We're losing the war against drug-resistant infections faster than we thought
npr.org
npr.org
- Overuse in meat agriculture evolving new DRB as a side-effect of profiteering from animal cruelty by force-feeding animals soy and corn.
- Overuse for emotional customer satisfaction reasons rather than evidence-based scientific treatment of viruses with totally-inappropriate antibiotics. This isn't a problem limited to the Global South that this article wags its finger at with imperial arrogance. This happens all the time with American primary care doctors dispensing antibiotics without proof of bacterial infection.
- Lack of R&D into new drug classes.
While delaying prescriptions campaigns like US CDC may be holistically helpful to discourage some overprescription abuse, it doesn't address the lack of sufficient rapid, systematic, integrated clinical pathological screening and surveillance.
For maximum human benefit, I think essential medical testing services should have a nationwide option provided at minimal costs for anyone including those without health insurance. Some things shouldn't be completely privatized because of the perverse incentives created, like private equity buying up rural hospitals decimating local care options to favor air ambulance services they also own.
I think we can and must do things better and smarter to reduce individual and aggregate harm.
It's just an immunoblot quick test. You can probably order a kit online (not much use until it expires though).
https://www.praxisdienst.com/en/Lab+Equipment/Tests/Point+of...
Many people, even doctors will blame patients for creating antibiotics resistant strains. While it’s true that a resistant strain can develop and spread due to an individual’s actions, those strains will gradually lose their resistance once no longer exposed to antibiotics, so it’s probably better have antibiotics be accessible drugs everywhere to prevent any initial spread and just trust people won’t use them chronically for no reason. Though I’d argue lack of access to antibiotics contributes more to the spread of disease then careless patients stuffing down their mouths, it really depends on what type of bacteria it is. Patients with viruses often misdiagnose themselves as needing antibiotics and that’s another reason it’s not over the counter, that builds resistant bacteria, not inside the patient but in the external environment due to excretion in urine etc.
Doctors will often chide patients for not taking the whole bottle of antibiotics once they stop feeling symptoms as if this gives more opportunity for the resistant strain to spread. It’s true it’s probably safer to totally ensure you are free of disease before stopping a medication, but increasing the overall level of antibiotics in the environment boosts resistance in every case. As people on this thread have pointed out the mass use of antibiotics in cattle farming is going to contribute significantly to resistance because it permanently increases the amount of antibiotics in the environment. Other than stopping that not much can be done to prevent this
It’s kind of a non-issue on an individual level as resistant strains lose resistance over relatively short periods time, once no longer exposed to the antibiotic, people just assume if the bacteria evolved an advantageous trait it will never lose that trait even though it’s no longer advantageous once it’s environment returns to normal.
I've never heard this. Can you cite an example or source for this? How could we be losing if medicine can afford to "wait out" a strain? MRSA's been around 80 years. Call me skeptical.
“We previously reconstructed a 1,000-year-old remedy containing onion, garlic, wine, and bile salts, known as ‘Bald’s eyesalve’, and showed it had promising antibacterial activity. In this current paper, we have found this bactericidal activity extends to a range of Gram-negative and Gram-positive wound pathogens in planktonic culture and, crucially, that this activity is maintained against Acinetobacter baumannii, Stenotrophomonas maltophilia, Staphylococcus aureus, Staphylococcus epidermidis and Streptococcus pyogenes in a soft-tissue wound biofilm model” [1].
> How could we be losing if medicine can afford to "wait out" a strain?
In general, “mutations that confer larger” resistance “are more costly” in terms of fitness [2].
Absent the selection pressure of a particular antibiotic, the bugs without that resistance generally outcompete the ones weaving chainmail against Tomahawks.
And the more important part is losing resistance in a meaningful timeframe, much smaller than 1000 years. Also the relevant genes can't be easy to reactivate.
No proof, but when I came across this it was suspected the treatment fell out of use due to resistance.
The vast majority of resistance mechanisms are detrimental to the cell that has them.
1. The bacteria consumes energy to be resistant by pumping out the antibiotic, blocking it with a protein or breaking it down with an enzyme.
2. Alters it's billion-years-optimized metabolism or structure to be resistant and this affects it's efficiency.
3. Forgoes on a source of energy because it can't use it anymore.
When in a competition with regular bacteria (no antibiotic around), these resistant cells will be outcompeted and gradually replaced.
No, they do not. Bacteria eventually optimize and streamline genes that confer resistance, and they stay around basically forever in a small reservoir of bacteria. So once you start using the antibiotics again, these streamlined genes almost immediately reappear.
A few years ago, a North Korean soldier was shot several times as he dashed across the border in plain sight of other soldiers. After he arrived in the South, the surgeon who treated his wounds reported an unusually high effectiveness of antibiotics administered to him. The bacteria on his skin and in his guts had been exposed to little to no antibiotics before.
This is an incredibly poor read. New antibiotics are a necessity of greater resistance but this magic conveyor belt of novel antibiotics isn't the best solution; preserving the efficacy of our existing drugs is.
Honestly not sure how to reply to the rest of this. Antibiotics being over-the-counter does not create higher resistance. Bacteria can't pass in urine as they are [far] too big. Inappropriate farm antibiotics are a real problem but it's the same problem with the same solution. And bacteria only lose resistance if the resistance causes a disadvantage in low-antibiotic environments. Many resistances do not, and so persist.
Your doctors aren't making this up. Take full courses, don't use antibiotics when they're not needed. Yes, it's just kicking the ball down the field, but it's essential.
They kept insisting asking if we did give it twice a day, are we sure we did the full course, did we respect the 12h interval, etc. The vets told us this (we saw about 6 different vets at the clinic), the person manning the phone berated us, the nurse welcoming us again repeated the same thing.
Eventually I asked to see the test results (the cultures). It was clear that another antibiotic was effective, and that the one they were giving us wasn’t (it was about 25% better than the control). I asked why we couldn’t get the other one, and it turned out it was difficult to get in our country because it was only approved for humans.
We had to get a dispensation from the health ministry to import it from a neighbouring country. It was a mess of a process that took weeks.
Blaming patients is so ingrained that we were being gaslit into giving our pet an ineffective treatment and made to feel like we were doing something wrong all along.
Please give more details, because I've done antibiotic susceptibility tests for 20 years and I'm not aware of any control used like that.
I just meant that over the course of 72 hours, the speed at which the Petri dish with the less-effective antibiotic was filling up seemed to lag behind the control by about 24 hours. At 72 hours both were “full” regardless.
Here, free videos from EUCAST (European Committee on Antimicrobial Susceptibility Testing): https://www.youtube.com/playlist?list=PLQU_kWRWBld4fDhv1T1KO...
Basically use dirty water, finely filter it, such that only things as big as phages remain. Put that liquid in a solution of bacteria you want to treat. Filter it again, repeat... In the end you should end up with some phage solution which specifically attacks the bacteria. If these phages don't work anymore, find new ones.
This reminds of the universal cure to disease being a bullet [1].
Phages are promising. That doesn’t mean they can’t hurt you [2].
The biggest hindrance is that the western process of developing and releasing new medicine is ill-suited for phage treatment.
The whole procedure of selecting a phage personalized for the patient and then growing it into a treatment is so slow the patient may die before it's ready. Works for chonic infections but not much else.
There are probably phage treatments that are not personalized: test susceptibility and then mail-order the treatment. That treatment:
- Would be very expensive to *produce* compared to most antibiotics. I emphasize *produce* because the price of antibiotics rarely reflect how much it costs to produce them. Compared to antibiotics, phage treatments have very low margins.
- Would work for a very limited percentage of patients (probably less than 10%). There are hundreds of phages for each bacteria species (yes, they're species-specific and sub-species-specific).
- Have a very *very* short shelf life, possibly a couple of days. So, no pharmacy or hospital can keep a sufficiently diverse supply of phages in store to treat most patients, possibly not even whole countries.
…as evidenced by the booming phage industry somewhere in the east?
(The weird thing is this railing against western medicine or whatnot is usually a dead ringer for pseudoscience. Yet phages are a scientifically valid thereaupeutic route [1].)
How is this different from antibiotics?
Nothing about phages makes them not worth developing. Exhibit A: they’re being researched and developed.
2) Phages are live organisms (as much as you can call a virus "alive"). The shelf life is very very short. A couple of days probably.
1 + 2 => A hospital would have to store thousands of different phages to be able to treat most of it's patients and it would have to replace those stores twice a week.
Couldn’t you create a few compound batches that treat sets of bacteria, balancing distribution cost and side effects?
Do that a little, remove phages that don’t work better than antibiotics, tailor for local conditions and I doubt you’re adding more than a few dozen medicines to the hospital’s inventory.
> shelf life is very very short. A couple of days probably
Plenty can survive cryogenic suspension [1].
And this makes them “not worth…developing” why?
(The comparison to antibiotics was that the antibiotic-bacteria system is coevolving too. Exhibit A: TFA on antibiotic resistance.)
Again, what are you basing this on?
> This is not cost effective to go through the whole process
Now do personalized medicine.
Personal medicine as in individual combination of existing drugs is easier to achieve in current regulatory framework then using new drugs.
For example antibiotic resistant urinary tract infections caused by the use of catheters. Effective antibiotics simply don't work when they can't reach the infection.
That's the packaging. Once you break the seal, it's contaminated from the surrounding air. But that's not even relevant. When the catheter is inserted, it picks up bacteria from the genitals. No washing and disinfection can remove all of them. Also, like @cyberax said, the catheter can move. The longer it's kept in place, the more bacteria gets upstream.
https://pubmed.ncbi.nlm.nih.gov/31532742/
The infection rate is initially 3-10% but increases by 5% for every day its left in.
Some more information here on biofilm development and sepsis/mortality rates which is chilling.
- Antibiotic-resistant bacteria evolution
- Animal cruelty
- Pandemic virus evolution
- Climate change
- Air, water, and soil pollution
You couldn't be more wrong. The overwhelming majority of people are against animal cruelty and creating more antibiotic resistance through cattle farming, even if it means slightly-to-modestly more expensive meat. The reason it continues is a failure to inform (seen the insides of many factory farms on the news lately?), organize, and act to that end. It is not because of selfishness that it continues (except the selfishness of those profiting from it, but there will always be someone selfish, no matter how selfless the average person gets), but because the virtuous have not gathered enough power to stop it (at home and especially abroad [1]).
Self-flagellation will accomplish nothing.
[1] https://ourworldindata.org/grapher/antibiotic-use-livestock-...
This is a hard one to prove without trying. A lot of people would say that and then buy the cheaper version when the time comes.
You're seem sure of yourself while being incredibly confused. Strawman fallacy. People may half-heartedly express some things like "they'd buy X if X existed at price Y" but then, time-after-time, they don't do it. Actions are all that matter and are the proof. The actions say most people are happy to maintain cognitive dissonance so long as they don't see how the sausage or hamburger is made. Some "less bad" alternatives are offered in some stores, but these aren't necessarily the standard or popular items because the customer is given the choice to buy Brazilian or American beef raised on CAFOs rather than banning them and banning feeding mostly corn diets altogether. Most consumers and most other buyers will simply choose the cheapest option available, no matter the externalities involved. The corporate meat industry encompasses a powerful lobby that has legal, legislative, and media power to maintain the status quo, and most Americans are low/no information consumers who are happy with (was cheap) fast food and don't think or care how it was produced because they're addicted to UPF. Only a small fraction (<~10%) even put a thought into how their choices matter and not all of those have the luxury to afford alternatives because the precariat are even more precarious these days. It would take radical socioeconomic and political change to undertake unpopular, necessary changes to reduce harm from existential threats. This won't happen until it's already too late and people are dying in massive numbers. Proactive harm reduction is avoided because too much kakisto-klepto-plutocratic forms of government are reactive because they don't care or are too stupid to care.
Fundamentally: the raising of animals for meat is impossible to regulate to assure anything close to uniform, humane conditions, biosecurity, and climate neutrality... because it necessitates suffering and resource intensive. People who are ideologically wedded to meat profiteering and consumption will espouse all sorts of bad arguments that there can be "organic, grass-fed" pseudo-permaculture-washed approaches possible, but it's really denying irreducible facts about growing large numbers of animals' cross-contamination with wildlife and people, feed inputs, waste pollution, and slaughtering them. There's no rehabbing a dirty industry except making it seem less bad with token, performative, greenwashing campaigns.
But they do vote for it. They vote for environmental laws that make products and food more expensive, they vote for animal cruelty laws that make food more expensive, they vote for tariffs to keep/re-shore industries that make products more expensive. Time and time again, they choose the more expensive options.
They only don't if the only "choice" you recognize is that of a consumer (and probably an uninformed consumer at that), not that of a citizen. Bot of course corporations would love it if the only action their opposition could take is in which products they consume.
This last bit is partially indirect, since it has the problem that while new antibiotics might very well exist, governments will not approve them unless they have no other choice. Yes, nationalized health insurance providers are the majority of the worldwide market. Second a number of markets (notably India, but certainly not just them) will rip off the medication and not pay a dime for it. This all combines to make it really hard to get people to invest in widely applicable antibiotics. Unfortunately that does include direct subsidies as well (governments do ask big pharma what to subsidize).
So the money is in medicines that fix one particular fatal illness, medications for which no alternatives exist, that are very difficult to produce. This makes getting approval very easy, and allows for high prices.
At least that was the situation ~2016. Since then governments have been "tightening the belt" or whatever they call it and the situation has gotten worse to the point that a number of (especially European) labs now don't exist anymore. Which means even if the defunding is undone they will take a decade to get back up to speed. This is affecting a lot of other things as well. Like the ever-worsening doctor shortage predicted to worsen to the point that even just actual life-saving operations (now ~40% of the total, which is already way too much) won't be able to happen anymore ... by 2035, in the UK. This is not when you get ill, and need a treatment in 6 months, this is about someone closing up internal bleeding when you get hit by a car. Needless to say, the government is defunding education of new surgeons further, worsening the situation. I mean, everything is getting worse, on purpose, in the UK. From roads, public transport, and indeed the NHS. "Doing less with less" seems to be the government motto.
People vote for a "slim" government and more free market mechanics. This is it.
So what's next?
humans are now, and have been for some time, the largest biological niche to exist.
biological law: all niches will be filled.
all life shares the same chemistry
humans are activly digging up and playing with every tiny little other nitche on the planet and moving stuff around, AND useing various genetic edditing technolgys to modify numerous life forms, which are "washed" down the drain after the experiment is over.
it goes on.(edit), and on
we are so fucked.