How we can stop antibiotic resistance
bbc.com
bbc.com
Combating multidrug-resistant Gram-negative bacteria with structurally nanoengineered antimicrobial peptide polymers https://www.nature.com/articles/nmicrobiol2016162
An article for non-expert: http://www.telegraph.co.uk/health-fitness/body/does-this-25-...
"Lam successfully tested the polymer treatment on six different superbugs in the laboratory, and against one strain of bacteria in mice. Even after multiple generations of mutations, the superbugs have proven incapable of fighting back.
“We found the polymers to be really good at wiping out bacterial infections,” she says. “They are actually effective in treating mice infected by antibiotic-resistant bacteria. At the same time, they are quite non-toxic to the healthy cells in the body.”"
"Professor Greg Qiao, her PhD supervisor, says that Lam’s project is one of the biggest scientific breakthroughs he had seen in his 20 years at Melbourne university."
In almost all cases where nanoparticles have shown promise to treat various conditions, there remains one huge hurdle: how do you get them into the patient? i.e. Swallow a pill full of nanoparticles, and later that day you'll end up taking a nanoparticle-filled dump. Oral bioavailability is almost nonexistent. The only practical delivery mechanism is IV. For treating cancer, that's fine. Most advanced chemotherapy drugs already are delivered via IV. For an antibiotic, which will see greatest demand in locations with poor health facilities, i.e. with no real means of safely delivering IV drugs to large numbers of people, that's pretty much a deal breaker.
Well, that doesn't really have a lot of confidence behind it.
Bacteria can do thousands or millions of generations more rapidly than we can tweak our nanotech.
That is, anything that can live in a 40+% alcohol environment is also not going to find the human body hospitable.
Of course none of this will matter until we can crack down on misuse of new antibiotics in places like India and China. If each new antibiotic developed is stolen and abused then nothing will work.
http://phenomena.nationalgeographic.com/2015/12/14/you-cant-...
This is not a discussion of Indian or Chinese laws on "intellectual" "property".
Because, once again afaik, that's one of the driving factors for the emergence of MRSA bacteria: Too liberal use of antibiotics, which especially applies in the US.
The suggested solution, of using different kinds of antibiotics, feels like the sledgehammer approach that could just as well make the problem worse. By creating MRSA bacteria even faster, giving them a whole load of antibiotics to mutate resistances to at once vs one at a time.
The BBC Article has a whole paragraph about this dynamic:
"The most important part of this is that bacterial resistance is essentially a numbers game: the more humans try to kill bacteria with antibiotics, and the more different antibiotics they use, the more opportunities bacteria have to develop new genes to resist those antibiotics."
This is normally not a problem because the drug kills enough of them that your immune system mops up the rest.
The problem now is that the fraction has slowly become larger and larger until the point that a viable population of survivors remains to pass on their genes.
The way around this is to use multiple drugs that require multiple different mutations to survive. If before each drug left a tiny fraction of population, the intersection of those drugs will leave a fraction of a fraction of a fraction. Not enough to make a viable population that passes along multiple resistances.
In some cases, you can stack drugs in a way that requires bacteria to have three mutually exclusive mutations, so they're dead either way. There is an antibiotic candidate right now that is estimated to be 15,000x more effective because of smart design to require 3 different mutations to survive, but those mutations don't work together.
Or it might just as well end up beeing the fastest way for creating, even more, MRSA bacteria strains because the harsher the treatment, the more sturdy the survivors we will be.
>There is an antibiotic candidate right now that is estimated to be 15,000x more effective because of smart design to require 3 different mutations to survive, but those mutations don't work together.
As corny as it might sound, we really shouldn't underestimate nature like that, it's part of the reason what got us in this mess in the first place. If we can design something requiring 3 different mutations to survive, then sooner or later nature is gonna evolve something with those 3 different mutations. Nature has played this game far longer, and far more successful than we will ever be able to.
That's why imho we need a better approach than "use more types of antibiotics", as that's essentially exactly what we've been doing this whole time.
Edit. When I was a science undergraduate in the early 1990s on my own I came up with HAART (not original of course) from first principles. It seems so obvious that I didn't understand why it was not standard practice (such is the arrogance of youth).
Compared to other drugs, antibiotics are relatively easy and cheap to discover or "invent" with modern techniques. Getting them through clinical trials, on the other hand, is not cheap.
Many clinicians should be less loose with antibiotics, sure. But, that won't eliminate resistance. Realistically, when superbugs become common, the incentives pharmaceutical companies face will shift. It's just there will be a lot of morbidity and mortality while we're waiting for their drugs to make it to hospital pharmacies.
As someone who used to do antibiotic R&D I strongly disagree with statement. Making a drug that kills bacteria but not the host is really damn hard.
Your point about the economic incentives is very true.
This statement seems to directly contradict what the article says:
"According to Sprenger, “there are no legal instruments to prohibit the use of a new antibiotic.” What that means is if a new antibiotic is released there’s no way to stop the world from overusing it. At current usage levels a new antibiotic, he says, would only have about two years on the market before bacterial resistance to it develops."
If the world overuses a new antibiotic then the pharma company should be swimming in cash. And if the pharma company isn't swimming in cash because people reserve them for rare cases, then it should not be possible for the world to overuse the new antibiotic.
Maybe cost is less of a factor in life threatening situations.
I'd like to see a year-on-year graph of human lives lost in exchange for making livestock grow faster.
For instance, its because of many of the practices of "Big Agriculture" that world hunger has dropped so massively in underdeveloped countries over the last 30 years. With even a 10% decline in Asia ( since 92 ), thats about 450 million people who aren't living under malnourished conditions who were doing so 30 years ago.
I'd be surprised if there's a big overlap between antibiotics usage and reduced world hunger.
solution: don't eat any meat from countries where this is allowed. Yes this is a bit of a hassle if you happen to live in one of those places but it might be possible to at least find organic meat that isn't given antibiotics when healthy. Buy that.
So if anyone is receptive to your argument it ought to be me. But I'm not buying it.
Public nutrition does not require that we sacrifice antibiotic effectiveness for incrementally cheaper meat.
Some fire-brand ecologists want to go back to "traditional" ways outside of the paths of modern intensive agriculture but fail to realize that traditional agriculture both have a higher ecological footprint and is much more labor intensive.
If you want to lower the impact of intensive agriculture, promote contraception and demographic decrease.
You don't need to promote demographic decrease (you might need to do something about the Catholic church, though ...). All you really need to do is improve the opportunities for women.
Once women have opportunities and don't need to worry about 4 of 5 children dying, suddenly they don't want to be pregnant so often.
Many of the most advanced countries are already under replacement level. I believe the US would be, as well, if it weren't for immigration.
No, couples who decide to have more children are not helping society. They are draining its resources. If you want kids, have only one and give her/him all the education and resources you can.
Re parents with many kids are draining resources - this holds true for countries like India, but certainly not regions like Europe. Here, farmers are paid by the EU for letting fields lie fallow, because there is only so much produce that is consumed in the EU. Also, consider the amount of food thrown away by supermarkets, which could be used if we were content with eating crooked looking cucumbers. An argument might be that those extra kids still deplete scarce resources by proxy, e.g. oil.. but as we are slowly transitioning to solar and wind power, this might almost entirely go away.
Meanwhile, while it looks as if most continents are going in the right direction, we need to stop the extremest religious/political warrior movments prevalent in North Africa, Middle East and South East Asia.
Eg. In Somalia, a lot of men want 20 kids, and while I can't personally understand why, it's encouraged by religious leaders. It's apparent that Somalia itself won't sustain that in only a generation. This can only lead to conflicts, presumably with richer regions. There are so many pear-shaped scenarios to go to from there, but I leave to your own imagination what a highly industrial neighbouring region could come up with if cornered.
Hint: that region have only minor concerns about locking down the borders, setting up incentives that leads to that whole ships filled with people and kids drowing. Ther might be some public lamenting but no policy changes.
Seems to me that the patent system, meant to encourage invention, is seriously broken in the case of antibiotics. So stop using it. Set up a bounty system instead. Pay drug companies directly for developing new antibiotics. Without the pressure of having to sell them quickly we can instead use them more strategically, even holding some in reserve.
If the chance to get the right mutation to resist one antibiotic is, say 0.01 (1%). Then the chance to mutate to resist three antibiotics at once is 0.01^3, thats 1e-6 (0.0001%).
* Genetic drift vs fixation. As bacteria reproduce and die, the relative frequency of genes tends to remain fixed in the absence of selection. In layman's terms: if 0.0000001% of bacteria in a population have antibiotic resistance, they will likely all die before passing it on. If 10% have resistance, there's a much better chance of it sticking around. The more antibiotics prescribed, the more you enrich the population for resistance, the greater chance it sticks.
* Many antibiotic resistance genes put bacteria at a disadvantage relative to the same bacteria without resistance. If antibiotics are not present, then resistance will eventually be selected against and disappear. Overprescription of antibiotics ensures that this doesn't happen.
for that given environment
That's why antibiotics should generally be used as conservatively ass possible because overkilling bacteria does nothing but accelerate the evolution of the few surviving into "super bacteria" that much faster by giving them a harsh environment they can adapt to.
A lot of the low hanging fruit involves banning the use of antibiotics on healthy farm animals, and at least with the largest producers who raise and slaughter the majority of animals I think this could be achieved.
>> First, the entire world needs to get on board.
Like the entire world got on board with climate change. Yep, we're screwed.
As is much of the USA, even if not the federal government. 12 states and Puerto Rico in the US Climate Alliance, another 10 states and numerous local jurisdictions expressing official support for the Paris Accords outside of the Alliance.
And that the USA is one of the largest contributors to climate change, of course.
Less monoculture, smaller farms, no use of antibiotic for animals. Pure form of greed, they feed them antibiotics pro-actively.
(This is not to ignore the fact that quite few were designed for social exclusion as well)
Take away the antibiotic, and resistance slowly declines.
50 years from now, we'll have a global system that coordinates the rotation of antibiotics so we use them in lockstep.
That is really cool idea.
When I showed up I encouraged her to stop taking any antibiotics and build up defence system by taking vitamins and adjusting some bad habits. The first time she had flue it was bad, she had it for 3 weeks and was forced in the end to take antibiotics. Since then she was not sick even once (usually she would be sick every 3 months). Her health improved, her defences are strong and whenever she starts feeling bad she just jumps into the bed for 2-3 hours and get out feeling good. Her bode learned how to defend on her own.
The flu is a virus and antibiotics have no effect on it. There is a yearly vaccine for the flu and the CDC recommends all adults take it, although it usually only protects about 40-70% of the time due to the large number of flu strains in circulation. The flu is a deadly disease and even a person in good health (taking vitamins, etc) in the prime of their life can be killed by it, which is why vaccination is recommended.
The thing to understand about antibiotic resistance is that we humans are but foot soldiers in a global war that has been raging for literally billions of years! Plants killing bacteria, bacteria killing fungi, viruses killing bacteria, bacteria killing viruses, even bacteria killing other bacteria; this conflict rages on with or without our input constantly. Almost all of our current antibiotics are natural products or derivatives thereof, taken from the plants and fungi that have been fighting off bacteria much longer than we have. Increasingly, we're finding that the antibiotic resistance that arrises in human pathogenic bacteria is not the result of novel mutations (as this article suggests), but rather the adoption of a pre-existing resistance trait from one species that has nothing to do with humans into one that does. In a teaspoon of dirt there are more different species of bacteria than have ever caused diseases in humans, all of which are in a constant struggle for survival, many of which have developed highly specialized weapons and defenses with which to fight this war.
We've been fighting bacteria with antibiotics for just about 100 years, and we're already losing!
The idea that management of distribution or development of novel agents will be sufficient to prevent bacterial infections into the indefinite future is laughable on its face for any semi-serious student of evolution.
No, antibiotics have won us an important battle, but the war is far from over. New antibiotics will help, but each new one will hold off fewer infections, with more serious side-effects, lasting ever less time before resistance takes over. We'll never see the sort of success with antibiotics in the future that we have in the past. Interesting alternatives, like bacteriophage therapy, stool transplants, and other means of grooming our natural bacterial flora will go a bit further.
Ultimately, though, the incontrovertible truth of nature is this: the only lasting alternative to conflict is cooperation (a.k.a. symbiosis). Fortunately, for reasons we still don't fully understand, organisms in conflict naturally evolve to a cooperative state...given enough time. Unfortunately, evolution is very slow, and there is no rule stating that there won't be casualties (i.e. extinctions) along the way.
So, as uncomfortable as it may be to many, there really is only one long-term hope that humanity has for permanently stemming the tide of infectious agents in less than an average lifespan's time: genetic engineering. Luckily, we are developing new tools for this all the time. Yes, they pose great danger, but so did fire the first time humanity harnessed it to provide warmth and a way to cook food (coincidentally enough, yet another of our small victories in the war against disease).
That a bit of hyperbole, people don't take antibiotics for minor scrapes - soap and water is the prescription. quite often when the minor scrape is life threatening, its something like MRSA. which leads me to think of the stories of people in the past dying of minor scrapes: maybe its been around for longer than we think.
after all of the scare tactics, much of the drug resistance where it matters has been appropriate use. TB, gonorrhea, etc. These diseases didn't become drug resistant because people were taking antibiotics for the flu or use in agriculture.
1) its very rare a cut needs antibiotics 2) if an infection is severe from a 'minor scrape', the prior for it being something like MRSA is much higher 3) minor scrapes in the past also rarely needed antibiotics 4) rare stories of people dying from minor scrapes in the past might have been MRSA
2) in 2017, yea. in the past, the prior for it being MRSA is essentially 0
3) thats because vaccination predates antibiotics
4) nope
your statements amount to "i have no clue how evolution works". bacteria are single cell organisms that dont just suddenly exist into the world being resistant to antiobiotics, which were specifically developed to kill those organisms off.
MRSA existed pre 2017, which it was in fact discovered in the early 1960s.
While I understand that MRSA is probably emerged from antibiotic use, I am open minded enough to consider it could have predated modern use of antibiotics.
bacteria in the world weren't suddenly under threat once antibiotics came along. they have been fighting the fight for 3 billion years. In fact, Penicillin is a natural occurrence used to fight bacteria before humans stumbled upon it.
All of the ways our antibiotics are used to fight bacteria have been something bacteria have been dealing with since they existed.
in a pre vaccine pre antibiotics world, every time you get dirt into an open wound, you run the risk of:
https://en.wikipedia.org/wiki/Tetanus
thats not hyperbole. it looks like hyperbole to you because vaccines.
the hyperbole part is trying to sell a world where a minor scrape leads to death. SURE, its possible (but very unlikely) that could happen, but that could happen under any circumstance anyways.
antibiotics resistances dont make bacteria immune to vaccination. entirely different mechanism.