I wonder if we should have been prescribing 3 antibiotics at a time. This would be for the same reason we use redundant disk drives--the odds of one disk write failing might be one in 100. But the odds of 3 disk writes failing simultaneously should be 1 / million. If some bugs need to survive to develop resistance, this seems like it would reduce the chances.
Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”
381–390 of 414 posts
Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”
#382Earlier quoted context omitted.
> We lost the fight with viruses a decade ago. If you get infected with a deadly viral disease, like rabies, it's curtains. There's nothing any hospital can do for you except sedate you until you're dead. The fight we have not yet one is the fight against poverty. Not many wealthy people die of rabies. AIDS which was once fatal, is no longer, provided you can afford the treatment.
Keeping you alive is not the same as living. A few would like to stay in situation where you can't do 99% of the things other humans do. Its very common in a lot of of places in the world to ask for euthanasia in case of such diseases.
Magic Johnson and Andrew Sullivan have had HIV for over 20 years and seem to be handling it fairly well. Certainly a harder life than most, but that's not stopping them from living a full life.
Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”
#383I submitted this a few days ago about future alternatives to antibiotics. Maybe it's more interesting now? https://news.ycombinator.com/item?id=6559134
Wow, harsh downvote. Sorry for submitting something related to antibiotics I thought you guys would find interesting.
Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”
#384The 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 ki…
Good summary of human being's advantage in the war. But don't forget bacteria's key advantage: iteration speed. Bacteria may be blind and and random in their micro-level behavior. But the speed at which they replicate is multiple orders of magnitude faster than the speed at which we can test and iterate new defenses. It's a race of blindingly fast random iterations VS top-down snail-paced logical defense. If human's…
Yes, that was the background idea in the talk. Among the ideas explicitly said was that our iteration for antibacterial defenses is low and slowing, and that we actively contributed to the increase of bacterial mutation opportunity. The solution mentioned include corrections for both these.
Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”
#385Earlier quoted context omitted.
Umm...rabies pretty much is curtains. If we miss the postexposure prophylaxis window, the fatality rate for rabies is indistinguishable from 100%
Actually, there are experimental treatments that involve an induced coma and seem to produce survival rates of over 10%: https://en.wikipedia.org/wiki/Milwaukee_protocol
I hadn't seen the newer revision of the protocol, only the original 2 out of 25 number. "Indistinguishable from 100%" was perhaps a little severe, but 90% survival is still pretty long odds.
Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”
#386Earlier quoted context omitted.
Of which I am well aware, and has absolutely zero to do with the content of my post. Someone disputed that a rabies infection is "curtains" - I posed the circumstances where it is.
I realize you're probably playing devil's advocate, but there are more issues with the original statement anyway. He implied this was new. Rabies has always been a 100% mortality rate past a certain point in the infection. In addition, he implied that if you're infected, it's game over. It's definitely not. As you've said, there is a window in which you'll most likely be fine with treatment.
Less devil's advocate and more talking about just that particular point. There's a reason I haven't talked about the rest of his post.
Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”
#387Earlier quoted context omitted.
You pretty much nailed it in a very succinct manner. That's why it's so important to complete a course of antibiotics rather than stopping once you feel better. Once you've started antibiotics, you're basically enriching the population in bacteria that aren't affected by the antibiotic. This is normally a very small population, but if you stop half-way, the pressure on those bacteria from other bacteria (the ones tha…
This is an unconvincing argument to me - if antibiotic resistant bacteria survive, why would finishing the course of antibiotics make a difference? Does it clinically happen that stopping a course of antibiotics early causes an antibiotic resistant form of the infection? (I couldn't find evidence either way, but I did find a few articles saying typically prescribed course lengths could be safely reduced in the effort…
>> if antibiotic resistant bacteria survive, why would finishing the course of antibiotics make a difference?
I can only speculate, but here's how I imagine it.
Your body can kill a certain number of bacteria on its own. Antibiotics help reduce the infection to the point where your body can do the rest.
If the resistant bacteria are a small minority, taking antibiotics long enough to kill most of the non-resistant ones will let your body kill the remaining resistant ones.
If you stop too early, the battle tide has not yet turned. Instead, by killing, say, half the non-resistant ones, you've made the resistant ones a larger proportion of the whole infection. Then both groups continue to multiply.
If you repeat this several times, starting and stopping the antibiotics depending on how you feel, the resistant bacteria could go from being 1% of your infection to 50%.
Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”
#388Earlier quoted context omitted.
Of which I am well aware, and has absolutely zero to do with the content of my post. Someone disputed that a rabies infection is "curtains" - I posed the circumstances where it is.
You used the wrong term. What's lethal is not "infection" with rabies -- but a full-blown case of rabies. Rabies infection is very survivable if caught before symptoms start to show up. We have a post-infection vaccine that can be used during the incubation period. We've had a vaccine for over a hundred years, and it works very well. In fact, the original rabies vaccine was the second vaccine ever developed, after sm…
When I suggested that there are some "Hail Mary" treatments once the post-exposure prophylaxis window closes, I was talking about the Milwaukee Protocol. Or the, I believe, single reported case of someone surviving a untreated rabies infection with no clear treatment.
As for whether or not I used the right term, I'd actually suggest that "infection" is kind of a fussy term to begin with. But I also never used it in my post, so I'm curious as to how I could have used it wrongly.
I stated that after the treatment window closes for PEP, we're in the realm of very difficult treatments that are really only workable in the developed world. I don't see anywhere that your post and mine are contradictory.
Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”
#389Earlier quoted context omitted.
So much wrong with this post: > There is a testable prediction here of course: either bacteria outrun human antibiotic development or they do not. I'm confident that more bacterial lineages will be wiped out before human medicine is seriously compromised by natural selection of bacteria that are resistant to most antibiotics used in human medicine. Do a dumb test. Walk into your nearest hospital, I don't even want to…
Firstly, there's a real difference between rates of MRSA colonisation and rates of MRSA infection, which implies a pathological process at work. Secondly, what on earth do you mean when you say we lost the fight against viruses a decade ago' ? We have only got better at treating viruses; we had almost no treatment for viruses a decade ago and we have some treatments now; for example we are now much better at treating…
I'm also curious as to how any period where we "Lost the fight against viruses" also includes the elimination of Rinderpest.
Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”
#390Earlier quoted context omitted.
> We lost the fight with viruses a decade ago. If you get infected with a deadly viral disease, like rabies, it's curtains. There's nothing any hospital can do for you except sedate you until you're dead. The fight we have not yet one is the fight against poverty. Not many wealthy people die of rabies. AIDS which was once fatal, is no longer, provided you can afford the treatment.
Keeping you alive is not the same as living. A few would like to stay in situation where you can't do 99% of the things other humans do. Its very common in a lot of of places in the world to ask for euthanasia in case of such diseases.
Honestly, at this point HAART treatments for HIV are giving folks a near natural lifespan, and the major threats to their health are becoming diseases of old age - cancer and the like. And the years they have are fully functional.
Compared to a chronic, wasting disease that will take years of opportunistic infections before you die, that's damned good.