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The thing is, we need to kill bacterias in many other places than the human body:

- medical equipment: handles for scalpels, syringes, operation tables... All those things we need to clean again and again.

- passage ways: doors, handles, stairs handrails, subway grab bars... All the things that propagate infections in very dense populated areas.

- research fabs: hazmat suits, protection googles, fum hood protections,... All the stuff you want to make sure don't end up cross contaminate your batch or escape.

So it's still very useful.

> - medical equipment: handles for scalpels, syringes,

I hope these things are autoclaved and not just disinfected.

They also need to be mechanically cleaned. Simply sterile is not sufficient due to the presence of pyrogens after sterilization.

https://ethidelabs.com/depyrogenation-and-sterilization-for-...

Yes, but once they are out of their container, they start collecting bacterias.

No matter how clean operating rooms are (which can vary a lot), it's never perfectly sanitized.

A cheap way to get many surfaces agent free would be a nice additional safety measure.

It depends on the instrument, you can't autoclave the scope used for cystology for example, they're generally treated with vaporized Hydrogen peroxide. It's very effective, but not as effective as an autoclave.

> passage ways: doors, handles, stairs handrails, subway grab bars... All the things that propagate infections in very dense populated areas

Sterilizing those often increases disease spread. By default, they are covered with a microbial community that can outcompete things that are human pathogens.

If you sterilize it, then you’re either leaving a coating of food (mostly dead skin cells) for pathogens to eat, or a coating of nasty poisons that strip the protective barrier off people’s skins, which undermines their ability to fight off what pathogens they do end up touching.

I believe you mean sanitize, not sterilize.

Probiotics can be applied to mitigate undesirable bacterial growth after sanitizing [1].

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7350316/

Not with such material which kills everything.

Out of the body, we have a number of solutions; fire, bleach, uv-c, lye; on your list, only the plastics (personal protection stuff) can't cleaned with these many times around

Unfortunately, bacteria resistant to bleach are starting to develop https://www.microbiologyresearch.org/content/journal/micro/1...

You are not going to bleach a handrail 50 times a day, it's not economically viable.

> I am firmly of the opinion it is not possible to develop an antibiotic guaranteeing the bacteria will not be able to gain resistance to it.

I think the main approach to prevent antibiotic resistance is coming up with a way to prevent bacteria ever coming across a low dose of the antibiotic. As long as we make sure the dose is either huge or zero, antibiotic resistance shouldn't evolve.

Unfortunately, humans aren't a well controlled lab experiment - and there will always be people taking a half-dose, or flushing the antibiotics down the drain where they get diluted and suddenly trillions of sewer bacteria get exposed to a low dose and suddenly start developing resistance.

> I think the main approach to prevent antibiotic resistance is coming up with a way to prevent bacteria ever coming across a low dose of the antibiotic (...)

That's not the only way. We have more ways:

* use low dose of antibiotic to kill enough bacteria to let the immune system to deal with the rest. Then ensure the subject is cured until all bacteria are killed so that none escape. Low dose might be needed because most antibiotics are actually pretty harmful and the harm is managed with low dose.

* use more than one antibiotic in combination with the idea there is very little chance bacteria will gain resistance to both of them at the same time.

* use the antibiotic only as a last resort. This is especially useful for bacterias that are not very harmful normally, but might become harmful for certain subjects (for example, immunosuppressed). If a bacteria with resistance escapes, the resistance might not be very useful advantage in outside environment where people do not need any help to fight off infection or when infection can be more routinely treated with another antibiotic.

Again, these are our current strategie

We don't need to develop an antibiotic that's impossible to gain resistance to. We just need to stay ahead of the cat&mouse game, which can go around in circles. If we start using a completely new type of antibiotics and stop using the old ones for a century, bacteria will gradually lose resistance to the old ones as they gain resistance to the new ones.

>suddenly trillions of sewer bacteria get exposed to a low dose and suddenly start developing resistance.

I think you're misunderstanding how resistances work.

Bacteria don't "start developing" resistance, if they survive the antibiotic at all they already had resistance by stroke of luck. The surviving, resistant bacteria will subsequently survive and outnumber the dead, not-resistant bacteria and we generally call this "developing resistance", but the resistance itself is down to a simple question of whether it was already there or not.

Resistances do not come to existence after bacteria come across an antibiotic. If resistance is there, the dosage won't matter because the resistant bacteria will survive regardless.

> If resistance is there, the dosage won't matter because the resistant bacteria will survive regardless.

That’s not how evolution works. A few bacteria could be resistant to low doses. After the low dose, and a short wait, now the entire population is resistant to the low dose.

That gives them a much better starting point for mutations to the resistance gene and for crossing with bacteria that have some other complimentary resistance gene.

Sounds like you actually have no idea how resistance occurs. There are mechanisms for bacteria to gain resistance they didn't start out with, it's called horizontal gene transfer. At least read the wiki before you speaking so confidently about something you know so little about.

I think the OP's statement is perfectly fine.

We don't really care which of those trillions of sewer bacteria carries the pre-existing genes that resist an anti-biotic; we care when a new strain starts becoming prevalent and decreasing the effectiveness. From our perspective, it's a new resistant strain.

I am as layperson as they get on this subject matter, but I would think that even if your statement is true, perhaps we can get to the point where bacteria need to evolve so much to overcome new antibiotic approaches that they lose some of the properties that make them harmful and transmissible, i.e. it becomes harder for them to exist outside of the host, penetrate the host's defenses, etc. At some point a bacteria would need to seem so like a human cell or beneficial bacteria that it becomes non-harmful.

>... the point where bacteria need to evolve so much to overcome new antibiotic approaches that they...

Can't. Changed it a bit for ya.

This is the zone we need to be in for any successful treatment. This is also why e.g. humans will never evolve bullet resistance.

Sure you can. This is what happened with Covid (though antibiotics had nothing to do with it). The early, more deadly strains are less fit for transmission to masked and (later) vaccinated populations, so we ended up with less virulent but more transmissible stuff like omicron.

https://xkcd.com/810/

> A polymer that kills cell walls indiscriminately is hardly an acceptable solution for a human.

Human cells don’t have cell walls, so it would not affect them.

Funny... you are actually right.

But there are also bacteria without cell walls.

> A polymer that kills cell walls indiscriminately is hardly an acceptable solution for a human.

On the contrary. Animal cells do not have cell walls. They have cell membranes but that's a different thing. Many existing antibiotics interfere with the cell walls of bacteria.

> To do this, we essentially need to develop something that will cause serious harm to the bacteria and yet not harm human cells.

The other problem is we depend on mutualistic bacteria to survive, if we kill all bacteria in our bodies we’ll die of malnutrition. And even worse sometimes the problem is those mutualistic bacteria getting out of balance, so we need to kill some while promoting an increase of others.

And those bacteria are constantly topped up from the environment, so we can live in a sterile environment our whole lives. It’s a delicate balance, we can’t just throw anti-bacterial things around without thought.

Usually antibiotic treatments do kill significant portion of bacterial flora.

That's why antibiotics are typically followed by probiotic preparations to replenish our bodies with "good" bacteria. This is not necessarily done to prevent us from dying of malnutrition. The bigger problem is that lacking "good" bacteria, we can have "bad" bacteria take over the void, causing even more problems.