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The Age of the Superbug Is Here

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Re: The Age of the Superbug Is Here

#141

Post by dharmach »

alkonaut wrote: post #135
rm2889 wrote: post #68

I live in India and despite some improvements, the level of antibiotic abuse here is shocking. They're available over the counter and people self-medicate with antibiotics all the time. The attitude is, "if my sore throat doesn't go away in a couple of days, its time to take antibiotics. No point in going to the doc coz they'll prescribe antibiotics too and this way I save money." People self-medicating on antibiotic…

A country that allows humans to buy antibiotics over the counter OR allows antibiotic use in healthy livestock needs to be heavily sanctioned very quickly. Sanctions from the international community can include ceasing aid, adding visa requirements or other travel restrictions, food import bans, or whatever. I don't understand why other countries (and the international community as a whole) still accept this behavior…

"Approximately 80 percent of the antibiotics sold in the United States are used in meat and poultry production.2 The vast majority is used on healthy animals to promote growth, or prevent disease in crowded or unsanitary conditions."

https://consumersunion.org/news/the-overuse-of-antibiotics-i...

Re: The Age of the Superbug Is Here

#142

Post by wosos »

rufius wrote: post #77
rm2889 wrote: post #68

I live in India and despite some improvements, the level of antibiotic abuse here is shocking. They're available over the counter and people self-medicate with antibiotics all the time. The attitude is, "if my sore throat doesn't go away in a couple of days, its time to take antibiotics. No point in going to the doc coz they'll prescribe antibiotics too and this way I save money." People self-medicating on antibiotic…

I'd imagine it's not much different in Central and South America based on my travels. You can walk into any pharmacy and show them the word "amoxicillin" and they'll give you a 2 week course. Edit: a word

Central America here, can confirm.

Re: The Age of the Superbug Is Here

#143

Post by roywiggins »

mataug wrote: post #108

Everytime we consider something to be a silver bullet we end up in a mess such as this. We are truly victims of our own success.

Worst case scenario we end up with no working antibiotics. This is no worse than the pre-penicillin era. We haven't hurt ourselves by developing antibiotics.

Re: The Age of the Superbug Is Here

#145

Post by DanBC »

rufius wrote: post #77
rm2889 wrote: post #68

I live in India and despite some improvements, the level of antibiotic abuse here is shocking. They're available over the counter and people self-medicate with antibiotics all the time. The attitude is, "if my sore throat doesn't go away in a couple of days, its time to take antibiotics. No point in going to the doc coz they'll prescribe antibiotics too and this way I save money." People self-medicating on antibiotic…

I'd imagine it's not much different in Central and South America based on my travels. You can walk into any pharmacy and show them the word "amoxicillin" and they'll give you a 2 week course. Edit: a word

That's bad, but at least it's a two week course. Often people in India will buy a few days because that's all they can afford.

Re: The Age of the Superbug Is Here

#146

Post by Fomite »

floatrock wrote: post #116
darawk wrote: post #97

I spoke to an MD/biochemist friend of mine about this issue recently, and was told that this really isn't that big a deal. Specifically that antibiotic resistance is usually a self-limiting trait, so bacteria that evolve that capability will quickly lose it when no longer in a hostile environment. So these 'superbugs' can be an issue in particular settings, like hospitals, but are unlikely to ever produce major globa…

Not from a medical background, but I spent some time writing hospital infection surveillance software so can share a few anecdotes. What he's saying isn't inaccurate. The idea is antibiotic resistance generally carries some metabolic cost -- the bacteria disable or find some other way around whatever pathway is being targeted by the antibiotic. This means they operate "less efficiently" than their non-resistant peers…

I work in hospital epidemiology. It should be noted that even cycling has some serious problems. Many pathogens, such as community-acquired MRSA are causing a problem because our assumptions about the fitness costs taking care of things - and how swiftly that will occur - are not working nearly as well as some had hoped.

Re: The Age of the Superbug Is Here

#147

Post by Fomite »

DonaldFisk wrote: post #49

The article mentions phage therapy in passing, and links to this Nature article: http://www.nature.com/news/phage-therapy-gets-revitalized-1.... The Nature article hints that the main barrier to adoption is that it's difficult to for pharmaceutical companies to make a profit out of phage therapy: the cure is entirely natural, bacteriophage are the most common organisms on the planet, they reproduce very quickly, and…

That's not the only problem. Every time phage therapy comes up, I end up posting my thoughts on it (and this is from someone who loves, and wanted to work in, phage therapeutics):

Phage therapy is neat, it really is, but there are a couple major issues:

- There is no such thing as a "broad spectrum" phage. You can't do empirical treatment using phages, and there's not really "off the shelf" phage therapy - it tends to be a bespoke creation for a particular infection.

- There's some serious regulatory problems, similar to those experienced by fecal transplant treatments. We're not yet really equipped to think about handling evolving, custom microbes as a treatment. - Because of the first, it's going to require a considerable amount more lab capacity than most clinical settings currently have, and considerable delays until treatment.

- There's also some biosafety issues around phage prep, but those are easily solvable.

It's a great way to treat particularly resistant or hard to treat infections, but it's not a particularly great general solution. There's a reason it was abandoned in countries with easy access to antibiotics - they're just roundly superior in basically every respect.

Re: The Age of the Superbug Is Here

#148

Post by Fomite »

TeMPOraL wrote: post #136
DonaldFisk wrote: post #75

Earlier quoted context omitted.

Other than the last paragraph, the problems you mention are a market failure, which can be dealt with by having all aspects of phage therapy carried out within a government-owned health service, rather than by privately owned pharmaceutical companies. It's worth noting that phage therapy was successfully used in the Soviet Union, and is still used in Georgia where the phage was "farmed", and that attempts to commerci…

I wonder if the economic reasons isn't exactly why phage research seems (AFAIR) to be coming mostly out of Russia.

Phage therapy comes mostly out of Russia because they had much more limited access to antibiotics once the Cold War kicked off, so established some of the best research groups for other alternatives.

This was also why Germany, during the 2nd World War, were probably the world's experts in Sulfa.

Re: The Age of the Superbug Is Here

#149

Post by Fomite »

tombert wrote: post #61

There's a pretty good Frontline about this...I didn't see this fact listed in the article, but another huge problem is that it's generally not profitable for big medicine corporations to research new antibiotics, which means that for the time-being, we're stuck with our current regime.

There is active research funded by large pharmaceutical companies in developing new antibiotics. Merck bought Cubist Pharmaceuticals for a reason.

Re: The Age of the Superbug Is Here

#150

Post by alkonaut »

dharmach wrote: post #141
alkonaut wrote: post #135

Earlier quoted context omitted.

A country that allows humans to buy antibiotics over the counter OR allows antibiotic use in healthy livestock needs to be heavily sanctioned very quickly. Sanctions from the international community can include ceasing aid, adding visa requirements or other travel restrictions, food import bans, or whatever. I don't understand why other countries (and the international community as a whole) still accept this behavior…

"Approximately 80 percent of the antibiotics sold in the United States are used in meat and poultry production.2 The vast majority is used on healthy animals to promote growth, or prevent disease in crowded or unsanitary conditions." https://consumersunion.org/news/the-overuse-of-antibiotics-i...

Exactly. It happens almost everywhere. I claim moral superiority coming from a place where there are no over-the-counter antibiotics and none used in healthy livestock :)
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