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The antimicrobial resistance crisis needs action now

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Re: The antimicrobial resistance crisis needs action now

#141

Post by Fomite »

Gatsky wrote: post #126
zosima wrote: post #15

I am quite sure, that if a sufficient bounty was given out for developing new kinds of antimicrobials, they'd be developed in no time. The problem is that cost and risk of development and trials is too large for the current rewards, and hence there is very little new antimicrobials being developed. There are very many promising leads though, and either making development cheaper (by requiring smaller or fewer clinica…

Not sure I agree. Take a look at recently developed antimicrobials. It’s not like there haven’t been any new ones. The problem is this: they are very expensive compared to older antimicrobials (so don’t get used at all except in wealthy healthcare systems) and they are tightly held in reserve for only the most resistant cases (so very small market). The latter point is particularly insurmountable, since widespread us…

They also tend to not be new families of antimicrobials with novel mechanisms of action, which is what's needed for more significant gains against resistance.

Re: The antimicrobial resistance crisis needs action now

#142

Post by encryptluks2 »

MobileVet wrote: post #95
SergeAx wrote: post #94

Earlier quoted context omitted.

As we just saw with the COVID-19 vaccines, you may develop game changing drug, almost skip the testing phase and profit hugely off it, if the demand is high enough.

The mRNA vaccines were tested on 10ks of people before they were released to the general public. While the timelines were sped up and access to larger bodies of test subjects, the testing phase was not skipped by any stretch

So we're just going to forget that the labs faked test results and lied? Before you downvote as fake news, a Democratic AG sued over it.

Re: The antimicrobial resistance crisis needs action now

#143

Post by Fomite »

yarg wrote: post #64

Phage therapy seems like it's gonna become increasingly important (we've been using static munitions against increasingly dynamic enemies for far too long). Keyhole and robotic surgeries (already advancing rapidly) are going to be significant and useful. We also need to investigate, understand and classify symbiotic organisms with the same zeal with which we've approached pathogens. We've spent so long glaring at the…

My phage boilerplate:

Phage comes up a lot here - it seems to be on of HN's favorite biology topics. I have a deep and abiding fondness for phage, but they're not quite as awesome as they seem at first glance. From the perspective of an infectious disease epidemiologist who has been super-interested in phage for my whole career (literally tried to get a job out of undergrad with a phage therapeutics startup):

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 (after being abandoned for some very real, very serious safety concerns back in the day), 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 tenured 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, especially when trying to treat at scale.

Some of the most interesting applications are currently combination antibiotic and phage therapy - it's much harder for bacteria to maintain resistance mechanisms for both simultaneously.

Re: The antimicrobial resistance crisis needs action now

#144

Post by Fomite »

Brendinooo wrote: post #22

At the risk of sounding ignorant… I’ve been hearing stuff like this for twenty years now. And yet the crisis hasn’t happened. Why is that?

It has been, it's just slow.

The gut flora of many people in the developing world is pan-resistance.

Childhood diarrhea is getting harder to treat.

Healthcare-associated infections are more dangerous, and the gains made against them slower.

Before COVID-19 hit, there were several emerging drug-resistant bugs that were the major concern for my sub-field (hospital epidemiology)

Re: The antimicrobial resistance crisis needs action now

#145

Post by Fomite »

nextos wrote: post #8

We need more research in bacteriophages. They can be engineered to avoid any resistance, and they can replace antibiotics in all use cases. Besides, they are much more selective. Getting antibiotics when needed is OK, but they can lead to other health complications down the road.

Posted above, but putting it here too:

Phage comes up a lot here - it seems to be on of HN's favorite biology topics. I have a deep and abiding fondness for phage, but they're not quite as awesome as they seem at first glance. From the perspective of an infectious disease epidemiologist who has been super-interested in phage for my whole career (literally tried to get a job out of undergrad with a phage therapeutics startup):

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 (after being abandoned for some very real, very serious safety concerns back in the day), 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 tenured 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, especially when trying to treat at scale.

Re: The antimicrobial resistance crisis needs action now

#146

Post by Fomite »

mustafabisic1 wrote: post #2

I bet all those antibiotics prescribed for covid didn't help as well. That was happening on a massive scale in my country

Having looked at the data on this, the change in antibiotic prescribing was extremely heterogeneous.

It absolutely crashed in some areas, and went up in others.

Re: The antimicrobial resistance crisis needs action now

#147

Post by jjcon »

mmcgaha wrote: post #139

Last Wednesday night, I drove a torx bit right through the first knuckle on my left index finger. Since I type all day this seemed serious enough to go to the emergency room. When I see the doctor, I am sure I sounded like a fiend looking for a hit but in this case for antibiotics. He tells me that he does not want to give them to me because if I didn't really need them that it could make it so they don't work for me…

Does it work that way? I didn’t think so. Or did he mean in the proverbial, if we overuse them we won’t have them for anyone in 30 years?

Re: The antimicrobial resistance crisis needs action now

#148

Post by Fomite »

oa335 wrote: post #63
christkv wrote: post #33

Its a topic that comes up again and again. We are getting resistance against modern antibiotics. There are a ton of old antibiotics that have been out of use for decades that should be retested as possible weapons. Evolving resistance comes at a cost for bacteria and over time they might loose resistance against previous antibiotics. https://www.frontiersin.org/articles/10.3389/fmicb.2014.0055... The problem is no ph…

> Evolving resistance comes at a cost for bacteria and over time they might loose resistance against previous antibiotics. This is known as the "ecological fallacy". > reversion to sensitivity is neither an immediate nor necessary outcome of selection simply because a resistant pathogen is no longer in an antibiotic-laden environment [1] [1] "Why Do Antibiotics Exist" - https://journals.asm.org/doi/10.1128/mBio.01966…

...that is not how I've ever heard "the ecological fallacy" used, and this is what I do for a living.

Re: The antimicrobial resistance crisis needs action now

#149

Post by ip26 »

mmcgaha wrote: post #139

Last Wednesday night, I drove a torx bit right through the first knuckle on my left index finger. Since I type all day this seemed serious enough to go to the emergency room. When I see the doctor, I am sure I sounded like a fiend looking for a hit but in this case for antibiotics. He tells me that he does not want to give them to me because if I didn't really need them that it could make it so they don't work for me…

You drove a bit all the way through the finger? Through the joint/bone? And all you got was a tetanus shot?

Re: The antimicrobial resistance crisis needs action now

#150

Post by mmcgaha »

ip26 wrote: post #149
mmcgaha wrote: post #139

Last Wednesday night, I drove a torx bit right through the first knuckle on my left index finger. Since I type all day this seemed serious enough to go to the emergency room. When I see the doctor, I am sure I sounded like a fiend looking for a hit but in this case for antibiotics. He tells me that he does not want to give them to me because if I didn't really need them that it could make it so they don't work for me…

You drove a bit all the way through the finger? Through the joint/bone? And all you got was a tetanus shot?

Yeah it went through the joint and I got a call the next day telling me it was broken. The PA told me to get splint and to give it a rest for a week.
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