The Bugs Are Winning
nybooks.com
nybooks.com
Note: I'm not a doctor/biologist/etc., so I cannot comment on the details of this claim (e.g. how far away we are from a widely deployed phage-based treatment).
Bacteriophage evolve of their own accord, so phage resistance is temporary. Often the bacteriophage strain you need already exists and you just have to find it. This is much less effort than developing a new antibiotic.
US Medicine is for profit, and the money is in reoccuring treatment, not cures. So a never ending battle of cat-and-mouse is the type of R&D phramas would love.
A potential future scenario:
Keep going to your doctor to get a Rx for the latest strain or pay a monthly fee to a Bacteriophage-As-A-Service SV tech company to get the latest delivered right to your door you use in conjunction with a smartphone app.
The latter of which would have operated illegally until sufficiently large enough to hire insider DC lobbyists to gut the FDA.
Please provide numbers of patients treated with phages, time to treat one and efficacy numbers.
They are still in development and there are some technical hurdles, but before too long cheap, fast, and accurate strain typing should be ubiquitous. The next issue is then creating the specific phages, but the first stage is pretty close at hand.
Good luck trying to even get the bacterial sample to do it for quite a few kinds of infections. Lungs and other organs would need a good biopsy or at least really well done aspiration, handling of samples is very messy.
It is a good method to use in hospital settings perhaps where you want to sample anyway.
The FDA could help by letting anyone provide phage therapy without further testing given it's been proven over the decades and is pretty harmless to humans. At the moment I think you'd be blocked by regulations, unnecessary ones in my opinion.
You might be able to patent genetically engineered ones, or a novel process involving them.
One of the problems with phage therapy is precision. You have to know roughly what kind of bacteria is causing the infection. To know that it takes tests, and time, which cost money. Antibiotics on the other hand are broadspectrum and can be deployed without much prior knowledge (which is cheap, but also a problem that causes resistance).
The other problem is production and regulation. Antibiotics are chemical, phages are biological. It is much harder to produce a consistent safe product with a biologic compared. We don't have the infrastructure (yet) to mass produce viral phages for consumers.
So could we not "renew" some antibiotics by simply not using them for 5 to 10 years?
Moreover certain viruses cause the resistance to spread horizontally, and some bacteria do share genomes locally as well.
It is not just the bacteria that grow resistant to drugs, but the human body itself starts to develop resistances. One of the major factors behind this is the presence of antibiotics in the various meats we consume. Animal antibiotics are a huge gift to the factory farming industry. But to acheive better results, many animal farmers simply (and often illegally) use the highest dose of the antibiotic they can find. A small amount of these drugs eventually make their way to human bodies. Persistent exposure to such drugs then results in increased resistance to antibiotics. So where previously a regular dose of a milder antibiotic would have sufficed, now a high dosage of a strong antibiotic is required.
I don’t think the concept of human resistance to antimicrobrials is consistent with conventional biological knowledge.
https://www.google.com/search?rls=en&q=human+resistance+to+a...
While I’m not a trained professional in that area to debate the specific mechanisms, I am sufficiently informed from sufficiently reliable sources about the topic.
As an example, this report from the US National Institute of Medicine titled “The Antibiotic Resistance Crisis” seems to strengthen the case the article linked by the OP of this thread is making. To quote selectively from the aforementioned report,
"The overuse of antibiotics clearly drives the evolution of resistance. Epidemiological studies have demonstrated a direct relationship between antibiotic consumption and the emergence and dissemination of resistant bacteria strains. In bacteria, genes can be inherited from relatives or can be acquired from nonrelatives on mobile genetic elements such as plasmids. This horizontal gene transfer (HGT) can allow antibiotic resistance to be transferred among different species of bacteria. Resistance can also occur spontaneously through mutation. Antibiotics remove drug-sensitive competitors, leaving resistant bacteria behind to reproduce as a result of natural selection. Despite warnings regarding overuse, antibiotics are overprescribed worldwide"
“Incorrectly prescribed antibiotics also contribute to the promotion of resistant bacteria”
"More recently, molecular detection methods have demonstrated that resistant bacteria in farm animals reach consumers through meat products. This occurs through the following sequence of events: 1) antibiotic use in food-producing animals kills or suppresses susceptible bacteria, allowing antibiotic-resistant bacteria to thrive; 2) resistant bacteria are transmitted to humans through the food supply; 3) these bacteria can cause infections in humans that may lead to adverse health consequences."
Should you wish to debate the technicalities of the topic further, I can only suggest waiting for a trained microbiologist to show up in this thread, or getting in touch with the authors of the aforementioned report and the various references linked therein (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/)
Antibiotic resistant bacteria do kill people, but most often as secondary infections due to a compromised immune system. Further, even if the primary infection has near total resistance suppressing secondary infections is still extremely useful.
"While the cost of resistance is highly variable, such resistance mutations or genes often come with a fitness cost that reduces the rate of bacterial proliferation (Dahlberg & Chao, 2003; Melnyk et al, 2015)." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5371735/
"The success of resistant mutants critically depends on rapid counterbalancing of the decreased fitness by acquiring compensatory mutations (Levin et al, 1997; Marciano et al, 2007), which in most cases restore normal growth while preserving resistance to the antibiotics (Marcusson et al, 2009). The number and variety of compensatory mutations required to successfully compensate fitness cost varies with organism (Palmer & Kishony, 2013, 2014; Cheng et al, 2014) and the particular environmental conditions under which compensation occurs (Testerman et al, 2006; Hoffman et al, 2010; Toprak et al, 2012; Lindsey et al, 2013)."
Basically, resistance become extremely important so anything that works get's adapted. But, after that point the search for mutations that reduce cost shows up. The second stage also depends on continuous exposure to antibiotics as reverting the mutation in a population is relatively simple.
I'm fairly sure I've come across this idea before. Oh here's an example: https://www.quora.com/What-is-antibiotic-rotation
Seems like the problem is how long it takes to lose the resistance. Probably a few decades rather than a few years. And you'd need all the world to stop, which just isn't going to happen in Asia, Africa, South America where you can just buy a couple of pills from the local pharmacist if that's all you can afford. Not an easy problem to deal with sadly.
https://www.wnycstudios.org/story/best-medicine/
They take a thousand year old recipe for some medication and test it.
Like old code... most of those once useful genes don't ever fully go away.
> The resistance genes will likely remain, but be 'switched off', so resistance would re-emerge quickly. The cycling approach could theoretically work to some extent, but the logistics on a worldwide scale would be impractical. Mark B
[1] https://www.reddit.com/r/science/comments/3k32wi/american_ch...
In particular not using antibiotics as a growth stimulant (common on farms), reserving certain antibiotics for human use, and training doctors and vets on their use.
More info at: https://www.regjeringen.no/en/aktuelt/norways-battle-against...
Same site mentioned Germany users 50x more antibiotics in their meat preparation than Norway.
https://www.regjeringen.no/en/aktuelt/norway-takes-the-lead-...
Related article on fighting "super bugs" like MSRA: http://www.spokesman.com/stories/2010/jan/03/norways-mrsa-so...
The rational was: Bacteria becoming resistant due to a treatment has only ever been proven for a handful of conditions( TB , HIV syphilis, and so on). The other bacteria are ether resistant or they aren't prolonging the treatment does not encourage a resistant mutation.
By prolonging your treatment with antibiotics you create an environment in which antibiotic resistant bacteria, both the good and bad kind, can replicate easier. Due to Horizontal gene transfer good bacteria can transfer their antibiotic resistance to bad bacteria.
This advice is in stark contradiction to the Fleming quote.
I heard it on the radio and can't remember the sources, but it makes sense to my non medical mind.
*edit added sources.
Found the journal entry if anyone cares : https://www.bmj.com/content/358/bmj.j3418
Article about journal entry : https://edition.cnn.com/2017/07/27/health/antibiotics-course...
IE you feel better, aren't better, and risk re-infection.
It's probably much more effective overall to take the guesswork out and follow a consistent routine for each patient. If you give the patient the option to wing it, and they do and that doesn't work, they're not going to take responsibility for it. They'll blame everyone but themselves for a bad outcome.
I think the whole feel better approach will help antibiotics resistance not necessarily the patient.
Will be interesting to see the risk of "reinfection vs risk of over prescription" graph.
Horizontal gene transfer thing is what I found really interesting
Found the journal entry if anyone cares : https://www.bmj.com/content/358/bmj.j3418
Article about journal entry : https://edition.cnn.com/2017/07/27/health/antibiotics-course...