
Antibiotic 'apocalypse' warning - Nux
http://www.bbc.co.uk/news/health-21178718
======
atlantic
It's interesting that governments are aware of the threat, but they don't take
any action against the root cause, which is inappropriate, nonmedical
antibiotic uses, particularly with livestock and poultry.

[http://www.nytimes.com/2012/12/17/opinion/antibiotics-in-
liv...](http://www.nytimes.com/2012/12/17/opinion/antibiotics-in-
livestock.html?_r=0)

~~~
Nux
Cramming loads of animals together and pumping them with antibiotics is
probably widespread farming procedure by now. I would imagine changing this
will require some effort.

Not to mention this will prolly raise the price of your favourite horse,
errm.. beef burger at the local supermarket. :-)

~~~
evilduck
My understanding is that antibiotic usage in cows is that it significantly
increases their growth rate given the livestock feed we use by altering their
gut flora to utilize the nutrients better. If MRSA became resistant to
whatever antibiotic they use, I don't think it would alter agricultural
practice since that's not what they're using it for.

I could be wrong since this is way out of my areas of interest, but AFAIK it
has nothing to do with fighting off infections.

~~~
tocomment
Any idea how the antibiotics make them grow faster? You'd think killing gut
flora would make them grow more slowly?

~~~
MacsHeadroom
Cattle don't need flora to digest grains. They never ate grain in their
evolutionary past, only grass. Their flora doesn't process it- which is why E.
coli takes over.

The majority of cattle which end up in a grocer, convenience store, or
restaurant spent most of their life completely infested with E. coli. Right up
to the point of being thrown into the grinder.

~~~
wcoenen
E. Coli is commonly found in the intestines of _all_ warm-blooded animals, and
it is usually harmless. There are only a few problematic strains.

------
wcoenen
Time to step up the research into the therapeutic use of bacteriophages. If
the bacteria evolve, then let's create cures that evolve along with them.

<https://en.wikipedia.org/wiki/Bacteriophage>

<https://en.wikipedia.org/wiki/Phage_therapy>

~~~
fghh45sdfhr3
The problem is you can't talk to your immune system to explain why it should
leave those particular viruses alone.

~~~
astrodust
They're bacterial viruses. They have zero interest in your cells.

~~~
aplusbi
Right, I think the point is that your immune system doesn't know that and will
attack them.

~~~
astrodust
I'm not even sure that they're recognized by the immune system as a threat.
They won't be causing any infections that would trigger a response.

~~~
fghh45sdfhr3
Response is triggered by _any_ foreign protein. It does not matter it is not
infecting _your_ cells. Anything that is not known to be _you_ is attacked.
And the more and longer you have of it inside of you, the bigger the immune
response gets.

------
FollowSteph3
The biggest cause IMHO is the rampant use of antibiotics in farm feed. It's
been proven NOT to be effective. And worse, it's given everyday with no
infection. And the amount is multiples of human consumption!! Why focus on
human consumption when antibiotics in farm food is rampant and on a much much
bigger scale of consumption.

~~~
m_eiman
That's one of the reasons I prefer organic meat, where such behavior isn't
allowed.

~~~
falcolas
Really? Here's a whole list of synthetic medicines that can be used on
organically raised livestock (US Law):

[http://www.ecfr.gov/cgi-bin/text-
idx?c=ecfr&SID=0bc0fb14...](http://www.ecfr.gov/cgi-bin/text-
idx?c=ecfr&SID=0bc0fb14bb1cdd2a20a584274b0887cf&rgn=div8&view=text&node=7:3.1.1.9.32.7.354.4&idno=7)

And if it's considered to be non-synthetic, the only restriction is
strychnine.

~~~
cobrausn
As mentioned by _tocomment_ in another thread, the rules are apparently
changing.

<http://news.ycombinator.com/item?id=5110144>

~~~
falcolas
This is for Organic certified livestock, not general livestock.

------
mistercow
So I'm not an evolutionary biologist or a doctor, and this is a heavily
studied problem, so I am not going to say "they're doing it wrong." There's
probably just something I'm missing, and I want to know what it is.

But the problem with drug resistance is that these bacteria strains evolve
when exposed to a drug, so that the mechanism of action for the drug stops
being effective. What I want to know is: why aren't we treating new infections
by giving patients a drug with every (still working) mechanism of action at
once, attacking the infection on multiple fronts?

Essentially you'd be massively constraining the optimization problem that
evolution has to solve, and making it way more unlikely that the bacteria in
the patient could acquire all of the necessary mutations before being wiped
out.

So what is it about this strategy that wouldn't work? Why are doctors still
just prescribing amoxicillin alone?

~~~
lobster_johnson
I'm not an expert either, but combinations are apparently used. For example,
you mention amoxicillin, which is often combined with something called
clavulanic acid [1]. Another combination drug is Trimethoprim/sulfamethoxazole
[2].

Some diseases, like resistant tuberculosis, are sometimes treated with
antibiotic "cocktails".

The problem is that combinations of antibiotics may have cytotoxic effects
even at doses lower than normally harmful. Those two combinations above are
used because they are known to work in synergy, with few side effects.

Some antibiotics are not used except as a last resort precisely because they
are so toxic to the human body that they might kill the host in the process of
eradicating the target bacteria. In fact, antibiotics are found in nature all
the time, but they tend to be too toxic to use.

[1] <http://en.wikipedia.org/wiki/Amoxicillin/clavulanic_acid>

[2] <http://en.wikipedia.org/wiki/Trimethoprim/sulfamethoxazole>

~~~
robbiep
Precisely

There are some infections that call for combination therapy but it must always
be done with an eye to side effects;

Effectively microbiologists work out what the 'MIC' or minimum inhibitOry
concentration is, and then use that because hopefully that will be the least
likely to cause other side effects, or I.e. totally obliterate the patients GI
fauna which could open them up to attack by something worse

~~~
lobster_johnson
Surely the worst side effect would not be obliterating GI fauna but systemic
cell death (apoptosis) or similar, though?

~~~
akiselev
I don't think (not a doctor) that antibiotics can cause large scale apoptosis
(except in unrealistic quantities).

Many antibiotics in a cocktail in significant dosages can cause kidney
failure.

------
tomwalker
A great problem is partial treatment of disease in developing countries.

For example, India, Russia and China have a large amount of TB. Some patients
start treatment regimes but do not complete them. The bacteria develops
resistance and then spreads.

Allow this to happen over millions of individuals then throw in international
travel, bringing the infection to areas that do not suspect it quite as often.
London is having a TB boom due to immigration. (disclosure: I am a doctor,
partner specialises in infectious disease)

~~~
ars
> is partial treatment

I've never understood this, maybe you can answer me. Doesn't the immune system
also kill bacteria? By using antibiotics you kill most of the bacteria, and
then the immune system finishes them off.

After all, if any bacteria were left wouldn't they just get the person sick
again?

An infection starts with just a few bacteria, a reinfection would be the same
- unless the immune system keeps them in check, in which case there are no
bacteria left to build resistance.

If a bacteria is resistant then giving the full does wouldn't help anyway,
it's resistant after all. It won't do anything except remove all competition
so the resistant will be the only bacteria left. It seems to me it's better to
try to kill only some of the bacteria so you don't isolate the resistant one
so well, and rely on the immune system to kill most of the bacteria.

~~~
mayneack
On the last bit, resistance isn't a binary switch. If you assume a spectrum,
then day 1 kills all the really easy bacteria. By day 4 of 8, you've killed
the 85% most killable bacteria, and your symptoms are gone, so you stop. Then
you have leftover bacteria that your immune system may or may not be able to
handle, but you can still pass it to someone else who doesn't have an immune
system primed to fight it off, so their infection starts with the 85th
percentile bacteria.

(all numbers arbitrary)

~~~
ars
That just makes my question stronger! So why continue the antibiotic till you
create bacteria at the 98th percentile?

Stop the antibiotic as early as possible.

It's not like you're going to wait to infect people till you're done with the
antibiotic, so the "starts with the 85th percentile" scenario still happens.
But by taking even more antibiotic all you do (as far as I can tell) is make
even more resistant bacteria.

~~~
Riesling
One reason I can think of is that most Antibiotics do not only kill bacteria,
they also stall bacterial growth.

So while the most resistant bacteria are killed at last, they still might not
be able to multiply.

------
spo81rty
We should also try to cure common illnesses with other home remedies if
possible. How did people get over sinus infections 1,000 years ago? Or did
everyone just die? I don't know the answer, but these days antibiotics are
handed out to cure everything as a precaution.

~~~
davidw
I'd love to know the answer to that, because I get those things with some
frequency, and antibiotics clear them up very quickly and effectively: after
10/15 days of feeling shitty, I get immediately better within 24 hours. It's
hard to know beforehand, though, whether it's really an infection or just a
draggy cold. All the 'alternative' type remedies I've tried have been
completely ineffective.

~~~
sammyo
Well one answer is that they didn't. Infection was a major cause of death.
When you see a brutal dentist scene in a historical film it gives shivers, the
missing context is that the patients life was probably being saved.

~~~
LatvjuAvs
Whenever my old relatives talk about how they grandparents lived up to 120
years old in remote Russian villages without any doctors, it gives shivers.
Last relative died at age 98, so much for modern civilization.

And not like they were on life support when hitting over 100, they were out in
the fucking field working.

But yeah, eventually this will disappear and all we have is a book saying that
100 years ago average life span was 30 years so we are doing great increasing
it to 60 :D

~~~
astrodust
I guess they didn't mention the part about half their siblings dying before
they hit the age of twenty, as was common in those times. Cholera. Spanish
Flu. Polio. If you can survive all that you're one tough bastard.

~~~
LatvjuAvs
Things I learn what not to discuss in healthy discussions :)

------
knowaveragejoe
It makes complete sense. We are essentially exposing bacteria in the wild to
extremely efficient natural selection.

~~~
maeon3
Congressmen don't believe in evolution, ergo natural selection is a lie
because of jesus. On the plus side, natural selection will kick in for humans
as well when getting infections removes you from the gene pool, thus making
humans more naturally resistant to infection.

~~~
aroberge
A lot of religious folks, who do not believe in natural science, are
procreating much more(and at an earlier age) than the average population. With
this in mind, I don't think natural selection will be beneficial for
civilization...

~~~
roc
Was there ever a time when that was not the case?

If it were impossible for the children of anti-science fundamentalists to
constitute a sufficient and sane majority to protect science, we'd have almost
certainly never gotten to where we are.

That America, a country populated largely by those whose primary intent was
the pursuit of religious fundamentalism, was ever the world lead in science
and technology puts rather large holes in the "fundamentalists breeding will
be the downfall of us all" argument.

Similarly goes the concern about "dumb people breeding more/faster"
necessarily leading to the dystopic future of IDIOCRACY.

We can absolutely suffer a reversion to fundamentalism and/or a rise of
proudly celebrated ignorance. There are plenty of historical examples of
civilizations falling to those threats. I'm just saying that we also have
plenty of data that it needn't _necessarily_ go that way.

------
verelo
This has been one of the things that scares me the most about the future. I
really don't want to end up in medieval times, i fear something like this
would lead to a weird high tech medieval world.

~~~
maxerickson
The good news is that it is 'merely' a public health crisis. We still have
hygiene and sanitation and the germ theory of disease (that latter makes the
others far more effective and has only been widely accepted for ~100 years).

~~~
cstross
That may be so, but they had antisepsis, vaccination and the germ theory of
disease in the 1920s and 1930s ... and it still didn't save them from losing
as many people to fulminating bacterial infections as we lose to cancer today.

~~~
maxerickson
I'm not eager to be without antibiotics or anything. I'm glad (at least some)
people are taking the problem seriously.

I guess I just think about it from the angle that the public health system has
to run around drumming up popular support to get anything new done, even
though all the boring old stuff they do has such a huge impact.

~~~
cstross
Here's a thought: out-sourcing hospital cleaning services to the lowest bidder
is a _really bad idea_. Because the other term for "hospital cleaning
services" is "infection control".

Similarly, elderly patients frequently end up suffering from malnutrition in
hospitals because of poor food and/or not enough staff to feed people with
difficulty eating. And malnutrition leads to immunological depression. Again:
shaving margins on this stuff costs lives.

New drugs actually come some way down the checklist of things we need to be
doing to contain infectious diseases.

------
tomkin
Somewhat slanting the topic here, but what happened to Tetracycline (non-
synthetic)? One of the oldest, inexpensive treatments available – discontinued
for, what appears to be, no tangible reason. It was highly effective for all
sorts of infections and was involved in some groundbreaking studies that
tested its use as a cancer treatment, as well, was found to slow angiogenesis,
treat rheumatoid arthritis, aging, depletion of collegen, acne, prostate
cancer and treatment of fibromyalgia just to name a few. It's also a pretty
reliable anti-inflammatory.

For whatever reason, it is now hard to get or not available at all. Any
insight into this?

~~~
phormula
I think it has lost favor versus other drugs in the same family such as
doxycycline and minocycline are still available, but have less adverse effects

~~~
tomkin
Thanks :) I personally found that mino/doxycycline were not as good as
tetracycline for treatment of acne and I don't know why. I'm concerned that
the same is true of the other potential applications.

------
minikites
I wonder if phage therapy will be the best future treatment of bacterial
infections.

<https://en.wikipedia.org/wiki/Phage_therapy>

~~~
Nux
Saw this recently, and apparently there are people working on it:
<http://www.bbc.co.uk/programmes/b01ms5c6> (or on everyone's favourite torrent
site)

------
benpbenp
I'm imagining a completely modular hospital composed of detachable rooms and
corridors made of fabric, such that each room can be torn down, hard boiled,
and replaced after every patient/procedure/day. The same for corridors every
week, entire wings every month. (For example).

Is this anything approaching a workable idea?

~~~
Retric
Much better option is just to add high intensity UV lighting to sterilize the
AIR and most surfaces. For deep cleaning there are plenty of more or less
mechanical solutions that are next to impossible to evolve around.

~~~
tomwalker
In some hospitals they have rolling columns of UV lights that they leave in
rooms after chemically cleaning them to provide an extra cleansing effect and
also reduce airborne transmission of disease.

------
fsck0ff
I am not sure if this helps in any way, but it just popped up in my newsfeed
<http://mashable.com/2013/01/24/ibm-hydrogel/>

[edit: typo]

------
Tloewald
Auggesting that "we might not ever see global warming" is a foolish way to
raise awareness of this issue. To begin with -- we are seeing it just as we
are seeing increasing drug reistance in bacteria.

~~~
ryusage
I think the point she was trying to make was that, while global warming gets a
lot of attention from governments and media, it won't matter much if we're all
killed by drug resistant infections in the next 10 years. In other words,
she's saying that our priorities right now are not in line with the timeframes
of the threats we're facing. Of course, there's no reason we can't address
both at the same time.

------
Millennium
To claim that two threats are equal, only to then turn around and deny one of
those threats, is not a very good way to argue that the other threat is a
grave concern.

------
hhuio
You want to co-exist with bacteria, not wipe them out. Diplomacy versus war.

Se probiotics.

