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Comment by darkerside | Hacker News Reader

Lyme disease also causes symptoms that overlap with RA, due to the Borrelia burgdorferi bacteria. It is latent in some people and causes serious symptoms in others.

I truly wonder sometimes whether antibiotics are actually underused in medicine (while simultaneously being overused in the food supply chain).

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I think in general the answer is more likely to be probiotics than antibiotics.

I think we underestimate the extent to which pathogens thrive in niches carved out by the absence of symbiotic bacteria required by our microbiomes.

Fecal transplants have shown significant results in some diseases (such as Crohn's): https://academic.oup.com/ibdjournal/article/21/3/556/4602907

> Based on [Pediatric Crohn's Disease Activity Index], 7 of 9 patients were in remission at 2 weeks and 5 of 9 patients who did not receive additional medical therapy were in remission at 6 and 12 weeks.

> No or modest improvement was seen in patients who did not engraft or whose microbiome was most similar to their donor.

So I think it's either a case of pathogens that fit in with the established microbiome or that the microbiome is missing vital components.

Once your microbiome is disrupted, I believe studies indicate that it's unlikely that adding probiotics in will fix it. I could see antibiotics followed by probiotics being an effective treatment for a microbiome gone haywire.

You still should consider collateral damage - we've been throwing broad spectrum antibiotics at damned near everything for decades.

We've started an arms race with a staggeringly dynamic enemy, and our solution thus far has been to attack them with static munitions, until those munitions stop working.

You can mitigate the issue with combination antibiotic therapy (it's harder to evolve resistance on multiple fronts simultaneously), but in general (when we use them) we need to move towards targeted antibiotics.

The difficulty being that you actually need to diagnose the specific problem before treatment, not just that it's bacterial in nature.

This requires pathogen detection and recognition: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4941824/

This adds significant complexity (though I don't think that knowing what you're doing is a bad idea).

We've been using nukes for a long time now, we need to move to scalpels.

In the case of Chrons and Ulcerous colitis diet changes have big impact. There have been studies that show that high consumtion of processed food increase the likely hood of getting sick.

> I truly wonder sometimes whether antibiotics are actually underused in medicine

Killing gut microbiota is also being increasingly linked to diseases, so it's likely a very complicated balancing act where we need to maintain the correct bacterial flora.

Antibiotics are both overused and underused in medicine. We still see antibiotics being prescribed as a prophylactic measure even without a confirmed bacterial infection, or for minor bacterial infections that patients could probably clear on their own. People think of antibiotics as being benign but they come with significant risks and side effects, including disrupting the gut microbiome.

At the same time we lack evidence-based medicine guidelines for treating most low-grade chronic bacterial infections. In many cases there aren't even reliable diagnostic tests for such conditions, so it's not clear what the root cause of a patient's symptoms are and physicians have to try treatments at random in an attempt to find something that works. More basic research is needed in this area.

> Lyme disease also causes symptoms that overlap with RA

This could just mean that diseases trigger same pathways. Overlap doesn’t mean a common etiology.

Just about nothing means anything. But it's still worth investigating correlations.

>I truly wonder sometimes whether antibiotics are actually underused in medicine (while simultaneously being overused in the food supply chain).

In the US, this is basically a given. You don't have to look past the lobbying numbers to understand why.

I'm curious outside the US, how often antibiotics are given out. From my buddies telling me stories about Mexico + the fear mongering with US Physicians, you'd expect a superbug to have broken out by now.

What about the whole super bug antibiotic resistant thing

There are some who propound a more nuanced approach:

https://news.ycombinator.com/item?id=35704698

Multiple superbugs have broken out and are killing thousands every year. The irresponsible overuse of antibiotics in places like Mexico is certainly part of the problem.

https://www.cdc.gov/drugresistance/about.html

https://en.wikipedia.org/wiki/Clostridioides_difficile_infec...

There is no mention on your page, or the wiki, that antibiotics are the cause the resistant bacteria.

I can logically see why we would believe this, but you'd expect given the use of antibiotics on the farm and in non US pharmacies; we'd have such a superbug scientifically proven by now.

Scientifically it's nearly impossible to prove things. However, scientific evidence supporting the antibiotic-driven increase in antibiotic resistant "superbugs" has been found.

https://www.theguardian.com/environment/2019/sep/19/superbug...

Antibiotics, and antibiotic resistance genes, have existed for an uncountable number of megayears. Antibiotic use by humans is probably not creating many new antibiotic resistance genes, if any at all. But is is driving the increase in bacteria that contain these genes, as well as encouraging the horizontal transmission of antibiotic resistance genes and the accumulation of multiple such genes in so-called "superbugs".

https://www.nature.com/articles/s41467-021-22757-1

https://pubmed.ncbi.nlm.nih.gov/30248271/

https://genomemedicine.biomedcentral.com/articles/10.1186/s1...

It's a fairly clear case of natural selection.

One of the biggest risk factors for a C. difficile infection is being treated with fluoroquinolones (ciprofloxacin, gemifloxacin, levofloxacin, moxifloxacin, norfloxacin, and ofloxacin), which are often used in outpatient settings.

>>you'd expect a superbug to have broken out

You'd expect it, and it has.

> [MRSA] caused more than 100,000 deaths attributable to antimicrobial resistance in 2019.

https://en.wikipedia.org/wiki/Methicillin-resistant_Staphylo...

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