Bacterial resistance - not a problem?

[peter]

Much is made of the possible return of the world to it's 'pre-antibiotic state' as a result of increased bacterial resistance, due in part to profligate and irressponsible use of the group as a whole. Without doubt there is a problem with resistant straind of micro-organism - the emergence of the 'super-bugs' in our hospitals confirms this, but is the problem quite as serious as we have been led to believe.

Two things I have personally encountered have led me to believe we might be a bit further from 'the end of the antibiotic era' than we think. Firstly I remember a german veterinary student of my aquaintance, one of whose proffessors was scathing of the idea. His take was that given the different classes of antibiotic, the penicillins, the sulphonamides, the tetracyclines ect, it would always be the case that by judicious use of either different combinations or temporary removal from use of one or other class, resistence levels could be allowed to fall again untill the given antibiotic class regained it's efficacy as a theraputic agent. Wishfull thinking one might think - but in practice it did indeed seem to be at least partially true. When I first became involved in the veterinary buisiness as a manager of my familys practice it was common practice for the farming community to blanket medicate a group of calves that were showing signs of developing calf pneumonia. In my early days the farmers would not use tetracycline drugs for this, claiming they were innefective in controlling the spread of the disese through a group of calves in a closed house. At this point the drucs of choice were penicillin based or potentiated sulphonamides. Some fifteen years later they began to claim the efficacy of these were on the wane - you would get the same story from various scources spread over a wide area and even though the farmers themselves had a tengancy to exhibit a 'herd-mentality' you had to give them credit for knowing how to maximise their return from the livestock they reared on a daily basis. So we started supplyin OTC (a tertrcycline drug) again and lo and behold it rapidly became once again the leading drug they would request to achieve disease controll in their suckler calf herds. All sign of the previous resistance seemed to have vanished. This led me to think that maybe that old german proffessor knew a bit about what he was talking about.

[dlbpharmd]

I don't follow vet data so I can't speak to that. Bacterial resistance is a looming danger in human medicine. We're just a few years away from incurable gonorrhea (n engl j med 366;6 february 9, 2012,) and resistance among common Gram-negative pathogens such as Klebsiella has reached a level where even the broadest spectrum antibiotics are no longer effective. (Pharmacotherapy 2012;32(5):399–407.)

Here in the U.S., much of this comes from inappropriate prescribing of antibiotics. There is blame on all sides. Most MDs think bacteria first, virus second when diagnosing common ailments. American patients believe every runny nose requires an antibiotic. Pharma representatives inaccurately detail their latest, greatest antibiotic in such a way that MDs believe only the newest antibiotics are efficacious, and that requires a great deal of time and effort in counter detailing.

Restricting certain antibiotics or antibiotic classes can improve susceptabilities, but only with MD cooperation.

[peter]

I think the point our man was making was that resistence wanes as fast as it develops and thus it should be possible by judicious use, continual development and selective combination, to stay ahead of the problem to the point where the doomsday scenario of a post-antibiotic world is not realised. Certainly the prescribing of antibiotics for viral conditions (colds flu etc) has to stop - but even that is to see the loss of the help they give in the controll of the secondary bacterial infections that proliferate in the presence of viral challenge and people will die as a result.

One key problem area is that intensive farming practices demand the prophylactic use of antibiotics (as I described above) just to get animals to the 'finished' stage (ie ready to kill). The pig and poultry industries are particulrly 'guilty' of this practice - pelleted feeds for these animals are produced with antibiotics in them as standard to effect disease controll in the abnormally overstocked conditions in which they are kept (demanded in turn by the need to produce with economic viability the mass quantities of food needed to feed the burgeoning population). In the face of this problem (in the west) and the third worlds (perhaps necessarily) cavalier approach to the free availability of antibiotics 'across the counter' in pharmacies, it is difficult to see the controlls mentioned above, ever being effected.

[Vraith]

I think the point our man was making was that resistence wanes as fast as it develops and thus it should be possible by judicious use, continual development and selective combination, to stay ahead of the problem

I suspect that would be just a delaying tactic [though perhaps the delay could last generations, so time for better/targeted options to develop].
But I'd place a fairly large wager that each time it is, say, tetracyclines "turn" in rotating antibiotics, the buggies will adapt more quickly than the last time...because the bugs are never completely wiped out, and each time more of the survivors will be descendants of the survivors from the last cycle.

[peter]

Yes, agreed that this is a 'delaying tactic' at best and not a terribly sucessfull one for the reason given ie the ever shortening duration of the cycle of efficacy. But there are lots of antibiotics and lots of potential combinations yet to be used/developed (as in the use of clavulanic acid to overcome resistance to amoxycillin [Augmentin]) so there is hope yet.

Just to pull into perspective how difficult it is to come up with new, safe and effective classes of drugs one only has to consider the 'snail-pace' of development of anti-viral drugs. I may be wrong on this (most probably am in fact), but since the development of acyclovir (Zovirax) I don't believe there has been any significant progress in developing effective anti-virals at all. With a potential time-bomb of prion protein based diseases around the corner (the biggest user of mrm's with potential spinal/brain contamination was the baby food industry for God's sake) - one awaits with trepidation the passing of the thirty-year dormancy period of these diseases) there is in all likelyhood possibly bigger threats to face than the bacterial resistance problem.

(Caveat - I accept that much of the above may be BS but I don't think anybody really knows what the long term effect of some of the despicable practices carried out by the food industry will be, so I throw out the 'doomsday' scenario more as 'food for thought' than anything else. )

[Zarathustra]

I've always been skeptical and even critical of the organic food fad, but I'm starting to take it seriously for meat. This year we've stopped eating meat with hormones and antibiotics. It helps that we have a local butcher that has organic meat at a hell of a good price. It's also the best tasting meat I've been able to buy. So it's a no-brainer for us.

I know people who don't take all of their antibiotics, saving them for a rainy day, they think, and even share them with other family members who have a cold or the sniffles, when they haven't been to the doctor to find out what's the problem (virus or bacterial infection). Doctors need to get their act together, but even when they do, there are still uninformed people out there doing stupid things with these drugs.

[Avatar]

Agree with Dlb...antibiotics are over-prescribed. Hadn't thought of people not finishing their courses etc. that Z mentions.

Here we've already got serious problems with XDR (Extreme Drug Resistant) TB, which is a huge killer in Africa even in its non-resistant form.

--A

[Vraith]

Apparently it is a "randomly find stuff that relates to stuff peter wonders about" day.
www.nytimes.com/2015/01/08/health/from- ... -news&_r=0

[dlbpharmd]

Interesting, but it will be many years before this drug finds it's way to market, and lots of bad things could happen to keep it from ever doing so.

[Vraith]

Interesting, but it will be many years before this drug finds it's way to market, and lots of bad things could happen to keep it from ever doing so.

Heh...yea, I know...and it just occurred to me that---all things taken together in this kind of research=!=!=!=!=====:::

Is there anyone at this point, besides me, who wonders---considering how massively successful mouse/rat experiments usually are and how rarely they get to people---if there are millions [maybe billions] of lab mice all around the world that are big, strong, smart, healthy, immortal, and running everything? [a fun...well, not for people...mix of Douglas Adams and 'Planet of the Apes, except REAL!?!]

OTOH---what interested me most wasn't the particular drug. It was the process opening up so many more areas to find/breed/examine.
We're talking at least millions---and perhaps far more than that---of things that we can start studying now that were impossible to study before.

[SoulBiter]

A new anti-biotic has been found and is a breakthrough of sorts that works against even the worst strains of anti-biotic resistant strains of MRSA and TB.

www.telegraph.co.uk/news/science/scienc ... rough.html

The breakthrough was heralded by scientists who said it could prove a ‘game-changer’ in the struggle against antimicrobial resistance.

Prof Laura Piddock, Professor of Microbiology at the University of Birmingham, said: “The screening tool developed by these researchers could be a ‘game changer’ for discovering new antibiotics as it allows compounds to be isolated from soil producing micro-organisms that do not grow under normal laboratory conditions.”

[Vraith]

A new anti-biotic has been found and is a breakthrough of sorts

Hee....same thing as mine, just a different headline/paper!

[SoulBiter]

A new anti-biotic has been found and is a breakthrough of sorts

Hee....same thing as mine, just a different headline/paper!

Ha! I didnt notice your link.. I just read your verbage and didnt connect it to the link... woops

[lorin]

I remember, as a child that when a neighbor child or a cousin got sick with the measles or chicken pox, they would bring the sick child to spend the night with the healthy ones so we could all get sick during, say school vacations. I guess but I am not sure that may have been before vaccines. I also remember that my mother never ever allowed us to take antibiotics. Never. She felt the body should fight it's own battles and build up a resistance. These days she probably would have been arrested for child abuse.

When I worked in the homeless processing system tons of disease came through the door. Except for 2x I never got sick. But overtime staff from the main office got sick immediately. But the the times I did get sick...oh boy....pneumonia and shingles. Yikes.

[I'm Murrin]

It's pretty rare that you'd get something that needs antibiotics. They don't work on viruses, and viruses are the most common causes of illness. That's the whole problem with over-prescription.

[peter]

Secondary bacterial infection is however a major problem even in sickness where virus is the primary cause - hence why a doctor will often prescribe antibiotics even when the likelyhood is that the patient is suffering with a virus. Giving the body a 'helping hand' to deal with the secondary bactereal element can be the difference between sucumbing to the virus - or not.

[Avatar]

Uh, a new anti-biotic? All it will do is be heavily prescribed (if it does ever make it to market) and produce strains resistant to it as well eventually.

--A

[I'm Murrin]

Did you read the article? It's a whole new type of antibiotic and a new way of producing them, opening up access to a vast range of new ones. Maybe it'll just delay things, but it's a big deal.

[peter]

Antibiotics fall into classes [the penicillins, the sulphonamides, the tetracyclines etc] and the development of a new class is certainly a mighty step forward in the ongoing fight against disease; how productive the class will turn out to be [in respect of generating variations on a theme] remains to be seen - but it's grat news that someone out there is doing the very necessary work in this feild. Antibiotics [for whatever reason] tend not to be good returners on investment, which is the main reason we are in the pickle we are in today in respect of resistance; we simply have not put in the necessary R&D to generate new ones.

[Avatar]

[quote="I'm Murrin"Maybe it'll just delay things, but it's a big deal.[/quote]

It might be a big deal, but it'll just delay things.

--A