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My Husband Became a Poster Child of the Post-Antibiotic Era

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Re: My Husband Became a Poster Child of the Post-Antibiotic Era

#41

Post by pkaye »

sithadmin wrote: post #4
HillaryBriss wrote: post #2

...for most superbugs, health departments and the US Centers for Disease Control and Prevention (CDC) don’t track who acquires them, nor do they know how many recovered or died. The most recent CDC report estimates that 23,000 people die in the U.S. each year from superbug infections, based on data from 2010. But a recent report estimated that at least 153,000 people died from superbug infections the same year, an es…

Extremely scared, especially in light of barriers to drug approval killing off interest in antibiotics development. Just take a look at what happened to Achaogen: http://www.bioworld.com/perspectives/2019/04/24/a-decade-of-... The FDA granted Fast Track designation for their antibiotic, only later refuse to approve it for use in bloodstream infections due to quibbling over study size (which was admittedly smaller tha…

But they could still get approval in other countries.

Re: My Husband Became a Poster Child of the Post-Antibiotic Era

#42

Post by pkaye »

jen_h wrote: post #6
HillaryBriss wrote: post #2

...for most superbugs, health departments and the US Centers for Disease Control and Prevention (CDC) don’t track who acquires them, nor do they know how many recovered or died. The most recent CDC report estimates that 23,000 people die in the U.S. each year from superbug infections, based on data from 2010. But a recent report estimated that at least 153,000 people died from superbug infections the same year, an es…

The point of her article wasn’t to push despair, but rather to urge the Western medical establishment to get moving on phage research. Bacteriophages as a solution to our antibiotic resistance crisis have been largely ignored in the West due to unpatentability, research mainly performed in Eastern Europe, etc — but her story is that a bacteriophage cocktail saved her husband’s life where antibiotics failed...and the…

I've heard that phages have a narrow target. They are not broad spectrum like antibiotics. Most of the time you don't know they exact bacteria that is causing the infection and to figure out may take days.

Re: My Husband Became a Poster Child of the Post-Antibiotic Era

#43

Post by sithadmin »

pkaye wrote: post #41
sithadmin wrote: post #4

Earlier quoted context omitted.

Extremely scared, especially in light of barriers to drug approval killing off interest in antibiotics development. Just take a look at what happened to Achaogen: http://www.bioworld.com/perspectives/2019/04/24/a-decade-of-... The FDA granted Fast Track designation for their antibiotic, only later refuse to approve it for use in bloodstream infections due to quibbling over study size (which was admittedly smaller tha…

But they could still get approval in other countries.

Wouldn't have mattered previously, won't matter going forward. The USA is the most important and lucrative market, whether we like it or not.

Re: My Husband Became a Poster Child of the Post-Antibiotic Era

#44

Post by Fomite »

mensetmanusman wrote: post #35

Why aren’t all hospital surfaces coated with silver?

There's a lot of work in working antimicrobial sufaces - silver, copper, some interesting structural patterns, etc.

The problem is it's not particularly clear they work, and they are very expensive, and often a pain to clean.

Re: My Husband Became a Poster Child of the Post-Antibiotic Era

#45

Post by Fomite »

concerned209 wrote: post #10

Any recommendations on what an individual could do to help? Organizations to donate to? Challenges that could be tackled by a startup? Promising companies to consider investing in? Also, can anybody explain why the CDC doesn’t mandate reporting?

"Also, can anybody explain why the CDC doesn’t mandate reporting?"

Because a great deal of this is done at the state level. Working on these kind of problems, there's a very difficult balance of reporting requirements, agreed upon definitions (especially not just what you have but where you got it), various stakeholders, etc.

And the CDC collects a lot of data even if things are universally reportable. And there's a lot of ongoing improvement.

Re: My Husband Became a Poster Child of the Post-Antibiotic Era

#46

Post by Fomite »

Mirioron wrote: post #9
jen_h wrote: post #6

Earlier quoted context omitted.

The point of her article wasn’t to push despair, but rather to urge the Western medical establishment to get moving on phage research. Bacteriophages as a solution to our antibiotic resistance crisis have been largely ignored in the West due to unpatentability, research mainly performed in Eastern Europe, etc — but her story is that a bacteriophage cocktail saved her husband’s life where antibiotics failed...and the…

So, why isn't government funded research being done on it then? I often hear about how the government funds a lot of medical research, so this seems like the perfect thing for them to fund.

What makes you think they're not?

Re: My Husband Became a Poster Child of the Post-Antibiotic Era

#47

Post by Fomite »

jen_h wrote: post #6
HillaryBriss wrote: post #2

...for most superbugs, health departments and the US Centers for Disease Control and Prevention (CDC) don’t track who acquires them, nor do they know how many recovered or died. The most recent CDC report estimates that 23,000 people die in the U.S. each year from superbug infections, based on data from 2010. But a recent report estimated that at least 153,000 people died from superbug infections the same year, an es…

The point of her article wasn’t to push despair, but rather to urge the Western medical establishment to get moving on phage research. Bacteriophages as a solution to our antibiotic resistance crisis have been largely ignored in the West due to unpatentability, research mainly performed in Eastern Europe, etc — but her story is that a bacteriophage cocktail saved her husband’s life where antibiotics failed...and the…

Having seen her speak in person at IDWeek, I think an important thing to recognize is that the amount of work that went into treating her husband was pretty damned heroic - and it's not clear that that's not the standard for phage therapy.

I literally have a standard "Why phage are a problem", from the perspective of an infectious disease epidemiologist whose been super-interested in phage for like...a decade.

1) There's no such thing as a "broad spectrum" phage. They're organism specific, and that means not only would you need to keep a phage library on hand, but you'd have to do a lot of diagnostic tests. That's going to be both expensive and tricky. There are treatment guidelines for things like sepsis right now that are basically un-doable with phage therapy because of the time it takes to tune a phage library.

2) Phages are living things. Not only is that a weird regulatory framework to be in for a drug, but it also means that you need to be able to keep phage alive. In contrast, antibiotics are inert.

3) Phage therapy is also relatively new in the West, which means there's just less of a R&D infrastructure behind it.

There have been people working on commercializing phage therapy since I was in undergrad (I'm now a tenure-track professor). The problem is it's hard, and antibiotics are so much better as a treatment that there's kind of a ceiling on the excitement that they can generate.

Also, I would like to note that phage therapy wasn't only ignored due to unpatentability. A couple other reasons:

1) Antibiotics were superior in basically every respect. It's hard to justify decades of sustaining research into the fussy, expensive, edge-case alternative to something that works amazingly well.

2) Phage therapy was used in the West. Due to the technology at the time, it had a tendency to, well, kill people, due to contamination with bacterial endotoxins.

3) It's not clear phage can be turned into anything other than a pretty bespoke, custom tailored product. Even in the East it's not doable "at scale" in the way we talk about antibiotics.

Re: My Husband Became a Poster Child of the Post-Antibiotic Era

#48

Post by Fomite »

pkaye wrote: post #42
jen_h wrote: post #6

Earlier quoted context omitted.

The point of her article wasn’t to push despair, but rather to urge the Western medical establishment to get moving on phage research. Bacteriophages as a solution to our antibiotic resistance crisis have been largely ignored in the West due to unpatentability, research mainly performed in Eastern Europe, etc — but her story is that a bacteriophage cocktail saved her husband’s life where antibiotics failed...and the…

I've heard that phages have a narrow target. They are not broad spectrum like antibiotics. Most of the time you don't know they exact bacteria that is causing the infection and to figure out may take days.

This is the major problem, in my view, with phage. You cannot treat until you've not only diagnosed the infection, but tuned the phage library being used. That's slow, even at major hospitals, and a major problem in places where diagnostic availability is limited.

Re: My Husband Became a Poster Child of the Post-Antibiotic Era

#49

Post by Fomite »

wl wrote: post #8
est31 wrote: post #7

Earlier quoted context omitted.

For operations, sterilizations are carried out with a mixture of means like chemical disinfectants, subjecting instruments to extreme heat (Autoclaving), etc. but they don't rely on antibiotics. Instruments can be put into environments toxic to both human and bacterial cells. The big difference of antibiotics is that they are toxic to bacteria but not to human cells so they can be put directly into the system. Some b…

It's defense in depth. Yes, sterile technique is used to minimize the occurrence of surgical site infections. Sterile technique, when performed 100% correctly, isn't perfect and prophylactic antibiotics are standard to help mitigate any remaining risk.

The field uses "Swiss cheese" as a term for a reason - you can have holes in each layer (and will), but if you have enough layers you'll be okay.

Re: My Husband Became a Poster Child of the Post-Antibiotic Era

#50

Post by Fomite »

HillaryBriss wrote: post #18
Analemma_ wrote: post #3

Earlier quoted context omitted.

To me, the really scary thing about antibiotic resistance is not necessarily random infections in the hospital (as bad as that is) but the fact that antibiotics are what made surgery possible, and if they don’t work, all these medical procedures we’ve gotten used to as harmless suddenly carry a very serious risk-reward tradeoff. Imagine C-sections, biopsies, hip replacements, etc. all having a one-in-four chance of d…

agree. and my next fear is that all of the medical establishment, suppliers, and practitioners who depend upon surgical procedures for their profitability downplay the additional risks and continue to encourage all of us to undergo surgery

Surgeons are already the bane of many infection control specialists.
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