a solution ;) I did come across (I forget where) a very interesting talk which was outlining new techniques in antibiotics. The basic idea was that instead of straight out killing them (in which some breed resistance) instead you get in the middle of their chemical signals and basically tell them to attach before they've reached the point where the immune system won't win. Still, bacteria being bacteria they'll probably work their way around it, but maybe rewriting your messaging system is a little harder than breeding resistance.
HarryHirsch 13y ago
Another worrying development: Pfizer buying Astra-Zeneca. It's not to streamline drug development, the deal is a tax dodge in its entirety. Some lovely commentary down the hallway, in the Pipeline: http://pipeline.corante.com/archives/2014/04/28/pfizer_and_astrazeneca_what_the_hell.php http://pipeline.corante.com/archives/2014/04/28/pfizer_and_a... Scientists worry about the cuts to NIH funding, but the cuts to pharmaceutical research are ten times more worrying - who is going to develop the compounds to replace the current set of antibiotics when they have become useless? Wall Street is entirely unequipped to deal with this question; there are things that cannot be bought with money or at market, and scientific progress is one of them.
- refurb 13y ago
  Pfizer got out of antibacterial R&D a few years back. And I have to take issue with your comment "scientific progress can't be bought with money". What do you call all the new drugs that have been produced in the last century? It wasn't done by the government. Yes, basic research funded by the NIH advanced basic science, but it didn't put those pills in a bottle.
- Fomite 13y ago
  "who is going to develop the compounds to replace the current set of antibiotics when they have become useless" - Academic science. Most of the basic, foundational research in clinical medicine is done by academia, not the pharmaceutical industry.
- lotsofmangos 13y ago
  who is going to develop the compounds to replace the current set of antibiotics when they have become useless? IBM, with nanotech PET - http://www.research.ibm.com/articles/nanomedicine.shtml#fbid=klilCTIj3Vr http://www.research.ibm.com/articles/nanomedicine.shtml#fbid... And I know it is viruses, not bacteria, but MIT's DRACO is also pretty cool - http://www.ll.mit.edu/news/DRACO.html http://www.ll.mit.edu/news/DRACO.html
lightblade 13y ago
Instead of developing more antibiotics, can we reengineer these disease bacterias with a kill switch built in? Then release them into the wild to compete with non-engineered species and eventually displace them?
- slinkyavenger 13y ago
  You would have to also engineer an evolutionary advantage - something that would make them likelier to survive in the wild than their non-engineered counterparts. Building in a 'kill switch' by its very nature gives engineered bacteria a huge disadvantage, meaning there'd have to be something else making them more likely to reproduce. It would probably be a better use of time engineering the bacteria to be harmless to humans, negating the need for a course of drugs to kill it off.
jmzbond 13y ago
I think to make a dent in this problem we need to change many aspects of our culture and how we live: 1) that any annoying problem should have an immediate and rapid solution so that we can get on with our lives, 2) that we as people need to live in a bubble ecosystem from the rest of the natural world. 1) I stopped taking most medicines awhile ago because I realized that by relying on symptomatic relief, I wasn't actually listening to the needs of my body. Now when I feel a cold coming on, I start sleeping at 9pm, eat healthier, and reduce stress levels. Instead of popping a pill, I've learned to recognize that I'm deviating from "healthy" activity and had better get on track. The result? I haven't been sick in years and years, and am probably overall a more healthy, less stressed out person. 2) I often wonder to what degree language affects perception. Like the word dirty having such a negative stereotype yet so associated with dirt (i.e., soil). I feel like we often want such high levels of sterility that are just absurd, and do more to harm us in the long run. As part of a project, I interviewed farmers who said food safety experts are so draconian they expect cannons that shoot into the air to prevent birds from flying over with the risk of droppings. One food safety inspector commented that the farm was too "dirty." Can you imagine? I understand we don't want to get sick, there are bad things in the world, but I think we're pushing too far into the other end of the spectrum.
3rd3 13y ago
There are multiple kinds of antibiotics, right? Couldn’t one globally rotate the different kinds of antibiotics so that germs have a harder time adapting to it?
- refurb 13y ago
  Not really. Resistant strains of bacterial exist everywhere. Every area in the world needs the full range of current antibacterials. The other thing to remember is international travel. It's pretty easy for someone in North America, who has a resistant bacterial infection, to hope on a plane and spread it around Europe.
deleted 13y ago
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gabriel34 13y ago
I would like to know why wouldn't it work to simply flood hospital rooms (any time they were empty) with lethal (for bacteria) doses of non-ionizing radiation (or any kind that doesn't go through walls and don't make said walls radioactive) so that those pesky tolerant strains have a really hard time propagating
- refurb 13y ago
  Most of the transmission of infections is from human to human contact. Yes, bacteria can reside on equipment and facilities, but we have adequate measures to deal with that. As an interesting aside, more and more copper is being used in medical equipment as it is naturally antibacterial. http://en.wikipedia.org/wiki/Antimicrobial_properties_of_copper http://en.wikipedia.org/wiki/Antimicrobial_properties_of_cop...
chris_va 13y ago
(source: doing research into this) For those with a computational/hacker background wanting to make a difference: There is actually a lot of opportunity in the Computational Biology/Drug Development/Genomics space, with the caveat that it is a very difficult field (especially for company creation). It's a lot easier for CS folks to build another no-SQL database than it is to build a ML framework for, say, cancer prediction, but the opportunity is there. A lot of folks in this space come from the bio side, and teach themselves programming. Very few folks come from the CS side, and partner with the biologists. As a result, there is a giant gap between what is possible for a computer scientist and what is currently being executed. The state of the art in this space will probably make you all very sad. I will pay $$ for engineers to work on this: I have a side project working with an academic lab to develop a new antibiotic to target drug resistant beta lactamase (the primary protein associated with drug resistance) using a relatively novel computational approach. Sadly I've been distracted by my primary job, but if you are interested let me know. I am based in SF.
- Houshalter 13y ago
  It's something I am interested in getting into, but I don't even know where to start.
jmcmichael 13y ago
One alternative to antibiotics that may work, but will have a tremendous difficulty in clearing the regulatory burden for approving new drugs and medical procedures, is bacteriophage therapy.[1] Nobody's going to fund or approve this in the West anytime soon: - phage therapists often use cocktails of phages to treat their patient. This type of treatment isn't even on the FDA's map - it even takes years for compounds of conventional drugs to be approved. - phage therapists often prepare customized phage cultures to treat a specific patient's infection. The FDA would likely view this a a crime and prosecute anyone trying it. - phage therapies have been around for over 100 years and are likely unpatentable. No drug company will fund R&D on the technique and no venture capitalist will fund a scrappy startup. [1] http://en.wikipedia.org/wiki/Phage_therapy http://en.wikipedia.org/wiki/Phage_therapy
- DennisP 13y ago
  Then maybe we should change the way we regulate medical treatments. And maybe how we fund some of the research.
mvembu 13y ago
Homeopathy offers remedies for antibiotic resistant infections. I had a relative who had severe infection post knee replacement surgery. She was operated 4 times due to this infection as the bacteria is considered antibiotic resistant. A classical homeopath treated her to recover from the infection. This is the bacteria that caused the post surgery infection http://en.wikipedia.org/wiki/Acinetobacter_baumannii http://en.wikipedia.org/wiki/Acinetobacter_baumannii Here is a relevant article on how Homeopathy provides an alternative to antibiotics http://aurumproject.org.au/homeopathy-alternative-antibiotics/ http://aurumproject.org.au/homeopathy-alternative-antibiotic...

359 points by k-mcgrady 13y ago

Whilst I totally appreciate the seriousness of this, I still don't get what exactly I can do about this. Most likely, nothing. Therefore, much like the potentially developing WW3 in Ukraine, or Ebola outbreak in Africa, or rape culture in India, this kind of news is fairly useless. It just creates negative feelings with no positive outcome. I'm happy to be convinced otherwise - what can I do about this?

luckyno13 13y ago
The best thing you can do is keep informed, and keep others around you informed. Many people don't realize this is such a rapidly progressing issue. In fact, many people may not even know that they are improperly taking their Antibiotics and what the side effects are to doing so. If more informed I feel like the public could do a bit better at turning down Antibiotics when they aren't necessary, and using them properly when they are. Just that action would go a long way. Edit- I would also like to add that a lot of people don't realize just how easy it is to get an infection, and education could go a long way in keeping it from happening in the first place. It reminds me of that guy on reddit with the horrible case of necrotizing fasciitis that he ended up with after retrieving a football from a koi pond. His day by day imgur chronicle was both interesting and horrifying.
- midas007 13y ago
  It doesn't have to be that way, and waiting around for "someone else to handle it" will likely lead to a Tragedy of the Commons. Call your representatives [US: 0,1] or regional government representative (I just called my senator, and on hold for house rep now), tell them we need an emergency crash program to develop new, tightly-regulated antibiotics so that infection doesn't become the leading cause of deaths in 2025. Because it takes years and billions to develop new antibiotics, this is something companies will not pursue on their own initiative. If not, it'll be a return to the 19th century. Good luck with that. [0] http://www.house.gov/representatives/find/ http://www.house.gov/representatives/find/ [1] http://www.senate.gov/general/contact_information/senators_cfm.cfm?OrderBy=state&Sort=ASC http://www.senate.gov/general/contact_information/senators_c...
  - refurb 13y ago
    You're not going to have new antibiotics without biotech or pharmaceutical companies helping. The government needs to provide incentive for antibiotic research, right now regulatory and reimbursement issues are making the therapeutic area very unattractive.
goldenkey 13y ago
Antibiotics work on a specific mechanism of action. See here: http://en.wikipedia.org/wiki/List_of_antibiotics http://en.wikipedia.org/wiki/List_of_antibiotics New mechanisms of action are needed, more specifically, mechanisms that evolution cannot biologically defeat. Consider an agent like bleach, 99.99% effective because the makeup of a cell does not really permit it to protect against such a caustic agent. Clearly bleach can't be used as an antiobitic but I use it to illustrate the point that a evolutionary-unlikely antibiotic mechanism would be worldly profound.
- timr 13y ago
  You're right, but here's the problem: things that are robust to evolutionary change tend to kill everything (e.g. chlorine). There's a tension between finding targets that are specific to an organism, but well conserved, so that the organism can't simply evolve away from the specific threat. This is really the alpha and the omega of antibiotics and antiviral research: finding the specific lethal target that can't easily be changed. It's damned hard, and it's why most of our antibiotics have been generated by nature, not by rational design.
  - mikeash 13y ago
    As usual, there's a relevant xkcd: https://xkcd.com/1217/ https://xkcd.com/1217/ It's easy to kill bacteria, viruses, cancer, you name it. We have lots of tools that can kill them, from guns to flame throwers to acid. The trick is killing them without also killing the patient, as you say.
  - Already__Taken 13y ago
    So we need to make it another 50-100 year range so we can just replace it with robots?
    - timr 13y ago
      Hehe...the future is now, sort of. We already have robots that can screen large libraries of chemicals against bacteria for antibiotic effectiveness.
k-mcgrady 13y ago
>> "Whilst I totally appreciate the seriousness of this, I still don't get what exactly I can do about this. Most likely, nothing." I think you can help by informing others. If you know a family member not completing their course of antibiotics for example explain to them why it's so important.
dfxm12 13y ago
If your doctor is prescribing you an antibiotic, you can ask them what the pros and cons are of taking it. If you are willing to deal with the cons, then maybe don't take the antibiotic. Usually, the con will be that you feel sick for a bit longer. Note though, that you might need them to get over whatever it is you have.
- swalkergibson 13y ago
  This is absolutely accurate. "People were generally aware of the link between overuse of antibiotics and increased resistance. Only 8% of respondents did not agree that if antibiotics are taken too often they are less likely to work in the future. But many people (43%) incorrectly believed that antibiotics were effective in viral conditions." http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1934431/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1934431/
artmageddon 13y ago
I will echo lucky's sentiment - staying educated, and educating others around you, goes a big way. I know people very close to me who still believe it's okay to stop taking antibiotics the moment they feel better, rather than finishing out the entire prescription. I'd like to believe that buying meat / other foods that aren't treated with antibiotics could make a difference as well, but I'm not sure how much impact that would have.
FooBarWidget 13y ago
Not sure why swombat got downvoted, he makes good points. Heck, once in a while, an HN submission for along the lines of "Why reading news is harmful and why you shouldn't read it" goes by, and it gets upvoted a lot. What can the general public do about this? It's not like I can go to my family physician and tell him to use less antibiotics (he already doesn't; I'm in the Netherlands), and expect to make any kind of meaningful difference. This is one of those "tragedy of the commons" kind of problems that can only be solved if everybody cooperates.
pessimizer 13y ago
Be educated about it, and educate others. Eventually, you will be called on to vote on something, and some intrenched interest will try to convince you that it is an encroachment of big government on the sovereignty of job creators. Good luck trying to teach them then.
exratione 13y ago
Donate to research groups that are working on ways of controlling bacterial and viral infections that are a step beyond the present status quo. Things like DRACO [1] spring to mind. Present day fundamental (as opposed to translational) biomedical research is very cheap in comparison to the state of things even a decade or two ago. Small fundraising groups can make a big impact now. [1]: https://en.wikipedia.org/wiki/DRACO_(antiviral) https://en.wikipedia.org/wiki/DRACO_(antiviral)
coenhyde 13y ago
Pressure your government (where ever you may be) to make responsible use of antibiotics a priority. The misuse that terrifies me the most are antibiotics used on livestock. Particularly the antibiotics that are also used on humans. In my opinion antibiotics should not be used as a growth promoter and only used to help sick animals.
- sgk284 13y ago
  > should not be used as a growth promoter and only used to help sick animals The issue is that a lot of animals get sick from being crammed together in small areas, unable to move, while living in their own feces and urine. If we regulated animal treatment better and required certain living conditions for animals they wouldn't get sick nearly as often and wouldn't need nearly as many antibiotics. As it stands, regulating antibiotics to be used only on sick animals wouldn't change much since an incredibly large percentage of livestock are often sick (as a consequence of living conditions).
  - midas007 13y ago
    I don't eat meat or consume animal-derived products for this reason. This is where the next pandemic is mostly likely to originate, and it's completely preventable.
    - tomp 13y ago
      Unless you also avoid meat for other reasons, wouldn't it be better to eat meat, but only from those farmers that raise livestock in humane, sustainable conditions (organic/free range/...)? That would increase competition and support their business models.
  - coenhyde 13y ago
    You're right. This needs to change as well.
- midas007 13y ago
  That's one side, the other side would be a crash program to develop a spectrum of closely-guarded, last-resort antibiotics.
Slackwise 13y ago
The primary source of antibiotic abuse is in farm animals. Do you really want to help? Start eating less meat, and tell others to also do so. Tell them why. Tell them to also tell others. When there is less demand for meat, then there will be less land devoted to animal feed/grazing, and more to food crops. Less animals that can be infected, less antibiotics used, etc, etc. Want to really help solve it? Don't eat meat. Get others to stop eating meat. Invest in faux/lab-grown meat companies. Disease free meat can be grown. We just need to make it profitable. Honestly, this is the future. Farming like this is unsustainable, not only for the antibiotic reasons. (I'll spare everyone the ethical/transhumanist discussion.)
- azth 13y ago
  > Want to really help solve it? Don't eat meat. Get others to stop eating meat. Why not just get meat from farms that treat their animals properly (no cramming, free-range, etc)? I don't think it should be this extreme.
- pound 13y ago
  red meat is high in iron and anemia is not nice. of course there are other sources of iron, i'm just saying that stopping eating meat should go with balancing diet.
Houshalter 13y ago
That's true for pretty much all significant news. And it's not like we are helpless, it's still possible to invest in new antibiotics and strictly control the ones that still work.
vacri 13y ago
If given the option, you can decline antibiotics for minor ailments.

doktrin 13y ago

> Last year, the chief medical officer for England, Prof Dame Sally Davies, said the rise in drug-resistant infections was comparable to the threat of global warming. Perhaps I lack proper context, but drug-resistance terrifies me significantly more than global warming. Primarily, I think, because we are still speculating about the consequences of climate change - if not so much its causes. In contrast, we know what a world without antibiotics looks like, and it's pretty horrifying.

_dark_matter_ 13y ago
I completely agree with you. Maybe this was a subtle way to get the public to understand the catastrophe that is global warming as well...
luckyno13 13y ago
My concern with this line being drawn is the risk of people drawing a line between them and then transferring the overwhelming amount of skepticism of climate change to such a serious topic as this. All we need is to give the anti-vaccine nuts another reason to shit all over herd immunity.
- chc 13y ago
  Both are pretty serious topics.
- ams6110 13y ago
  I get what your're saying (I think) but vaccine != antibiotic. We're not (that I've heard) seeing the emergence of vaccine-resistant polio for example.
  - luckyno13 13y ago
    Right, I get that, but this article mentions vaccinations as part of preventive care.
  - akiselev 13y ago
    Polio? Maybe not yet, but "vaccine resistance" isn't the same thing as antibacterial resistance. Antibiotic resistance is generally created through contact with the antibiotic but stuff like polio, measles, mumps, and rubella just need an unvaccinated host coming into contact with vaccinated people long enough. Once the unvaccinated host's disease mutates enough (and it never stops mutating), it will start jumping to vaccinated hosts whose immune systems no longer recognize the threat as one it has prepared for by the vaccine [1][2]. [1] http://www.nejm.org/doi/full/10.1056/NEJMoa060775 http://www.nejm.org/doi/full/10.1056/NEJMoa060775 [2] http://www.sciencedirect.com/science/article/pii/S0264410X02006278 http://www.sciencedirect.com/science/article/pii/S0264410X02...

luckyno13 13y ago

The threat we now are facing with these resistant strains of bacteria are the main reason I got interested in the Public Health field. I am only in my second semester, going part time, but look forward to trying to address the growing need for infectious treatment "reform."

dopkew 13y ago
We may eventually need to have a compulsory hospital stay (or something else) for antibiotic treatment so that a patient treated with an antibiotic does not have any leftover resistant pathogens to transfer to the public.
- Fomite 13y ago
  Given the amount of antibiotic resistant bugs that live in hospitals, I'm highly skeptical that longer hospital stays will result in decreased colonization with resistant species.

mullingitover 13y ago

Oddly enough, I can't find a single reference to farms using antibiotics as a growth enhancer in this article. Isn't that the single biggest source of antibiotic-resistant bacteria?

luckyno13 13y ago
From what I understand, it isn't usually used as a growth enhancer (I may be wrong) but used because of the way livestock is maintained. When you have cows being kept standing in one place to maintain lean meat, they develop infections more so than being able to walk somewhere other than their own feces. So to keep production up and infections down, the livestock gets pumped full of antibiotics.
- maxerickson 13y ago
  Huge amounts of ionophores [1] are used as feed additives. That class of drugs is not used therapeutically in humans. I think other antibiotics are also used quite extensively as feed additives, but I'm less clear on them. If you search on 'vancomycin feed additive', you see discussion about replacing it with other drugs. There are health benefits to the animals (the drugs prevent 'bloat'), but they also increase the weight gain per pound of feed, which the farmer (rancher? lot manager?) is going to take into account. [1]http://en.wikipedia.org/wiki/Ionophore http://en.wikipedia.org/wiki/Ionophore
CapitalistCartr 13y ago
Yup. "The isolation of antibiotic-resistant Salmonella from Retail Ground Meats" in The New England Journal of Medicine. http://www.foodpoisonjournal.com/uploads/file/retailmeat.pdf http://www.foodpoisonjournal.com/uploads/file/retailmeat.pdf
anigbrowl 13y ago
Agricultural use of antibiotics has definitely been an issue, but perhaps they're trying to state narrow conclusions in the name of scientific rigor. Fortunately, in the US at least, the practice is being discontinued. http://www.fda.gov/animalveterinary/guidancecomplianceenforcement/guidanceforindustry/ucm216939.htm http://www.fda.gov/animalveterinary/guidancecomplianceenforc...

melling 13y ago

Isn't this caused because some countries make antibiotics easily accessible without a doctor?

cstross 13y ago
Yes; there are perverse disincentives built into the profit mechanism underpinning the commercial pharmaceutical industry. Patents on antibiotics last no longer than on any other type of medicine (20 years, minus the substantial time taken to test it, jump through regulatory hoops, and bring it to market -- typically 8-14 years). The cost of meeting those regulatory prerequisites is measured in the hundreds of millions of dollars in the USA alone -- more if you want to get a product license everywhere worldwide. So you need to earn back several hundred million bucks in profit in a single-digit period of years ... But antibiotics are unprofitable. A typical AB course lasts 5-14 days after which the patient is completely cured. Compare with antidepressants or ADHD drugs -- where you get a customer for life! Which would you invest in, if you were in that business -- a product 10% of the population will use annually for a week, or a product 10% of the population will be hooked on for life? It's not a coincidence that research into new antibiotics ground to a halt in the 1970s around the time that the regulatory barriers to entry rose so high that small and medium scale pharmaceutical companies were frozen out of the business and the surviving operators were the large conglomerates. (Disclaimer: wearing my ex-pharmacist hat here.)
- dopkew 13y ago
  I saw a documentary in which it was said that another disincentive to antibiotic research is that its very use causes its effectiveness (for the general population) to reduce, due to antibiotic resistance. So that it would eventually stop selling. It is not so in the case of medicines for BP, diabetes etc. We may eventually need to have a compulsory hospital stay (or something else) for antibiotic treatment so that a patient treated with an antibiotic does not have any leftover resistant pathogens to transfer to the public.
regoldste 13y ago
I think it's also occurring in part because of doctors who are prescribing aggressive and often unnecessary courses of antibiotics. I expect this is at least one explanation for why (as the article notes) antibiotics are ineffective at treating more than half of urinary tract infections caused by E. Coli. One standard treatment for persistent, recurrent UTIs in women is to prescribe a prophylactic antibiotic to be taken post-coitally, which typically means that a woman takes a pill irregularly--either every time after she has sex or once a week. This can last for years, without the doctor reevaluating the necessity of the treatment. While this is completely necessary for truly severe, recurring cases, I've seen several doctors prescribe this casually to women who don't have recurring UTIs but request it anyway. This is detrimental for the community and the patient, who has a higher risk of developing drug-resistant infections. I think one way to address this problem is making doctors more aware of the community-wide effects of aggressive courses of treatment, informing them about alternative treatments that don't involve antibiotics, and encouraging them to use aggressive courses of antibiotics (such as prophylacticly for recurrent UTIs) as a treatment of last-resort.

denzil_correa 13y ago

Isn't (one of the reasons) this due to excessive use of antibiotics?

luckyno13 13y ago
Yes, excessive use in not only humans, but in livestock.
- majkinetor 13y ago
  You are wrong. Excessive use in livestock contributes a lot given that 40% of worlds AB's are used for growth promotion and we eat that junk.
  - skj 13y ago
    When you say "You are wrong.", that indicates that you disagree. But the rest of your comment indicates that you agree. Could you clarify?
    - majkinetor 13y ago
      Ah, I misread that, didn't see that tiny "not". Yes, he is right :)

Orangeair 13y ago

Is there any particular reason we can't just create new antibiotics? Is there something inherent in the current design of antibiotics that prevents creating new versions of what we have? If so, is there an 'upper limit' of how many we can create, and have we reached it already?

pygy_ 13y ago
It's an active research topic, and little progress has been made recently. You'd have to find a new class of drugs that is safe for humans at the toxic dose for bacteria.
FooBarWidget 13y ago
The reason is that creating antibiotics is not profitable enough, and so 15 years ago pharmas stopped most research on them.
- refurb 13y ago
  Not sure why this was down voted because it's true. Only a few big pharma have R&D programs in the antibacterial space. As a reply above states, the current system penalizes new antibiotics by reserving them for only the most severe cases. With the cost of a new antibiotic approval in the hundreds of millions of dollars, companies put their R&D dollars into areas with better returns. That being said, a few new legislative changes have happened and will happens (GAIN Act approved, DISARM Act being considered) that will change the economics of antibiotic research and have already prompted drug companies to get back into the field.
majc2 13y ago
Apparently not. This article (http://www.telegraph.co.uk/finance/newsbysector/pharmaceuticalsandchemicals/9010738/The-battle-to-discover-new-antibiotics.html http://www.telegraph.co.uk/finance/newsbysector/pharmaceutic...) suggests its a case of economics. That is new antibiotics would be kept back as a last line of defence only; therefore not as profitable.
- 13y ago

kayoone 13y ago

So every few weeks we get these news but this isn't reversible anyway i guess. Does this basically mean a lot more people will die from simple infections starting 1-2 years from now ? How likely is it that new antibiotics will be developed ? By reading articles like these it sounds like we are facing a massive increase in deaths from illnesses, yet the general public doesn't seem to care much. Genuinely curious.

refurb 13y ago
Does this basically mean a lot more people will die from simple infections starting 1-2 years from now ? No, the problem is not that severe right now. In fact, some of the antibiotic resistant infections have decreased over the last few years. This is something we need to worry about 5-10+ years from now. It is inevitable that bacteria will become resistant to current antibiotics. The only way to keep ahead of them is to create new antibiotics.
- midas007 13y ago
  Exactly. But because of the difficulty, time and capital requirements, this is something that can't be left to the market economics. It will be too late by the time we need them because of the years it takes to develop a single new drug. This is a "going to the moon" type thing that needs to happen if we intend to survive. Because that's what's at stake.
  - alexeisadeski3 13y ago
    >But because of the difficulty, time and capital requirements, this is something that can't be left to the market economics. It will be too late by the time we need them because of the years it takes to develop a single new drug. Isn't this exactly what people used to say about the food supply?
    - midas007 13y ago
      Nope. It is what it is: capital-intensive research that is hard and it takes a long time to come up with a molecule that will stop an infection without killing or disabling the patient. That can't be done last minute like in the movies. FYI: One of the last-ditch antibiotics (I forget the name) has a side-effect of permanently damaging hearing. I have to basically yell at 95 yo grandmother for her to hear me. :)

ams6110 13y ago

I have long thought that humans (at least those living in the first world) had developed civilization to a point where natural selection was not really operating anymore. We can shelter ourselves, feed ourselves, and cure illnesses and injuries so well that almost all of us live to reproduce and raise our children to the point where they can take care of themselves. We haven't even had a large-scale war in the time that most of us have been alive. But on evolutionary timescales, we've really lived this way for only the blink of an eye. So maybe I'm wrong. This is a reminder that we live in a larger ecosystem that we really have a lot less control over than we might think. Nature has a way of keeping things in balance, and it's never pretty.

tokenadult 13y ago

Here is a link to the World Health Organization media release[1] about the new WHO report, which links to a fact sheet summary[2] of the findings, and to the full report.[3] What's new here is the comparative data from different countries. It has been known for a while that multidrug-resistant tuberculosis is a grave problem in India,[4] for example, but the new report makes clear that antibiotic-resistant microorganisms that cause major human disease are present all over the world. Some of the other comments posted here ask, well, what can we do about this? A submission to Hacker News from 189 days ago linked to a PBS report about the views of a Centers for Disease Control and Prevention epidemiologist in the United States[5] who advocated specific policy changes, some of which have been adopted since then. The discussion of that submission (including one of my highest-karma-ever comments[6]) provides more perspective on some biological evolution issues that are being brought up again in today's discussion here. [1] http://www.who.int/mediacentre/news/releases/2014/amr-report/en/ http://www.who.int/mediacentre/news/releases/2014/amr-report... [2] http://www.who.int/mediacentre/factsheets/fs194/en/ http://www.who.int/mediacentre/factsheets/fs194/en/ [3] http://www.who.int/drugresistance/documents/surveillancereport/en/ http://www.who.int/drugresistance/documents/surveillancerepo... [4] http://online.wsj.com/news/articles/SB10001424052702303444204577460734274201756 http://online.wsj.com/news/articles/SB1000142405270230344420... http://articles.economictimes.indiatimes.com/2013-06-23/news/40134749_1_stop-tb-department-mario-raviglione-jmm-meeting http://articles.economictimes.indiatimes.com/2013-06-23/news... http://www.iom.edu/Reports/2012/Facing-the-Reality-of-Drug-Resistant-Tuberculosis-Challenges-and-Potential-Solutions-in-India.aspx http://www.iom.edu/Reports/2012/Facing-the-Reality-of-Drug-R... http://www.tbcindia.nic.in/pdfs/RNTCP%20Response%20DR%20TB%20in%20India%20-%20Jan%202012%20update.pdf http://www.tbcindia.nic.in/pdfs/RNTCP%20Response%20DR%20TB%2... [5] https://news.ycombinator.com/item?id=6599040 https://news.ycombinator.com/item?id=6599040 [6] https://news.ycombinator.com/item?id=6599795 https://news.ycombinator.com/item?id=6599795

chez17 13y ago
In America, the number one thing you can do is stop eating factory farmed meat. That is a huge contributor to antibiotics resistance. Either eat mainly vegan or spend the few extra dollars to buy meat that isn't gross. Remember, it is MORE EXPENSIVE in the long run to buy that cheap meat. When you have a routine infection that can't be cured with antibiotics, the hospital bills will be far more then the few dollars you saved. Eat less meat. Oh, and you'll massively reduce your carbon footprint as well, and you'll use less land and water, and you'll be healthier (if you cut out red meat). It really is a no brainer.

volune 13y ago

time to buy an auto-clave

MichaelGG 13y ago
Sterilizing things you own is unlikely to help. You'd reduce any naturally acquired resistance, yet still remain vulnerable to getting infected from the entire world you cannot sanitize.

ScotterC 13y ago

What are the limiters to creating new, stronger antibiotics to beat the resistant strains?

WalterSear 13y ago
Same as everything else: money and attention.
jacquesm 13y ago
The one limit seems to be that even if we did that the bacteria will evolve to become resistant against those as well. This is a game of leap-frog, we've been ahead for a while, now we'll be behind for a while and so on. Think of it as a very slow arms race where on the one side there is intelligence and design and on the other there is the lottery driven mechanism of evolution that rewards the solver of the newly posed problem with a very large number of offspring. The sides are surprisingly well matched and short of total eradication this is likely going to be the game for the next foreseeable future. The bigger challenge will be to restrain ourselves to consume much more limited amounts if and when we do find antibiotics that work again in order to lengthen the time that we're 'on top'.
- midas007 13y ago
  That's part of it, but this is something governments have to take leadership on right now. That will only happen with direct pressure. Waiting until it's the leading cause of death will be too late, because of drug development pipeline timeframes.
- ScotterC 13y ago
  You'd think the companies behind creating this technology would welcome the never-ending arms race. They get to keep releasing products while their old ones get cannibalized for them.
DanBC 13y ago
Stuff that kills bacteria has to also not kill people. I saw a TV programme where scientists had a big tray of nutrient gel. They divided the tray into sections. The fist section was normal nutrient gel. The next contained a normal dose of antibiotic. The next section was 10x, the next section was 100x and the final section was 1000x a regular dose. This was far more than humans could tolerate. They stopped at 1000x because that was the limits of solubility - they couldn't disolve more antibiotic into the gel. Scientists then dropped a bit of e.coli on the normal gel and set their time lapse cameras. In just a few weeks the bacteria had evolved to live on all sections of the gel. (This was a BBC 'Horizon' programme called "defeatng the superbugs")

majkinetor 13y ago

Antibiotic resistance is a fact, what else can you expect given the game rules. What is less well known is that majority of people do not need antibiotics anyway and that majority of those who were taking them probably didn't need them too. Advice that recommended AB's before for stuff like otitis, helicobacter infection or even common cold (given for this disease because of opportunistic infections) is now changing without any problems, if anything, for the better. AB's should be saved for those few moments in life where you really need them and is not something you want to do every few months like majority of people, particularly kids. There are far better ways to strengthen your body and immune system without risks that are overwhelming with AB's (which are way better known today after we have some bits of microbiome) - nutrition and supplements. Even measures like using viruses as antibiotics are probably better then popping AB's like candies. This news is probably beginning of the "next big big pharma thingy" that will come to rescue and will typically, yet again, use inappropriate tool for the job. The only good that will come out of it are probably not going to be, however, lives saved but science advancement.

midas007 13y ago

On a personal note, my mom is still under the weather, having stuck to three different courses of antibiotics for a simple nasal infection. It's frightening when this becomes the norm, not the exception because we're basically running out of options by natural selection moving faster than research. We need a crash program to develop antibiotics before it's too late.

k-mcgrady 13y ago

Are there any potential alternatives to antibiotics? For example could nanotechnology be used?

majkinetor 13y ago
Yes, bunch of alternatives: - bacteriophages (viruses that kill bacteria) - vitamin C for some bacteria, vitamin D, other supplements like MSM. Most must be used in megadoses for this effect. - plant AB's (onion, black pepper, curcumin, the list is enormous and probably infinite)
- jmpe 13y ago
  There's a very good documentary about bacteriophages: http://www.youtube.com/watch?v=U6sZ7E9Hh-Y http://www.youtube.com/watch?v=U6sZ7E9Hh-Y It's history is muddied, mainly because of money & politics.
  - majkinetor 13y ago
    Apart from 'sacred rivers' the best known example is probably your mouth - viruses do kill majority bacteria there until you start to adopt non-natural cleaning systems (i.e. toothpaste) and carb overflowing you are actually making thing worse.
- Fomite 13y ago
  Bacteriophages, while fun, and something I once wanted to work in, are nowhere near as "point and click" efficacious as antibiotics are, even under the most optimistic scenarios.

RV86 13y ago

Best case scenario is that we find a way to get back in front of the mutations, but even that would just be buying time before the bacteria adapted again. On a long time scale, it's hubris to think we can stay in front indefinitely. We'd be better off improving our relationship with/attitude toward death on the whole.

patrickdavey 13y ago

Yip, this is definitely a serious threat, one that will affect the rich in ways that climate change won't so immediately do. Probably a good thing in terms of finding a solution ;) I did come across (I forget where) a very interesting talk which was outlining new techniques in antibiotics. The basic idea was that instead of straight out killing them (in which some breed resistance) instead you get in the middle of their chemical signals and basically tell them to attach before they've reached the point where the immune system won't win. Still, bacteria being bacteria they'll probably work their way around it, but maybe rewriting your messaging system is a little harder than breeding resistance.

HarryHirsch 13y ago

Another worrying development: Pfizer buying Astra-Zeneca. It's not to streamline drug development, the deal is a tax dodge in its entirety. Some lovely commentary down the hallway, in the Pipeline: http://pipeline.corante.com/archives/2014/04/28/pfizer_and_astrazeneca_what_the_hell.php http://pipeline.corante.com/archives/2014/04/28/pfizer_and_a... Scientists worry about the cuts to NIH funding, but the cuts to pharmaceutical research are ten times more worrying - who is going to develop the compounds to replace the current set of antibiotics when they have become useless? Wall Street is entirely unequipped to deal with this question; there are things that cannot be bought with money or at market, and scientific progress is one of them.

refurb 13y ago
Pfizer got out of antibacterial R&D a few years back. And I have to take issue with your comment "scientific progress can't be bought with money". What do you call all the new drugs that have been produced in the last century? It wasn't done by the government. Yes, basic research funded by the NIH advanced basic science, but it didn't put those pills in a bottle.
Fomite 13y ago
"who is going to develop the compounds to replace the current set of antibiotics when they have become useless" - Academic science. Most of the basic, foundational research in clinical medicine is done by academia, not the pharmaceutical industry.
lotsofmangos 13y ago
who is going to develop the compounds to replace the current set of antibiotics when they have become useless? IBM, with nanotech PET - http://www.research.ibm.com/articles/nanomedicine.shtml#fbid=klilCTIj3Vr http://www.research.ibm.com/articles/nanomedicine.shtml#fbid... And I know it is viruses, not bacteria, but MIT's DRACO is also pretty cool - http://www.ll.mit.edu/news/DRACO.html http://www.ll.mit.edu/news/DRACO.html

lightblade 13y ago

Instead of developing more antibiotics, can we reengineer these disease bacterias with a kill switch built in? Then release them into the wild to compete with non-engineered species and eventually displace them?

slinkyavenger 13y ago
You would have to also engineer an evolutionary advantage - something that would make them likelier to survive in the wild than their non-engineered counterparts. Building in a 'kill switch' by its very nature gives engineered bacteria a huge disadvantage, meaning there'd have to be something else making them more likely to reproduce. It would probably be a better use of time engineering the bacteria to be harmless to humans, negating the need for a course of drugs to kill it off.

jmzbond 13y ago

I think to make a dent in this problem we need to change many aspects of our culture and how we live: 1) that any annoying problem should have an immediate and rapid solution so that we can get on with our lives, 2) that we as people need to live in a bubble ecosystem from the rest of the natural world. 1) I stopped taking most medicines awhile ago because I realized that by relying on symptomatic relief, I wasn't actually listening to the needs of my body. Now when I feel a cold coming on, I start sleeping at 9pm, eat healthier, and reduce stress levels. Instead of popping a pill, I've learned to recognize that I'm deviating from "healthy" activity and had better get on track. The result? I haven't been sick in years and years, and am probably overall a more healthy, less stressed out person. 2) I often wonder to what degree language affects perception. Like the word dirty having such a negative stereotype yet so associated with dirt (i.e., soil). I feel like we often want such high levels of sterility that are just absurd, and do more to harm us in the long run. As part of a project, I interviewed farmers who said food safety experts are so draconian they expect cannons that shoot into the air to prevent birds from flying over with the risk of droppings. One food safety inspector commented that the farm was too "dirty." Can you imagine? I understand we don't want to get sick, there are bad things in the world, but I think we're pushing too far into the other end of the spectrum.

3rd3 13y ago

There are multiple kinds of antibiotics, right? Couldn’t one globally rotate the different kinds of antibiotics so that germs have a harder time adapting to it?

refurb 13y ago
Not really. Resistant strains of bacterial exist everywhere. Every area in the world needs the full range of current antibacterials. The other thing to remember is international travel. It's pretty easy for someone in North America, who has a resistant bacterial infection, to hope on a plane and spread it around Europe.

deleted 13y ago

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gabriel34 13y ago

I would like to know why wouldn't it work to simply flood hospital rooms (any time they were empty) with lethal (for bacteria) doses of non-ionizing radiation (or any kind that doesn't go through walls and don't make said walls radioactive) so that those pesky tolerant strains have a really hard time propagating

refurb 13y ago
Most of the transmission of infections is from human to human contact. Yes, bacteria can reside on equipment and facilities, but we have adequate measures to deal with that. As an interesting aside, more and more copper is being used in medical equipment as it is naturally antibacterial. http://en.wikipedia.org/wiki/Antimicrobial_properties_of_copper http://en.wikipedia.org/wiki/Antimicrobial_properties_of_cop...

chris_va 13y ago

(source: doing research into this) For those with a computational/hacker background wanting to make a difference: There is actually a lot of opportunity in the Computational Biology/Drug Development/Genomics space, with the caveat that it is a very difficult field (especially for company creation). It's a lot easier for CS folks to build another no-SQL database than it is to build a ML framework for, say, cancer prediction, but the opportunity is there. A lot of folks in this space come from the bio side, and teach themselves programming. Very few folks come from the CS side, and partner with the biologists. As a result, there is a giant gap between what is possible for a computer scientist and what is currently being executed. The state of the art in this space will probably make you all very sad. I will pay $$ for engineers to work on this: I have a side project working with an academic lab to develop a new antibiotic to target drug resistant beta lactamase (the primary protein associated with drug resistance) using a relatively novel computational approach. Sadly I've been distracted by my primary job, but if you are interested let me know. I am based in SF.

Houshalter 13y ago
It's something I am interested in getting into, but I don't even know where to start.

jmcmichael 13y ago

One alternative to antibiotics that may work, but will have a tremendous difficulty in clearing the regulatory burden for approving new drugs and medical procedures, is bacteriophage therapy.[1] Nobody's going to fund or approve this in the West anytime soon: - phage therapists often use cocktails of phages to treat their patient. This type of treatment isn't even on the FDA's map - it even takes years for compounds of conventional drugs to be approved. - phage therapists often prepare customized phage cultures to treat a specific patient's infection. The FDA would likely view this a a crime and prosecute anyone trying it. - phage therapies have been around for over 100 years and are likely unpatentable. No drug company will fund R&D on the technique and no venture capitalist will fund a scrappy startup. [1] http://en.wikipedia.org/wiki/Phage_therapy http://en.wikipedia.org/wiki/Phage_therapy

DennisP 13y ago
Then maybe we should change the way we regulate medical treatments. And maybe how we fund some of the research.

mvembu 13y ago

Homeopathy offers remedies for antibiotic resistant infections. I had a relative who had severe infection post knee replacement surgery. She was operated 4 times due to this infection as the bacteria is considered antibiotic resistant. A classical homeopath treated her to recover from the infection. This is the bacteria that caused the post surgery infection http://en.wikipedia.org/wiki/Acinetobacter_baumannii http://en.wikipedia.org/wiki/Acinetobacter_baumannii Here is a relevant article on how Homeopathy provides an alternative to antibiotics http://aurumproject.org.au/homeopathy-alternative-antibiotics/ http://aurumproject.org.au/homeopathy-alternative-antibiotic...