World on cusp of 'post-antibiotic era'
bbc.co.uk
bbc.co.uk
Probably not, for a number of reasons. The arms-race strategy of antibiotics vs drug resistance was doomed to fail from the start, as many know. The solution is counter intuitive: stop the arms race of stronger and stronger antibiotics completely, and the bacterial resistance to weaker antibiotics will be reduced over time. It's expensive for bacteria to keep antimicrobial genes around, and once the selective pressure of an antibiotic environment decreases, they'll lose the traits that confer resistance. It may even be possible to phase out one drug resistance trait at a time in multiple-drug-resistant populations. The horizontal gene transfer that the article mentions is really cool, but ultimately a non-sequitor when it comes to population-level infection control.
This solution means temporarily accepting uncontrolled drug-resistant bacteria in some narrow cases, which is unpalatable, but this strat works in the petri dish.
Are you sure you've thought this through?
Or are you (and I include in "you" any human being with the choice) going to want every antibiotic available for your loved one?
Maybe I miss the point of your comment, but if not, I doubt it is a viable strategy.
I don't know if we're going to need to "sacrifice" people who have poly-drug resistant bacteria, but I'm guessing it won't be in our control anyway, if the option is between doing nothing and the patients dying versus doing everything we can and still having the patient die. Damage control is critical, and sentimentality can't get in the way.
FWIW, I wrote an in depth report on controlling poly drug resistant tuberculosis in poor countries when I was in college... the conclusion was that quarantine was not only necessary, it was the only effective course of action for people with full spectrum drug resistant TB. Of course, TB is far more infectious and lethal than garden variety "bacteria".
The only thing to do is to remove the "apply antibiotics because it looks like we're doing something" and save the antibiotics to use for cases where it will actually work.
From recent experience of being hospitalized with pneumonia, they were pumping me full of antibiotics and asking questions later. The culture on my sputum never came back with a clear answer even a couple days later. But they found an antibiotic that worked. I doubt I'll ever know what bacteria ultimately caused the infection. Clearly it was resistant to a few antibiotics that weren't working. Should they instead have left me with a 104 degree fever near death for a few days while trying to figure out if antibiotics would be effective or not, even though the culturing process might not even give a clear answer?
It's going to be costly but we're "back-loading" our medical process so that we leave the problem to the next generation of healthcare providers.
It's like we want everything for free - get sick? just give out a ton of medicine! Eventually we have to pay for it.
I think that in the long term this will be a draw, we will need to discover new antibiotics, some bacteria will discover new resistance. (For the more nasty variants we can have to use other tools like vaccines.)
Researchers and funding moved on to sexier things. From a capitalist perspective, it's much better to wait for resistant bacteria than produce yet another antibiotic in a crowded field.
It's starting to pick up again. My money is on a continued battle until we develop nanomachines or wipe ourselves out.
The really challenging thing with antibiotics (as a reply below notes) is that if you create a great new antibiotic, nobody will use it unless they have to.
There is resistance out there, but for most infections, the 40+ year old antibiotics work just fine. It's not like almost every other disease where the best drug gets used first line.
Unless the financial incentives are fixed, it's unlikely there will be enough incentive to do the R&D to create new antibiotics.
The key information they presented was that just because bacteria evolve quickly to modern forms of antibiotics, doesn't mean they don't also reduce to their tolerance to older (in this case, 1000 years older) antibiotic-like medicines that we would dismiss outright because it wasn't created in the modern age. Old medicine was very much trial and error, but it doesn't mean it can't also be effective or worth looking into deeper for ideas.
It's going to suck though for those people who have anything that is resistant to multi-spectrum antibiotic treatment.
In order for us to "stop the arms race for stronger and stronger antibiotics", we have to let people infected with resistant bacteria die. In droves. You would be all for this strategy until it's you, or your spouse or child sitting there being eaten alive by MRSA. You could tell your toddler that she's not dying for no reason, and that a few years from now the bacteria won't be as deadly. That'll make her feel better.
Do you really think that this is even remotely realistic in any democratic society?
Different antibiotics have different pathways, much like barbituates and amphetamines have different pathways, despite both getting you high. Perhaps if we use only pathway "A" for a decade, bacteria will lose resistance on pathway "B" (and vica versa)?
I guess the alternative is to hand wave that us scientists can magically solve the decades-building problem that big-agriculture and doctors caused. Sure, we'll get right on it, but there needs to be a plan for the time between when research starts and when a new group of antibiotics is tested and ready for the market. Staged rotating/phasing out certain antibiotics so that they will be usable again after a period of time would ensure that there's something left in reserve for people who actually need it.
Tuberculosis is a prime example of why this is such an intractable problem. 1 in 3 people globally are infected with the TB bacterium. That's >2 billion people!
It is usually dormant, but there's a 10% chance it will flare up into the active - and deadly - state in a healthy individual's lifetime, so it really needs to be treated. It is the top infectious disease killer every year (>1.5 million people, including 140,000 children).
The current treatment regime requires daily doses of multiple kinds of antibiotics for 9 months, and that assumes you're lucky enough to have a strain that is vulnerable to first line drugs. In practice many treatment regimes require multiple antibiotics administered at once, and can take up to 24 months to clear from the body. Second line drugs have severe side effects.
Every time someone misses a dose, they risk creating a resistant strain. In fact, even if you're taking it regularly, there's a chance it will still develop into a resistant strain.
There is simply no way to ensure all of the 2 billion infected people around the world, mostly in low and middle income countries, will (1) be identified, (2) have access to these drugs, (3) consistently take them for 9-24 months even if faced with severe side effects, and (4) be monitored by a professional that can decide when to move to a second or third round of treatment.
A certain percentage of the population will never be treated, abandon treatment too early, or simply have terrible luck and not fully respond to treatment. You just can't identify and quarantine them all. Besides, even if you did, where would you house them? For how long, the 24 months of treatment? The rest of their lives?
It's also important to remember the human element here. We can't cycle/phase out antibiotics, even if you did manage to get every doctor in all 190+ countries of the world to agree to do so. What would you do if you or your baby needed treatment, but a doctor told you "no, we won't prescribe the most effective treatment because we're worried in 30 years it won't be effective anymore." Without effective treatment, an active case of TB has a 45% chance to lead to death. It's also in everyone's interest that that infected person be cured asap.
Finally, it's highly doubtful draconian containment or drug cycling restrictions would even work. Drug resistant genes are already in the natural environment. Life finds a way. In 2012, doctors found a strain of TB in India that is entirely resistant to =all= known treatment. They found 12 cases in one hospital alone. Most facilities don't know how to identify it, so it's spreading out there, right now.
Quarantine and treatment can slow the progression of resistance, but it simply can't be reversed. 3.5% of new cases every year are already resistant to =multiple= drugs. We will need to develop an entirely new model over the next century to eliminate these bacterial infections.
80% of antibiotic use in the USA goes to farm animals, not people. We could therefore significantly reduce the amount of antibiotics in our environment without affecting human lives.
You could make another very significant reduction by keeping doctors from prescribing antibiotics so often to placate patients who really don't need them.
This would go a long way towards reducing bacterial resistance without changing what treatments are available for truly sick people.
Good luck with that. This would mean regulation, and that would mean going up against corporate farms and their lobbyists as well as the Senators and Congressmen they have in their pockets. America's legislative branch is actively hostile to science and anything that could impact the bottom line of their campaign donors.
(tldr; household cleaners with antibiotics mean that when you do get sick, it won't be something that can be cured)
Ok, I see how the use of Tricolsan could lead to bacterial resistance. But just to point out what jeremyt said above, Triclosan is definitely not an antibiotic. But the effect is the same.
Using hand soap with triclosan has antibacterial properties, none of which contribute to antibiotic resistance. There are lots of reasons to quit using antibacterials in your house, and I have stopped, but contributing to the antibiotic resistance problem is not one of them.
http://online.liebertpub.com/doi/abs/10.1089/mdr.2006.12.83
(as far as I know, antibiotic and antibacterial are largely synonymous)
Not really.
Antimicrobial: an agent that kills bacteria or fungi.
Antibiotic: an agent that kills bacteria or fungi in the body.
This is a crucial distinction. Phenols have been around as antimicrobial disinfectants for over a century and a half, but you really don't want to take them internally. Whereas something like penicillin VK -- alas, no longer very useful due to widespread resistance -- is pretty much safe to take in large doses, unless an immune response arises.
We've got plenty of antimicrobial agents; what we're short on are ones that don't poison us along with the target organisms when we take them.
What's actually going to happen: We're going to have an epidemic of some sort of drug-resistant bacteria in the Western world--maybe that incurable TB that's going around, maybe something else. A few thousand Westerners are going to die--people the Western world actually cares about, as opposed to them poor people in them third world countries that are always dropping like flies anyway.
There'll be a media hysteria similar to the Ebola crisis. People will suddenly realize that antibiotic resistance isn't just a problem affecting poor people in third world countries, but that it is now a problem threatening them and their children.
The resulting media blitz will educate even the average idiot about the importance of taking the full course of antibiotics even if you feel much better already. Antibiotic use on lifestock will be banned. Western governments will pressure China and India into stopping the unrestricted sale of antibiotic. Western doctors are finally going to realize that prescribing antibiotics like candy just to shut a patient up is a mistake even if the patient is yelling really loudly. Developing a new antibiotic is sudenly going to be a lucrative or at least PR-relevant strategy for Big Pharma, instead of a likely fincancial loss. Hospitals are going to be forced to actually deal with the problem of MRSA. (Right now, many patients that should be tested and isolated aren't tested because there's no room to isolate them in case of a positive result.)
Within a few years, drug resistance will taper off sharply, without antibiotics ever losing their use except in the case of a few rare resistant diseases, which will be tested for and isolated. Problem solved.
These are all things we could do right now, if we wanted to, we just don't care about the problem enough. The moment it becomes big enough to interest the majority of the population, we know how to solve this.
Yet folks continue to harp on 'restrict antibiotic use'. What have I overlooked?
First of all, we will still have the Germ theory of Disease. Much of the early gains in lifespan from modern medicine came from the awareness of the correlation between cleanness and healthiness. For as long as we can support infrastructure for proper sanitation and disposal of dangerous agents, those gains will persist.
Second, we will still have vaccination. Many dangerous diseases are kept at bay not by heavy use of drugs but by immunization the population instead. This technique is also subject to diminishing returns due to bacteria evolution, but the dynamics are different. Over use antibiotics and you end up with resistant diseases; reach full immunization and you root out the disease out of your population.
Third, we have better palliative care now. Even if everything else fails, we are better prepared now to keep people alive long enough for their own antibodies to fight off most diseases.
This will be shitty for our current expectations - to be able to take a pill and bounce back in a day or two. But it does not mean either that half of our children are going to die of colds or tummy aches or anything like that.
…
> It is likely resistance emerged after colistin was overused in farm animals.
What the heck? Shouldn't the antibiotic of last resort be used only as … a last resort? I can't believe that any farm animal would be worth the use of such a drug (although I suppose it's possible, were it the last of its breed or something).
Bad journalism again.
So in China, and every country there are a few relevant players. Farmers, farm owners, politicians, and scientists.
Farmers (laborers) have to survive and most work wages so they arent accountable. Farm owners have to compete and if they dont they go out of business and someone will take their place so they're not really accountable. But its the law that makes the rules of the game and so it is the responsibility of the political class to avoid designing "tragedy of the commons" scenarios.
There are at least SOME good-willed politicians who dont want things like antibiotic-apocolypse. The problem is that they have a ton of scientists whispering different things in their ears so they dont know what issues are big threats and which are scientists trying to get funding into their own field of study. Its therefore also the responsibility of the scientific community to effectively communicate with the political class.
See? At least some people out there arent perfectly rational!
Government is ostensibly the system that prevents external costs, and imposes rules that skew what's rational for individuals today to be closer to what's rational for society tomorrow, but in practice it fails to do so much of the time.
Also, per tradition, let me post a handy reference on coordination problems:
I'm not trying to deflect blame or avoid responsibility. I'm simply saying that this "madness" comes from individual people making completely rational choices. Widespread antibiotic use on farms is both awful and completely sensible for the individuals involved.
That doesn't mean there is no responsibility or that we're helpless. It just informs the remedies. It means that attempts to get people to act rationally will fail, because they already are. If you want to change things, then you need to make it so that the rational choice for the individual is also the best choice for society as a whole. And that's typically where the laws come in.
In particular, it does not explain why people perceive their self interest the way they do and it does not explain how those perceptions change. It does not explain how people come to find common interest with others and does not explain how someone's notion of self and notion of society commingle and interact. These things are the definitions that let you talk about rational behavior in the first place.
This is by no means a defect of the concept. A microscope is not defective just because it is not a telescope, but it is still just a microscope. If you magnify a festering wound enough, it ceases to look so gruesome.
For instance, in a little simplified example, each farmer would prefer to not abuse antibiotics because they deeply care about their health and maybe even about the future of mankind. But in a competitive environment, the first farmer to use more antibiotics will gain advantage over the others, so some other farmers - maybe afraid of losing the money to feed their children - will start using more antibiotics too to stay competitive (and those who refuse on ideological grounds will simply get outcompeted). Soon, everybody is abusing antibiotics even though no one wanted it (maybe the first defector was greedy, or maybe he really needed the money). The end result is the same (competitive advantage gained by antibiotics cancels out when everyone is using them), everyone is collectively worse, and no one can break the cycle.
That's why we need external actors, like governments, to enforce some coordination. But real-life governments too often fail at that.
I linked to a powerful microscope in a parallel subthread.
The competitive environment you mention is the large scale structure of society itself. Those external actors you mention are the very forces that define the environment and define the context in which a farmer determines their self interest. These structures do not arise from the aggregate of individuals working independently, but from the coherent actions of ensembles of actors. The very notion of 'self' is ill-defined and subject to change as social forces construct the way people perceive the relationship between their bodies and the rest of the world. There is no state of nature.
It's essentially a big and complicated version of a simple game: if you press this button, you will get $10, but everybody else on the planet will lose $0.00001. Do you press the button?
The rational choice is to say yes. The benefit to you far outweighs your cost. It even far outweighs the combined costs to all the people you know.
In short, externalities make people choose bad things in a rational way. It has pretty much nothing to do with how society is structured. If you want to change it, then you need to figure out a way to make the costs to the individual outweigh the benefits to the individual.
Since we live in the same universe and have to deal with some of the consequences of each others' actions, there's some natural correlation between our utilities, but we live in civilizations which have far more social structure built on top of this basic structure, and these social structures inform and structure our possible preferences and the relations between them.
In fact, these social structures can have preferences and play their own games! The United States government, for example, is an entity whose preferences and actions are embodied in the coherence of its constituent individuals, and its structure informs the games and preferences of its individuals in a feedback loop we like to call bureaucracy. Does the large-scale behavior of the US government explain the choices of its constituents, or vice versa? Clearly the answer is neither and both: They are two ways of looking at the same dynamical structure.
In one view, things can look perfectly rational. In the other view, things can look stark raving mad. I don't think either point of view is distinguished as canonical.
I agree that neither point of view is canonical. That is basically my point: it's only madness from a certain perspective, and it's completely rational from another. Neither is right nor wrong, it's simply that the different perspectives are in conflict.
I'd say that's not the point. The point is, individual selfish choices aimed at producing good outcome for the choicemaker start to produce bad outcomes for the choicemaker when everyone else makes the same choice too, but at this point it's too late to leave the ship.
A canonical toy example would be working overtime. Say everyone is working 8 hours, but you decide to stay one hour longer. The boss notices and gives you a bonus for your dedication to company. Your co-workers notice, some of them decide to stay an hour longer too. Since the bonus pool is limited, you all get somewhat smaller bonuses. Ultimately so many people stay the extra hour that it turns into a new normal; 8h/day workers become seen as slackers and are pushed to 9h/day mode to avoid angering the boss. And since it's a normal mode, nobody gets bonuses. End result: you work 9h/day and get paid the same as you used to be before.
The article I linked[0] has much better examples of this happening in real-life.
The point is, things can look "stark raving mad" pretty much objectively, because the end result is bad in the choicemaker's value system. It's easy to get into a coordination trap and incredibly hard to get out of it.
[0] - for convenience, http://slatestarcodex.com/2014/07/30/meditations-on-moloch/
In context of the large scale structure of society, one that promotes large scale exploitation for the benefit of an individual, it makes sense to profit now and let others take care of the costs accrued by your actions.
There is no clear economic disincentive to steer people away from making this decision despite the negative outcome it will eventually have for everyone including the individual.
It's terribly morbid and I really don't think it will come to this but if many people start dying due to once easily treatable infections then it could rapidly (within a dozen generations or so) change how our immune system works.
A mass dieoff of a species due to a single catastrophic event is unlikely to intensely select for certain traits.
A flood amonsgst a non-swimming species is as likely to select for resillience or sleeping late in your tree or some other unpredicable attribute as it is for the "swimming" gene
But constant intense pressure could easily single out favorable attributes and I wonder what those will be and what the side effects or emergent traits of those genes will be.
Of course we are evolving via technology and society more rapidly than genetically so that could change everything.
We used antibiotic technology to "evolve" resistance to bacteria. Bacteria responded much more rapdily than we could have naturally and is now a different organism than what our grandparents had to contend with. Now our technological "evolution" is unable to keep up with natures and we face a new threat not an old one. One we helped to create.
https://publichealthmatters.blog.gov.uk/2015/11/02/i-need-an...
> If we can’t stop the infection, however, we can’t stop the sepsis. A world without effective antibiotics will mean that every one of the 100,000 people who develop sepsis each year in the UK - every one of the 18 million people with sepsis each year worldwide - could certainly die from simple infections like chest and water infections. A human could die from infection every second.
> When I started treating people with bacterial infections it was rare that I didn’t have tablet antibiotics that I could treat them with; rare that I needed to keep people in hospital to treat their infections. Now every week, I treat young women with last resort antibiotics for urinary tract infections. Rather than given them a simple 7-day tablet course, they have to stay in hospital for a week or more, or come to the hospital every day for an injection.
https://publichealthmatters.blog.gov.uk/2014/11/18/10-reason...
> When we discuss antibiotic resistance we talk about a frightening future and rightly ask for action to stop the problem from getting worse. But this doesn't mean it's all just an issue for future generations. It’s estimated that 25,000 people already die every year in Europe because of infections resistant to antibiotics and in the USA the figure is 23,000 people, every year.
https://publichealthmatters.blog.gov.uk/2015/11/18/7-more-re...
> In 2013 there were 480,000 recorded cases of multi drug-resistant TB (TB that can’t be treated by our usual medicines). TB is a bacterial infection that can spread through the lymph nodes and blood stream to any organ in your body. It commonly affects the lungs and while a lot of people might not consider it to be an issue in the UK, or think it couldn’t affect them, this isn’t true. 37 million lives worldwide have been saved by antibiotic treatment for TB since 2000. In some countries, it is becoming increasingly difficult to treat MDR-TB. Treatment options are limited, recommended medicines are not always available, and patients experience many adverse effects from the drugs.
Such a case has never happened in the past, unless I didn't learn about an antibiotics crisis in ancient Egypt.
Before the end of this century we'll be directly editing the genome of every child born in the first world. Human evolution is no longer in nature's hands, and it will never be again unless technological progress rolls backwards drastically (at the rate it's accelerating, that is possible but unlikely; it's more likely we're about to achieve lift-off in regards to rapid evolution; if you think CRISPR is interesting, just wait until you see what we have in just 30 years).
We are essentially already doing this. We are selecting for cancer and other disease processes when we cure cancer and other diseases in children who would otherwise have died who then survive to reproduce. It's not polite to say this, but that is what is happening.
Humans are a cybernetic species. Always were.
I'm actually starting to think that the Industrial Age is the worst thing that could have happened to human kind. Even this antibiotics apocalypse, along with outbreaks of potentially deadly viruses, like the mad cow disease or the aviary flu, are caused by industrial farming practices, which are also guilty of polluting the soil they stand on and the nearby water streams, damaging the area and the people living nearby,
A post-industrial age is long overdue.
If you really feel that all progress for the past thousand years has been worthless, go ahead and live a life from a thousand years ago. I'm pretty sure it will take you less a month to realize that life sucked back then.
A recent example of a new antibiotic:
http://www.smithsonianmag.com/science-nature/new-antibiotic-...
Or how about this: a break-through that goes beyond classic antibiotics. Something that hasn't been thought of yet. Not like humans have a history of accomplishing such feats, right? Not like the entire last century of medicine falls into that category.
I can't think of a single example in modern history, in which our species has failed to think its way out of a major problem. X Y Z bad thing was supposed to take us down, or impede our progress, and we thought our way out of it. We'll continue to do that, and the overly dramatic forecasters of doom will continue to be wrong as they always are.
It's difficult to recoup your investment costs for a drug that has an effective use window that small.
Been the government that threw a few billion bucks and saved thousands of (electorate) lives is a good vote winner.
The cost of developing antibiotics is large (in the billions) but US defence spending is 600bn dollars, UK defence spending is 60-odd bn dollars.
Governments should already be funding this stuff (imo) since the defence of the realm is theoretically their first goal.
It actually varies significantly across antibiotics. I can't find the source right now, but there was a neat diagram that showed the introduction of each antibiotic and when resistance was first identified.
Some resistance was found in less than a year after the antibiotic was introduced and some were found 20 years later.
So what should the BBC headline read, then? "We're running out of antibiotics, but surely some clever person will think of something!"?
War. Poverty. Hunger.
The point being, we're not solving our most important problems, we've been merely leaving them out for later. If we hadn't found that "oil" card, we'd already be fucked, per what "overly dramatic forecasters of doom" were saying. Lucking out of a problem is not something you should attribute to your skills.
Moreover, problems we had in the past weren't serious. And we haven't thought our way out of them - we just let them happen. War? Famine? Floods? Oh, people died. So what, there are people elsewhere, and civilization didn't fundamentally change since the ancient history anyway. Only after the industrial revolution, when the progress of technology finally gained its pace, we've entered the times in which we actually have something to lose if we fail to maintain our civilization. We've also entered the era when for the first time in history, we're creating extinction-level problems for ourselves.
I love science and I do believe in human power to solve even most difficult problems. But let's not pretend that we got here by something else than just being lucky. And let's not treat serious problems as if they were child's play.
A radically different incentive structure seems necessary...
For every bacteria, there is a phage that will kill it.
Back in the Soviet Union they used this medical technology extensively to cure all sorts of things, and the hospitals in Georgia and surrounding areas would be sprayed down with phage to kill bacteria within the hospital corridors and rooms to prevent the hospitals themselves from becoming breeding grounds for bacteria.
If you're interested in learning more I would recommend the 1997 BBC four documentary called 'The Virus that Cures'
http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3400130/pdf/fmi...
http://metatalk.metafilter.com/21925/Interesting-Profiles#10...
Excerpt:
> Over the last fifteen years or so, with the breakup of the Soviet Union and the exponentially growing crisis of antibiotic resistance, phage therapy is looking very exciting again. Unlike the ‘30s, we now have a decent understanding of phage biology as well as the infrastructure to keep phages cold until use, effective diagnostic tools, and most importantly, regulatory structures that shut out hucksters. The need is also dire, for example multi-drug resistant Staph infections kill more people in the United States than AIDS does.
> Basic phage biology has also been undergoing a resurgence as we discover just how important phages are to the global ecosystem, they are indeed the dominant organism on Earth outnumbering anything else by two orders of magnitude. Indeed, despite being just ~125 nm tall (check this out for scale), if one were to stack the 1031 phages on the planet end to end you would get a tower that would stand 200 million lightyears tall. Our oceans are remarkably free of cellular life and the reason is phages, as well as the other the viruses of microbes. For example the growth and death of algae blooms are centrally mediated by viral dynamics. Meta-genomics studies of the oceans pull out more predicted phage proteins than anything else without some fancy filtering, and even then they get a bunch. Phages are also teaching us a lot about the primordial origins of life, they are after all proto-cellular organisms.
> These days are exciting times to be interested in phages.
The opposition to bacteriophage research comes from the belief that bacteriophage research could accidentally produce viruses that are deadly to humans or be used as a cover for biological weapons research. But these concerns are invalid: bacteria and human cells are drastically different, and so are the viruses that attack them: there's no chance that bacteriophages will mutate into viruses that attack human cells. And as the necessary equipment to do research on viruses becomes cheaper and cheaper and more easily constructable from widely available components, blocking legitimate bacteriophage research does less and less to prevent illegal biological weapons research.
Doesn't that sort of depend on what you consider a human cell? Our gut bacteria is supposed to be fairly important to us, and something that might affect it on a large scale might have consequences.
Note, that I'm not saying that bacteriophage use if harmful, just that you have to be careful when discounting possible harmful side-effects. History is rife with examples of new safe health technologies that we only understand the negative aspects of later.
Mitochondria, the "power houses of cells" seem to be bacteria.
Uh, that's not actually an issue as I understand it. The treatment, as I understand it, works by starting with a sample of infected tissue from the infected person. The bacteriophages are then grown starting from a few different kinds of starters, but the process I read about starts with a broad spectrum of bacteriophages. As long as a bacteriophage is close enough to being able to attack the desired bacteria, it some percentage of the bacteriophages will mutate into the exact bacteriophages you want. Since the available food for the bacteriophages is the bacteria you want to kill, the bacteriophage specific to that bacteria grows exponentially until there are enough bacteriophages. At this point the solution contains a large number of bacteriophages specifically bred to kill the bacteria in question. The solution is reintroduced into the infected tissue, where it eats most of the bacteria.
> Antibiotics are much simpler to use.
Chanting healing spells is simpler to use than antibiotics and in a few decades time it will be equally effective.
Don't get me wrong, it could be a viable backup. But, it's not nearly as useful for things like surgery where you want to knock everything down before there is a problem. And it's not nearly as cheap as handing out penicillin was.
PS: Another issue is separating out the Bacteria phages without introducing a lot of new possible infections.
And are antibiotics a catalyst for the evolution of bacteria or its demise?
The hottest thing right now in fighting bacteria seems to be bacteriophages[0]. I've heard Russians had some success in R&D there, but I don't know much more. Maybe some knowledgable HNer could elaborate.