I submitted this a few days ago about future alternatives to antibiotics. Maybe it's more interesting now?
Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”
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Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”
#62Earlier quoted context omitted.
>The reason that antibiotics work is because they are attacking some function that has deliberately evolved, through natural selection, to be like that. Antibiotic resistance must literally cost bacteria some efficiency in some of their other functions. I'm not convinced that there must be a cost; furthermore, I think it's unlikely that if there is a cost, it is high enough to be significant. Bugs evolve, but they do…
http://en.wikipedia.org/wiki/Plasmid "In nature, plasmids carry genes that may benefit survival of the organism (e.g. antibiotic resistance)," Plasmids cost energy, they are dropped in the course of natural selection if they stop conferring an advantage. More quickly than you might think, too. If we stop using antibiotics, the bacteria will become less resistant.
Plasmids are only one of the ways that bacteria adapt.
Adapting antibiotic resistance can take as little as a single nucleotide mutation in the right part of a bacterial genome. Many of the known antibiotic resistance mechanisms involve small mutations to critical proteins.
Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”
#6380% of the antibiotics we use are given to animals.[1] That seems like a good place to cut back. [1] http://www.nytimes.com/2012/09/04/health/use-of-antibiotics-...
In Denmark, they prevent infections in chicken houses by thoroughly cleaning them, then using techniques developed for clean rooms to prevent infections. In the US, we let them wade in their own filth and pump them full of antibiotics. We should just make it flat out illegal to use antibiotics across entire herds of livestock. We should also fine doctors for prescribing antibiotics to patients with a viral infection and no sign of bacteria in their systems, unless they are severely immune compromised.
Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”
#64For the past half century, we should have been treating our antibiotics like weapons of mass destruction - tools of last resort only to be used in emergencies, with great hesitation, and only when absolutely necessary. The industry and the doctors responded: antibiotics were too profitable and the risk seemed too distant. Now we have no weapons; we're helpless and the world is again going to be a scary place where a…
> tools of last resort only to be used in emergencies, with great hesitation, and only when absolutely necessary.
Really? And whose lives are you willing to play that game with?
Your 8 y.o son, who just broke his arm and has new swelling three days after the arm has been set?
Your wife, with a bladder infection so severe it's bleeding and she has a fever?
"Sorry, son - your suffering is for the betterment of mankind. I'm pretty sure you'll survive."
"Sorry, honey - let's just see if you can make it another week or two."
Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”
#65Earlier quoted context omitted.
> we're helpless and the world is again going to be a scary place Whoa there. According to the article, we have few new antibiotics precisely because the old ones have been so effective: >Infections are not that common compared to other types of conditions like high blood pressure or high cholesterol. [...] They have to develop drugs that will make money, and that’s not an antibiotic. When we had lots of development…
I still worry about the profit motive getting in the way. You'll buy antibiotics for days or maybe weeks; you'll buy drugs for high cholesterol the rest of your life.
>you'll buy drugs for high cholesterol the rest of your life
Not if you get killed by an infection first.
Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”
#66I've been hearing about the coming Antibiotics Apocalypse for some time now, and while it sounds very dangerous I'm wondering what signs to look for about how bad it's getting. Articles like these point to limited things like an increase in MSRA outbreaks or vague statements about increasing infections from hospitals, but it's not like average people are dying in the streets or anything. How do we tell how much we're moving on the long continuum from here to there while keeping isolated stories in the larger context of overall antibiotic resistance?
Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”
#67Earlier quoted context omitted.
> Now we have no weapons; we're helpless and the world is again going to be a scary place where a cut or a scrape can land you in a hospital or in a mortuary. Perhaps most terrifying is that the mere act of hospitalization will likely be the highest vector of transmission of nearly untreatable infections. Go in for a routine procedure and end up in the isolation ward due to some highly infectious, deadly disease.
This, right here, is the biggest issue. Routine, minor surgery? No longer a risk free proposition. This sort of antibiotic resistance will have, and is having, enormously deleterious effects on the kind of basic health care and medical science we take for granted.
Fun fact: modern plastic surgery -- including purely cosmetic, non-normative surgery -- predates both antibiotics and anesthetics.
Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”
#68I heard the author on NPR yesterday. I think it's all very true, but it seem disingenuous to blame antibacterial soaps. I haven't ever heard of human antibiotics being added to soaps. And I don't think a triclosan resistant bacteria would be of much risk to us.
The only argument I can think of against antibacterial cleaning products would be that our bodies get less exposure or "practice" against ordinary bacteria?
Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”
#69What about Linezolid? http://en.wikipedia.org/wiki/Linezolid
You basically have polymixins (colistin) and, depending on resistance profile, fosfomycin and tigecycline. Colistin is avoided if possible because of nephrotoxicity, but as usual, medicine is a field heavily involved in balancing risks and benefits.
Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”
#70The interviewed expert has very good credentials and clinical experience to be talking about what he is talking about, and his warnings should be taken seriously. But even at that, the fallacious teleological language he uses about biological evolution by natural selection suggests a way out of this problem. When he says, "Bacteria, like any living organism, want to survive," and "So anything that we do to try and kill bacteria, or anything the environment does to try and kill bacteria, bacteria will eventually discover ways or find ways around those" he is making factual statements that are plainly incorrect on their face. Bacteria don't desire anything, and they don't seek out anything or plan anything. Moreover, it is perfectly possible for lineages of bacteria to go completely extinct, and that has undoubtedly happened more times than human beings are aware.
Current antiobiotics are themselves mostly derived from "natural" chemicals emitted by microorganisms so that those microorganisms survive natural selection to go on reproducing in a world full of bacteria. Many of the early antiobiotics, for example penicillin, are derived from mycotoxins produced by fungi. Human medicine can use chemicals from fungi for protection against bacteria because human beings and all animals are more closely related to fungi than either fungi or animals are related to bacteria,[1] so fungi have a biochemical similarity to animals that makes it likely (although not certain) that a mycotoxin that is lethal to bacteria will be relatively harmless to human beings.
And this is the way forward to developing new antibiotics. As we reach a deeper biochemical understanding of the basis of all life, we will eventually understand the differences, which are biochemical differences at bottom, between human beings and bacteria, between human beings and protists, between human beings and fungi (yes, there are some systematic differences between animals and fungi) and between human beings and all other harmful microorganisms. Only human beings have science labs and clinical research studies to come up with new defenses against the thoughtless, largely immobile threats from other living things. We can form hypotheses, test those hypotheses rigorously, and perhaps make some lineages of harmful microorganisms as extinct in the wild as the smallpox virus and rinderpest virus now are. The intelligence that the hominid lineage has evolved gives human beings advantages that bacteria will never possess.
[1] http://ucjeps.berkeley.edu/DeepGreen/NYTimes.html
http://www.nytimes.com/1993/04/16/us/animals-and-fungi-evolu...