
How we can stop antibiotic resistance - sergeant3
http://www.bbc.com/future/story/20170607-how-we-can-stop-antibiotic-resistance
======
nopinsight
This approach could prevent resistance far into the future. Can an expert
weigh in if it is likely to be practical for wide adoption soon?

Combating multidrug-resistant Gram-negative bacteria with structurally
nanoengineered antimicrobial peptide polymers
[https://www.nature.com/articles/nmicrobiol2016162](https://www.nature.com/articles/nmicrobiol2016162)

An article for non-expert: [http://www.telegraph.co.uk/health-
fitness/body/does-this-25-...](http://www.telegraph.co.uk/health-
fitness/body/does-this-25-year-old-hold-the-key-to-winning-the-war-against-
th/)

"Lam successfully tested the polymer treatment on six different superbugs in
the laboratory, and against one strain of bacteria in mice. Even after
multiple generations of mutations, the superbugs have proven incapable of
fighting back.

“We found the polymers to be really good at wiping out bacterial infections,”
she says. “They are actually effective in treating mice infected by
antibiotic-resistant bacteria. At the same time, they are quite non-toxic to
the healthy cells in the body.”"

"Professor Greg Qiao, her PhD supervisor, says that Lam’s project is one of
the biggest scientific breakthroughs he had seen in his 20 years at Melbourne
university."

~~~
tradersam
> "quite non-toxic"

Well, that doesn't really have a _lot_ of confidence behind it.

~~~
BurningFrog
I'd say it has quite a lot of confidence.

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danieltillett
The solution is to stop giving one antibiotic at a time. HAART for HIV [1]
showed that to prevent resistance you have to give multiple drugs at the same
time. The problem of course is each drug you add to the mix the more you
increase the risk of bad side effects.

Of course none of this will matter until we can crack down on misuse of new
antibiotics in places like India and China. If each new antibiotic developed
is stolen and abused then nothing will work.

1\.
[https://en.m.wikipedia.org/wiki/Management_of_HIV/AIDS](https://en.m.wikipedia.org/wiki/Management_of_HIV/AIDS)

~~~
contras1970
How about a crackdown on misuse of (new and old) antibiotics in places like
the USA?

[http://phenomena.nationalgeographic.com/2015/12/14/you-
cant-...](http://phenomena.nationalgeographic.com/2015/12/14/you-cant-buy-
antibiotics-over-the-counter-can-you-yes-you-can/)

This is not a discussion of Indian or Chinese laws on "intellectual"
"property".

~~~
danieltillett
The new antibiotics are not being misused in the USA - in the main they are
not being used at all in the USA which is a big problem for any company
thinking of developing a new antibiotic.

------
rcdmd
Unfortunately, drug companies have few economic incentives to develop novel
antibiotics given the immense costs/risks of human trials and the minimal
expected monetary reward. Clinicians reserve the "big gun" antibiotics for the
rare cases that need them-- which reduces the cash drug companies get from
pushing them through clinical trials.

Compared to other drugs, antibiotics are relatively easy and cheap to discover
or "invent" with modern techniques. Getting them through clinical trials, on
the other hand, is not cheap.

Many clinicians should be less loose with antibiotics, sure. But, that won't
eliminate resistance. Realistically, when superbugs become common, the
incentives pharmaceutical companies face will shift. It's just there will be a
lot of morbidity and mortality while we're waiting for their drugs to make it
to hospital pharmacies.

~~~
candiodari
Sounds like the solution is to have a very effective, very expensive
antibiotic.

~~~
xherberta
I don't know. With the third-party payer system, cost is hardly a factor in
medical decisions.

~~~
epmaybe
Is it not? I was under the impression that as providers we should provide
affordable care as well. For example, theres no reason to throw every test at
a patient that has clear signs of a certain bacterial infection.

Maybe cost is less of a factor in life threatening situations.

------
rectang
Torches and pitchforks for Big Agriculture?

I'd like to see a year-on-year graph of human lives lost in exchange for
making livestock grow faster.

~~~
jfaucett
It would very much surprise me if the net lives were a loss instead of a
significant gain, so yes this would be an interesting statistic.

For instance, its because of many of the practices of "Big Agriculture" that
world hunger has dropped so massively in underdeveloped countries over the
last 30 years. With even a 10% decline in Asia ( since 92 ), thats about 450
million people who aren't living under malnourished conditions who were doing
so 30 years ago.

~~~
Iv
Can't agree more. The craziness is not that we do intensive agriculture, it is
that we need it and we still do not question our demographic growth.

Some fire-brand ecologists want to go back to "traditional" ways outside of
the paths of modern intensive agriculture but fail to realize that traditional
agriculture both have a higher ecological footprint and is much more labor
intensive.

If you want to lower the impact of intensive agriculture, promote
contraception and demographic decrease.

~~~
bsder
> If you want to lower the impact of intensive agriculture, promote
> contraception and demographic decrease.

You don't need to promote demographic decrease (you might need to do something
about the Catholic church, though ...). All you really need to do is improve
the opportunities for women.

Once women have opportunities and don't need to worry about 4 of 5 children
dying, suddenly they don't want to be pregnant so often.

Many of the most advanced countries are already under replacement level. I
believe the US would be, as well, if it weren't for immigration.

~~~
Iv
Well, I think we still need to promote the merits of bringing the population
down because when you read about countries arriving below replacement level,
it is almost universally presented as a negative thing and government try to
fight that by giving natalist incentives.

No, couples who decide to have more children are not helping society. They are
draining its resources. If you want kids, have only one and give her/him all
the education and resources you can.

~~~
manmal
If you consider resource scarcity as an engineering problem, then removing
consumers is only one solution. The other is to just increase the amount of
resources available.

Re parents with many kids are draining resources - this holds true for
countries like India, but certainly not regions like Europe. Here, farmers are
paid by the EU for letting fields lie fallow, because there is only so much
produce that is consumed in the EU. Also, consider the amount of food thrown
away by supermarkets, which could be used if we were content with eating
crooked looking cucumbers. An argument might be that those extra kids still
deplete scarce resources by proxy, e.g. oil.. but as we are slowly
transitioning to solar and wind power, this might almost entirely go away.

~~~
kpil
We can't increase the population forever,in unless we go full Culture-tech,
and even then it's not "forever."

Meanwhile, while it looks as if most continents are going in the right
direction, we need to stop the extremest religious/political warrior movments
prevalent in North Africa, Middle East and South East Asia.

Eg. In Somalia, a lot of men want 20 kids, and while I can't personally
understand why, it's encouraged by religious leaders. It's apparent that
Somalia itself won't sustain that in only a generation. This can only lead to
conflicts, presumably with richer regions. There are so many pear-shaped
scenarios to go to from there, but I leave to your own imagination what a
highly industrial neighbouring region could come up with if cornered.

Hint: that region have only minor concerns about locking down the borders,
setting up incentives that leads to that whole ships filled with people and
kids drowing. Ther might be some public lamenting but no policy changes.

------
perilunar
> "That’s because the process of developing any new drug is extremely
> expensive and the potential profit in an antibiotic after that massive
> investment is relatively low. ... At current usage levels a new antibiotic,
> he says, would only have about two years on the market before bacterial
> resistance to it develops."

Seems to me that the patent system, meant to encourage invention, is seriously
broken in the case of antibiotics. So stop using it. Set up a bounty system
instead. Pay drug companies directly for developing new antibiotics. Without
the pressure of having to sell them quickly we can instead use them more
strategically, even holding some in reserve.

------
chadthenderson
So, I thought genetic mutations were random. If that's the case, why does the
amount of antibiotics prescribed matter? Won't these mutated bacteria excel
regardless?

~~~
_0ffh
Simplified, to survive one antibiotic, you need only mutate to resist that one
antibiotic. To survive n antibiotics, you need to mutate to resist n
antibiotics _at once_. Being vulnerable to just a single of them will kill
you.

If the chance to get the right mutation to resist one antibiotic is, say 0.01
(1%). Then the chance to mutate to resist three antibiotics at once is 0.01^3,
thats 1e-6 (0.0001%).

~~~
chadthenderson
You might need to simplify some more.

~~~
undersuit
I'm going to ship you a item. Luckily I have multiple copies of the item. I
ship using UPS, Fedex, and USPS. You'll probably get three copies, but to get
no copies of the item I'm shipping you something has to go ridiculously wrong
in three different companies.

------
Gatsky
This article seems to exist in lalaland. Implementing antiobiotic stewardship
in China and particularly India will not succeed, at least in the next ten
years.

~~~
nwah1
The world has had success with eliminating CFCs from refrigerants, banning
leaded gasoline, eradicating iodine deficiency, dramatically increasing crop
yields, eradicating polio, scaling up electrification, plumbing, internet
access, etc etc. The idea that we can set a goal like this is completely
conceivable.

A lot of the low hanging fruit involves banning the use of antibiotics on
healthy farm animals, and at least with the largest producers who raise and
slaughter the majority of animals I think this could be achieved.

------
YeGoblynQueenne
>> How do we get ourselves out of this?

>> First, the entire world needs to get on board.

Like the entire world got on board with climate change. Yep, we're screwed.

~~~
jballanc
The entire world minus the United States of America and Syria _is_ on board
with climate change. What's your point, again?

~~~
dragonwriter
> The entire world minus the United States of America and Syria is on board
> with climate change.

As is much of the USA, even if not the federal government. 12 states and
Puerto Rico in the US Climate Alliance, another 10 states and numerous local
jurisdictions expressing official support for the Paris Accords outside of the
Alliance.

------
frik
> Until recently antibiotics in the US actually listed animal growth as an
> indication for use on antibiotic labels and a prescription was not required
> for farmers to obtain them.

Less monoculture, smaller farms, no use of antibiotic for animals. Pure form
of greed, they feed them antibiotics pro-actively.

------
gumby
I wonder if an increase in antibiotic-resistant organisms will lead to a
resurgence in table manners and resistant clothing (e.g. gloves). Many of
these rules were designed to reduce the spread of pathogens.

(This is not to ignore the fact that quite few were designed for social
exclusion as well)

------
jfaucett
This article essentially says that in the best-case we can only slow
antibiotic resistance. Is there anyone working on things to actually render
the bacteria less effective at survival (perhaps using the same evolutionary
principles that got them resistent in the first place)?

~~~
ocschwar
Antibiotic resistance imposes a metabolic cost on bacteria.

Take away the antibiotic, and resistance slowly declines.

50 years from now, we'll have a global system that coordinates the rotation of
antibiotics so we use them in lockstep.

~~~
danieltillett
People have tried this and it doesn't work. The problem is mobile genetic
elements like plasmids and transposons. What happens is the antibiotic
resistance genes cluster together and so the selection for one selects for all
the others. Even if you go back to an antibiotic that hasn't been used for
decades the resistance hangs around. Bacteria really are formable.

~~~
autokad
if they were easy to kill, life would have never formed / progressed in the
first place =)

~~~
danieltillett
The speed of evolution is proportional to the population size - there are way
more bacteria than non-bacterial life and they are way ahead of us :)

------
DavidFlint
I am amazed by how many people take antibiotics for no reason. I have a
partner since a year and she used to go to the doctor every time she had the
flu. And the doctor, to be on a safe side - prescribed antibiotics every time.

When I showed up I encouraged her to stop taking any antibiotics and build up
defence system by taking vitamins and adjusting some bad habits. The first
time she had flue it was bad, she had it for 3 weeks and was forced in the end
to take antibiotics. Since then she was not sick even once (usually she would
be sick every 3 months). Her health improved, her defences are strong and
whenever she starts feeling bad she just jumps into the bed for 2-3 hours and
get out feeling good. Her bode learned how to defend on her own.

~~~
nemeth88
This is a somewhat strange story re: "the flu" and I'm guessing that's why
it's been downvoted.

The flu is a virus and antibiotics have no effect on it. There is a yearly
vaccine for the flu and the CDC recommends all adults take it, although it
usually only protects about 40-70% of the time due to the large number of flu
strains in circulation. The flu is a deadly disease and even a person in good
health (taking vitamins, etc) in the prime of their life can be killed by it,
which is why vaccination is recommended.

------
cel1ne
Relevant story:
[https://news.ycombinator.com/item?id=14453281](https://news.ycombinator.com/item?id=14453281)

------
suneilp
I'm curious what others here think about natural antibiotics, either extracted
or consumed food which has antibiotic properties.

~~~
ch4s3
Like penicillin?

------
jballanc
This article, like much of the debate about antibiotic resistance, is fatally
flawed by its anthropocentric viewpoint.

The thing to understand about antibiotic resistance is that we humans are but
foot soldiers in a global war that has been raging for _literally billions of
years!_ Plants killing bacteria, bacteria killing fungi, viruses killing
bacteria, bacteria killing viruses, even bacteria killing other bacteria; this
conflict rages on with or without our input _constantly_. Almost all of our
current antibiotics are natural products or derivatives thereof, taken from
the plants and fungi that have been fighting off bacteria much longer than we
have. Increasingly, we're finding that the antibiotic resistance that arrises
in human pathogenic bacteria is not the result of novel mutations (as this
article suggests), but rather the adoption of a pre-existing resistance trait
from one species that has nothing to do with humans into one that does. In a
teaspoon of dirt there are more different species of bacteria than have ever
caused diseases in humans, all of which are in a constant struggle for
survival, many of which have developed highly specialized weapons and defenses
with which to fight this war.

We've been fighting bacteria with antibiotics for just about 100 years, and
_we 're already losing!_

The idea that management of distribution or development of novel agents will
be sufficient to prevent bacterial infections into the indefinite future is
laughable on its face for any semi-serious student of evolution.

No, antibiotics have won us an important battle, but the war is _far_ from
over. New antibiotics will help, but each new one will hold off fewer
infections, with more serious side-effects, lasting ever less time before
resistance takes over. We'll never see the sort of success with antibiotics in
the future that we have in the past. Interesting alternatives, like
bacteriophage therapy, stool transplants, and other means of grooming our
natural bacterial flora will go a bit further.

Ultimately, though, the incontrovertible truth of nature is this: the only
lasting alternative to conflict is cooperation (a.k.a. symbiosis).
Fortunately, for reasons we still don't fully understand, organisms in
conflict naturally evolve to a cooperative state...given enough time. _Un_
fortunately, evolution is very slow, and there is no rule stating that there
won't be casualties (i.e. extinctions) along the way.

So, as uncomfortable as it may be to many, there really is only one long-term
hope that humanity has for permanently stemming the tide of infectious agents
in less than an average lifespan's time: genetic engineering. Luckily, we are
developing new tools for this all the time. Yes, they pose great danger, but
so did fire the first time humanity harnessed it to provide warmth and a way
to cook food (coincidentally enough, yet another of our small victories in the
war against disease).

------
autokad
“Consider going to back to an era when a minor accident like a scrape could
lead to death.”

That a bit of hyperbole, people don't take antibiotics for minor scrapes -
soap and water is the prescription. quite often when the minor scrape is life
threatening, its something like MRSA. which leads me to think of the stories
of people in the past dying of minor scrapes: maybe its been around for longer
than we think.

after all of the scare tactics, much of the drug resistance where it matters
has been appropriate use. TB, gonorrhea, etc. These diseases didn't become
drug resistant because people were taking antibiotics for the flu or use in
agriculture.

~~~
swombat
It's not, actually. Minor scrapes _could_ lead to death doesn't mean they
always did. Same is true today. Most scrapes won't lead you to need
antibiotics, but if you start to get very ill after your scrape, you will get
treated with antibiotics and live. 100 years ago you might have died - from
cutting yourself while gardening, for example.

~~~
autokad
thats exactly what i said, they could lead to death but they usually dont.
Maybe I have to walk you through it:

1) its very rare a cut needs antibiotics 2) if an infection is severe from a
'minor scrape', the prior for it being something like MRSA is much higher 3)
minor scrapes in the past also rarely needed antibiotics 4) rare stories of
people dying from minor scrapes in the past might have been MRSA

~~~
wayn3
1) is only right because we are vaccinated.

2) in 2017, yea. in the past, the prior for it being MRSA is essentially 0

3) thats because vaccination predates antibiotics

4) nope

your statements amount to "i have no clue how evolution works". bacteria are
single cell organisms that dont just suddenly exist into the world being
resistant to antiobiotics, which were specifically developed to kill those
organisms off.

~~~
autokad
vaccinations have nothing to do with the conversations about drug resistant
bacteria. get that through your head, maybe even write it down and say it out
loud.

MRSA existed pre 2017, which it was in fact discovered in the early 1960s.

While I understand that MRSA is probably emerged from antibiotic use, I am
open minded enough to consider it could have predated modern use of
antibiotics.

bacteria in the world weren't suddenly under threat once antibiotics came
along. they have been fighting the fight for 3 billion years. In fact,
Penicillin is a natural occurrence used to fight bacteria before humans
stumbled upon it.

All of the ways our antibiotics are used to fight bacteria have been something
bacteria have been dealing with since they existed.

