Urinary tract infections are becoming increasingly resistant to antibiotics | Hacker News Reader

Urinary tract infections are becoming increasingly resistant to antibiotics

nytimes.com

84 pointsjseliger50 comments

My partner is particularly prone to UTIs. In the UK, people in her position are given a virtually endless stream of antibiotics. Often doctors end up recommending taking a small dose every time after sex. No wonder resistance is increasing!

After a lot of research and self-testing, we came across D-Mannose and had an idea [1] to help others in a similar position. We were very excited to be able to help reduce peoples’ recurrent pain and to decrease overall antibiotic use.

Unfortunately it hasn’t been popular as of yet. Any feedback would be appreciated!

[1] https://chickpea.care

D-mannose is surprisingly effective.

Wow, that's not cheap (normal price of £32 per month, currently on offer for £24 per month). Is there support from the healthcare system or do you have to pay everything yourselves?

A lot of people with chronic conditions are on constant small dose antibiotics. I have a daughter that contracts pneumonia from every little common cold. She’s on small-dose antibiotics every day now with good results.

Her doctors say a very good reason to keep the use of antibiotics down in the general population is just because those people would be extra vulnerable to resistant bacteria. Doctors here have effectively stopped prescribing antibiotics for things they prescribed it for almost always just a few years ago, such as regular tonsillitis. That’s the sort of thing that helps. Obviously a total ban on antibiotics in healthy livestock that the EU adopted is even more important. I wish we could see that in China/India soon.

Have you looked into the effects of zinc supplementation of common cold frequency and severity? I am not a doctor, this is not medical advice, etc.

https://www.mayoclinic.org/diseases-conditions/common-cold/e...

I haven’t but I could. The part where colds turn into pneumonia is due to a congenital issue (a surgically fixed EA+TEF) so that’s probably hard to do anything about except growing, but if the initial viral infection could be stopped that would be good. My saying trick for preventing colds currently is normally a lot of saying e.g “no! don’t lick elevator buttons!”

Tripped across this while trying to confirm that it is what I think it is:

https://www.webmd.com/vitamins/ai/ingredientmono-1114/d-mann...

It is what I thought. It's a glyconutrient and probably basically the same stuff I took for, I'm not sure, maybe a few years.

I have a genetic disorder that predisposes one to infection generally. A friend who was a former nurse bought me glyconutrients as a gift on the condition that I agree to just take it long enough to give it a fair shot.

I did. It helped. I kept taking it on my own dime.

One year for Christmas, she hand packed me low dose, additive-free guaifenesin. That helped me make it through Christmas without a trip to the ER requiring antibiotics for the first time in years.

Those are not the only things she did for me and my health. There were others. She very much helped save my life and start me on the road to recovery.

So, anyway, I was spending $100/mo on glyconutrients and $300/mo on supplements overall. If I missed a single dose of glyconutrients, I began deteriorating.

I was curious why. What the hell was this doing for me?

So I began googling around and I found that a lot of the important stuff in your immune system are classified as glycoproteins.

So I surmised it was providing targeted nutritional support for my immune system so it could crank out "soldiers" for the war effort and keep cranking them out.

Have you ever looked into zinc supplements? If I recall correctly, a huge (50%) part of the population are zinc deficient, and zinc deficiency lowers white blood cell count, amongst other things.

I took zinc for a time. The aforementioned former nurse recommended it for other reasons.

It seemingly helped those other issues. It was not a magic bullet in terms of my immune function.

I can confirm this can help based on what I know from relatives. Such supplements try to make the urinary tract inhospitable for bacteria.

If the infections are caused by specific bacteria, Uro-Vaxom is a drug that may help.

Doctors typically recommend some basic things to avoid UTIs, like wiping from front to back and peeing after having intercourse. Having the partner shower before can't hurt either.

Will pass that on to someone I know. They are using high-strength cranberry extract and zinc, with great success (cranberry specific for UTIs, zinc just to ensure not deficient, as that impacts immune system). UTIs still occur occasionally but rapidly subside without antibiotics. Zinc supplementation should be early in the day, or there will be some wild dreams. Avoid zinc oxide though, imho. I am not a medical doctor, this is not medical advice, everyone must do their own research/talk to doctor etc.

TIL that one of the drugs mentioned in the article has a side effect of rupturing tendons. [1]

[1] https://www.webmd.com/osteoarthritis/news/20080708/fda-warni...

My mother spoke at the meeting preceding the FDA [1] requiring a black-box warning be added to that class of antibiotics. Rupturing tendons is bad, but it gets a lot worse than that.

She suffered life-altering symptoms which ended her career of 25 years in insurance sales.

The drug is routinely prescribed and dispensed without patients being warned of these symptoms. Just a few months ago, she was at a pharmacy and overheard the drug being dispensed and asked the pharmacist why she didn’t warn the person who received it about the possible reactions.

It apparently takes too much time to tell them, according to that pharmacist.

[1]: https://www.fda.gov/drugs/drug-safety-and-availability/fda-d...

My grandmother received an antibiotic that made her virtually deaf (ototoxicity of an aminoglycoside).

That side effect is well known. Usually they won’t use those antibiotics unless hearing damage is less worse than not using them ((e.g. death).

Those antibiotics are used routinely for specific indications (preop prevention, for instance). Professionals are well-aware of their downsides. Hearing damage generally stems from overdosing.

It's not so much that it ruptures tendons, as they were some studies in dogs a while ago that showed that if you marinate canine achilles tendons in cipro some of the fibroblasts die off - which has the effect of diminishing the tendon structural integrity over time. The study was in achilles tendons, so you only ever heard about it being associated with achilles tendonitis. As a foundation of knowledge this was crap, but it made it into the med school curricula and textbooks. Which... well, when every med student in the country is taught "CIPRO = ACHILLES TENDONITIS" (and has it on their board exams that it can occur even years out), it's going to tend to create a certain bias for detecting and reporting. I mean, "Oh, my patient tore their achilles, and I treated them for a UTI three years ago. It must be the cipro!" I mean, no one would ever think that if they hadn't had it drilled into their heads in school.

It's /probably/ bullshit... but there are better UTI meds, so most practitioners don't use it first-line regardless.

It should be illegal to classify fluoroquinolones as antibiotics. The point of an antibiotic is that it specifically targets bacterial cells while doing no damage to multicellular organisms. Fluoroquinolones indiscriminately damage everything they touch, so they're just a really fancy and strange poison. They don't just rupture tendons, people will often experience waves of intense pain throughout their entire body for the rest of their life from the damage done to their nervous system. Many suspect that "gulf war illness" was in fact soldiers reacting to fluoroquinolone "antibiotics" which they were the guinea pigs for. Always check the acting component of an antibiotic that a doctor prescribes to you, and if it contains fluoroquinolones then you should frankly treat their act of prescribing it to you as barely any different than a murder attempt.

This is an unreasonable position to take.

Every drug has off target effects, that’s why they have side effects.

Oncology drugs, particularly chemo, attacks pretty much every cell in your body. That doesn’t mean they aren’t effective.

Cipro does far worse than rupture tendons.

It has two black box warning labels on it, the other is for nerve damage (causes peripheral neuropathy).

It has been implicated in retinal detachment, kidney failure, heart damage, brain fog, and some have tied it to fibromyalgia.[1] Which makes some potential sense given the rate at which women have taken it for UTIs.

With the damage that it is now known to cause, veterans groups have been looking at Cipro as the cause of Gulf War Syndrome.[2] Soldiers were forced to take Cipro as a guard against anthrax during the Gulf War, with little evidence at the time that it would do anything to protect against it.

There may be no drug more vile - outside of opioids - that is being very routinely given to people in the US than Cipro.

It strips magnesium from your body and leaves necrotic damage behind (the only partial counter to it, prior to taking it and after, is supplementation with something like eg magnesium citrate). In addition to tendons, it can also destroy cartilage.

And if you make the mistake of taking it with NSAIDs or steroids, watch out (there is a warning for that, but one can imagine many people ignoring it in regards to something like Advil). That can amplify the damage dramatically.

[1] https://well.blogs.nytimes.com/2012/09/10/popular-antibiotic...

[2] https://www.militarytimes.com/2013/11/01/new-fda-warnings-on...

Fluoroquinolones can do worse than tendon ruptures. One possible side effect is neuropathy. I got a bit of this the last time I took levofloxacin. My skins felt...wrong, for a couple of months. I had random painful prickly sensations. I absolutely can't drink caffeine anymore. And my case is hardly a serious one. Imagine the sensation of being on fire--some people have ended up in exactly that situation.

I'll never take another fluoroquinolone as long as I live.

I worry that doctors are still WAY too prone to prescribe antibiotics.

I take my kids in as they've got respiratory issues that when they get the flu heir airway starts to narrow. A steroid fixes that just fine.

But man most doctors will still offer an antibiotic too ... like dude, I know that won't help, it's a virus...

Why on earth would they prescribe antibiotics for a virus? They don't seem very competent

And you don't seem like you have any clue about this topic. There are guidelines for that. Professionals (even incompetent ones) do follow them, based on academic research.

I suspect because people who come in want... something.

I just pass on them.

What we've been told is that during the virus phase the child's immune system becomes so weak, that it's prone to develop a bunch of infections (most common being every toddler's favorite - ear infection), and that the pattern was so common that they would write a prescription as a preventative measure.

Antibiotics are available without prescription in countries like India. Not to blame the people who purchase and take them because the government provided care is a total failure and they can’t afford private care. Even the private doctors prescribe antibiotics even for minor viruses without tests. So no wonder common bacteria are evolving into resistant strains.

Those citrus farmers in Florida are fine with it:

> "Citrus Farmers Facing Deadly Bacteria Turn to Antibiotics (nytimes.com)" https://news.ycombinator.com/item?id=19945233

IIRC c. auris is sometimes a culprit. And now that there's mycotic-resistant strains and very few antimycotic drug classes, it's not a good trend. We need more antimycotic drug classes.

Antibiotic resistant is a huge problem that is only going to keep growing. Unfortunately very few new drugs are in the pipeline because they aren't particularly profitable to develop.

"depending on a person’s insurance, getting a culture can be expensive."

How is this possible?

I live in a country not famous for its low cost health treatments, but I paid the equivalent of $6 (six dollars) for an urine culture just some days ago, and it was a full price paid to a private company, no insurance, no subsidy.

How much can a culture cost in the US?

The tragedy of the commons strikes again.

Luckily there's bacteriophages waiting in the wings.

That the failing power of antibiotics is not a major national political issue says very bad things about our society.

<s> Didn't you read the other front page article on HN today? Modern medicine is useless anyway. </s>

Saw it, but cannot find it again. Search doesn't show it and I checked the first 250 stories. It's not there.

Did it get deleted? Do you have the hn link?

https://news.ycombinator.com/item?id=20434325

It's a puff piece for Stegenga's new book.

> Stegenga's

Who is this?

https://news.ycombinator.com/item?id=20434325

There is a certain disconnect between "warning about antibiotic overuse" and ignoring that the same selection pressures are exerted by vaccine use.

Got any citations on that? I’ve never heard of pathogens evolving around vaccines.

Because vaccination creates a series of various antibodies that are not identical from person to person, and often target highly invariant portions of a target microbe.

The GP just conflated two wildly different things. A citation is not likely forthcoming.

Thanks. My bullshitometer was going off but I’m not a biologist.

I have no idea, but I Googled "pathogens evolving around vaccines" and got a couple of interesting hits.

Here is an article about how vaccines cause evolutionary pressure:

https://www.quantamagazine.org/how-vaccines-can-drive-pathog...

And here is a paper about how they mostly don't:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6304978/

I feel like it's weird that people say something exists and then other people say no it doesn't without ever typing it in to Google. If you are that uninterested in the topic, why even post? Surely you can't reassure yourself about your knowledge that way.

I did google it. I wanted to know what this guy would say about it. Don’t be an asshole

Edit: Thanks for digging up references though. And I do feel the same way about people asking questions when they’re too lazy to search. In this case I had reasons to do so.

Sorry but that is just not true. Vaccine use applies the same selection pressures as [people existing and having immune systems]. The things you are comparing are totally different and not comparable.

So, I'm risking sounding like a fringe anti-vaxxer here, but no, vaccine use does not apply the same selection pressure, because we know that vaccines wane, but generally speaking, acquired immunity is for a lifetime. Also, there are different types of vaccines - some target bacterial infections such as pertussis, while others target viruses. Here's an example of pertussis adapting to the vaccine use [1]

[1] https://www.ncbi.nlm.nih.gov/pubmed/11485646 > In the Netherlands, as in many other western countries, pertussis vaccines have been used extensively for more than 40 years. Therefore, it is conceivable that vaccine-induced immunity has affected the evolution of Bordetella pertussis. Consistent with this notion, pertussis has reemerged in the Netherlands, despite high vaccination coverage. Further, a notable change in the population structure of B. pertussis was observed in the Netherlands subsequent to the introduction of vaccination in the 1950s. Finally, we observed antigenic divergence between clinical isolates and vaccine strains, in particular with respect to the surface-associated proteins pertactin and pertussis toxin. Adaptation may have allowed B. pertussis to remain endemic despite widespread vaccination and may have contributed to the reemergence of pertussis in the Netherlands.

Because pertussis vaccine targets a specific, purified protein from the target microbe (that is, a fairly non-conserved element, that is fairly small and provides fewer targets for variation in Ab targets).

Most vaccines don't do this, and none of the new vaccines under development do this (that I am aware of, admittedly.) It's historical inertia at this point. But going back at least as far as "since when I was a kid" it's a fundamental point of vaccine design that you aim for things that the microbe has a difficult time evolving away from (highly conserved molecules), and that offers multiple antigen targets.

I can't say that's never deviated from - not letting the perfect be the enemy of the good and what-have-you - but it's the norm.

Pertussis vaccine is notably unreliable. About 60% efficiency. This is well known and has been for decades.

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