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Antibiotics and resistant bacteria

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CharliesDragon
1090269.  Tue Aug 19, 2014 12:40 am Reply with quote

Well, if we get to the point where no antibiotics work, it will be hugely profitable, I think. Or governments will just demand it?

 
gruff5
1090313.  Tue Aug 19, 2014 5:27 am Reply with quote

Thanks for the comprehensive reply, julesies, very informative.

Carrying plasmids must still be costly, though, and disadvantages a bacterium if the antibiotic is not in the environment in significant concentrations. I can see that presence in the soil on huge acreages of farmland would cause that - a big argument for prophylactic use of ABs in farm animals to be banned. Do ABs breakdown in the environment over time?

I've been aware of dark murmurings of the "end of the age of antibiotics" being muttered about for decades & although the problem has got somewhat worse, an AB crisis doesn't look imminent to me. Sorting out hygiene in hospitals seems to have made a big reduction in the MRSA issue in UK hospitals. It's certainly good not to waste our antibiotic advantage, but I do wonder if, like CJD disease, if the danger is not as extreme as some pundits portray.

 
julesies
1090476.  Wed Aug 20, 2014 8:29 am Reply with quote

CharliesDragon wrote:
Well, if we get to the point where no antibiotics work, it will be hugely profitable, I think. Or governments will just demand it?

The reason it's not profitable is that people take antibiotics for a week, maybe two, and then don't need it anymore. Compare that to anti-cancer drugs, for example, which some people have to take for years, so the pharmaceutical companies make a lot more money for those. I think you're right about the governments though. It seems like any new antibiotics will come from research mostly conducted in government labs or university labs (which are largely funded by the government).

gruff5 wrote:
Do ABs breakdown in the environment over time?

Good question. A quick Google search brought me to this article whose abstract tells me that the half-life of some antibiotics ranges from a few days to >120 days with most around two weeks. So they do break down, but it takes a while.

gruff5 wrote:
I've been aware of dark murmurings of the "end of the age of antibiotics" being muttered about for decades & although the problem has got somewhat worse, an AB crisis doesn't look imminent to me. Sorting out hygiene in hospitals seems to have made a big reduction in the MRSA issue in UK hospitals. It's certainly good not to waste our antibiotic advantage, but I do wonder if, like CJD disease, if the danger is not as extreme as some pundits portray.

The danger is pretty extreme. MRSA used to just stand for methicillin resistant Staph. aureus, but now is stands for multi-drug resistant Staph. aureus, so less and less antibiotics can now be used to treat it. We also now have multi-drug resistant TB, which is terrifying.

 
gruff5
1090996.  Sat Aug 23, 2014 2:58 pm Reply with quote

Yes, I can see the dangers - there was a report on the news this week about blood poisoning bugs newly resistant to ABs. Also saw a Michael Moseley TV program about meat production. The program was somewhat confused & contradictory, but I did learn that the AB used in cattle feed in the USA is not used medically, so if resistance develops from overuse to that one, it won't impact medicine.

 
julesies
1091135.  Mon Aug 25, 2014 2:18 am Reply with quote

gruff5 wrote:
the AB used in cattle feed in the USA is not used medically, so if resistance develops from overuse to that one, it won't impact medicine.

That's not exactly true. The program was probably referring to antibiotics used to promote growth, and some of those are different from antibiotics used to prevent disease, but some are still chemically related to antibiotics used by humans, so resistance is still a problem.

 
gruff5
1091154.  Mon Aug 25, 2014 4:39 am Reply with quote

Yes, they were referring to growth promoter ABs. Michael Mosely did look worried that they were using them, even though the cattle farmer believed (or said he believed) resistance to them was no threat to ABs used to prevent disease.

 
gruff5
1091155.  Mon Aug 25, 2014 4:40 am Reply with quote

Yes, they were referring to growth promoter ABs. Michael Mosely did look worried that they were using them, even though the cattle farmer believed (or said he believed) resistance to them was no threat to ABs used to prevent disease.

 
gruff5
1097098.  Tue Oct 07, 2014 9:41 pm Reply with quote

New article on resistance and ABs:

http://www.telegraph.co.uk/health/healthnews/11120831/Up-to-half-of-antibiotics-fail-due-to-superbugs-study-finds.html

Reading this, I am again left with the impression that AB resistance is a very serious problem, but that the "age of the end of ABs" that was supposedly coming 20+ years ago has not happened and I doubt will. This sentence in the article caught my eye:

"Between 1991 and 2012 overall antibiotic failures increased from 13.9 per cent to 15.4 per cent."a

Is not really a cataclysmic change in that timespan, is it?

 
gruff5
1109936.  Thu Jan 08, 2015 1:58 am Reply with quote

1st new ABX in 30 years:

http://www.independent.co.uk/life-style/health-and-families/health-news/first-new-antibiotic-in-30-years-could-be-key-to-beating-superbug-resistance-9963585.html

 
gruff5
1243567.  Thu Jul 27, 2017 1:46 am Reply with quote

You don't have to finish the course of tabs afterall, now:

https://www.theguardian.com/society/2017/jul/26/rule-patients-must-finish-antibiotics-course-wrong-study-says

 
dr.bob
1243576.  Thu Jul 27, 2017 4:05 am Reply with quote

According to the Royal College of GPs chair, Prof Helen Stokes-Lampard:

Quote:
We are concerned about the concept of patients stopping taking their medication midway through a course once they ‘feel better’, because improvement in symptoms does not necessarily mean the infection has been completely eradicated.


And Prof Dame Sally Davies, England’s chief medical officer, said:

Quote:
The message to the public remains the same: people should always follow the advice of healthcare professionals. To update policies, we need further research to inform them.


Of course, you have to scroll right down to the bottom of the article to find those quotes :-S

 
L on earth
1243587.  Thu Jul 27, 2017 6:06 am Reply with quote

dr.bob wrote:

Of course, you have to scroll right down to the bottom of the article to find those quotes :-S


Bloody hell, that whole article is pretty concerning/irresponsible. The opinion seems to be that it may make sense to stop antibiotics sooner if a) it's a long course and b) the infection is caused by a commensal. Not quite the same thing as always stop taking your antibiotics once you feel better. Plus, saying that there isn't enough evidence to be certain current advice is the best doesn't strike me as the same as there being enough evidence to change the recommendations...

Bad grauniad.

 
Jenny
1243649.  Thu Jul 27, 2017 3:22 pm Reply with quote

I always thought that stopping your antibiotics too early was supposed to be the way that the most antibiotic-resisitant bacteria survived and thrived.

 
L on earth
1243652.  Thu Jul 27, 2017 4:03 pm Reply with quote

Jenny wrote:
I always thought that stopping your antibiotics too early was supposed to be the way that the most antibiotic-resisitant bacteria survived and thrived.

Yes and no. If a course of antibiotics is too short (because you stop them early), traditional thinking says the bacteria that caused the infection are more likely to come back and be resistant. However, antibiotics also affect other bacteria in your body, and the longer you're on antibiotics, the higher the chance these bacteria will become resistant. So it's essentially a balancing act.

This new research article is essentially saying that a lot of courses of antibiotics may well be too long, since we've historically been more concerned with making sure the infection's gone, rather than worrying about the potential problems with resistance associated with longer courses. That said, I do think they've slightly overreached saying that we should be telling people to stop when they feel better; the take-home should be to review the length of antibiotic courses and ensure the balance is as good as it should be. Plus, as they mention, for certain bacteria and infections (e.g. TB), the advice would always be to absolutely finish the course regardless.

(link to article here: http://www.bmj.com/content/358/bmj.j3418, although I think it may be paywalled)

 
dr.bob
1243688.  Fri Jul 28, 2017 5:45 am Reply with quote

L on earth wrote:
Bloody hell, that whole article is pretty concerning/irresponsible.


Much as I'd hate to agree with The Donald when he says that the mainstream media distorts the facts, I'm beginning to think he's got a point in certain circumstances.

Compare with this article that claims a Banksy mural is Britain's favourite work of art*. The biggest problem with this story is that it's complete bollocks. Turns out the "nationwide poll" was simply a PR story dreamt up by Samsung in order to promote the launch of one of their new televisions.




*to be fair to the Grauniad, the story was also run by Sky News, The ToryGraph, The Times, and the Daily Wail (not linking to that, as I don't want to encourage traffic to their site).

 

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