
The Bugs Are Winning - prostoalex
https://www.nybooks.com/articles/2018/06/28/superbugs-are-winning-antibiotics/
======
majewsky
Counterpoint: A recent Kurzgesagt video suggests that we may be able to deploy
bacteriophages (bacteria-attacking viruses) to combat superbugs.
[https://www.youtube.com/watch?v=YI3tsmFsrOg](https://www.youtube.com/watch?v=YI3tsmFsrOg)

Note: I'm not a doctor/biologist/etc., so I cannot comment on the details of
this claim (e.g. how far away we are from a widely deployed phage-based
treatment).

~~~
DonaldFisk
Bacteriophages were used instead of antibiotics in the Soviet Union, and are
still used today in Georgia.

~~~
smaddox
My extremely limited understanding is that a given bacteriophage only attacks
a very specific strain, and thus that you would need to constantly evolve them
to fight new strains. While perhaps not useless, that doesn't sound like a
replacement for antibiotics.

~~~
balls187
Given how medicine works in the US, that's not a problem, but an opportunity.

US Medicine is for profit, and the money is in reoccuring treatment, not
cures. So a never ending battle of cat-and-mouse is the type of R&D phramas
would love.

A potential future scenario:

Keep going to your doctor to get a Rx for the latest strain or pay a monthly
fee to a Bacteriophage-As-A-Service SV tech company to get the latest
delivered right to your door you use in conjunction with a smartphone app.

The latter of which would have operated illegally until sufficiently large
enough to hire insider DC lobbyists to gut the FDA.

~~~
DonaldFisk
And yet phage therapy's been successfully used under communism but not
capitalism. This is because it's cheap, low tech, and there are no economic
barriers to market entry.

~~~
AstralStorm
You forgot to mention the scale. It does not easily scale as the required
laboratory space to handle even a few hundred phage strains is enormous.

Please provide numbers of patients treated with phages, time to treat one and
efficacy numbers.

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choeger
I wonder how these bacteria can /remain/ resistant against older antibiotics.
If they mutate really fast, should not the resistance against, say penicillin,
vanish after a few years when they are not exposed to the medicine?

So could we not "renew" some antibiotics by simply not using them for 5 to 10
years?

~~~
jhbadger
It depends on how the resistance works. Some forms of resistance require
active effort by the bacterium (for example efflux pumps), and you would
expect that in the absence of an antibiotic they would tend to be lost by
natural selection. But other forms of resistance are just minor mutations
stopping the antibiotic from binding or whatever, and these probably would
remain at least in some fraction of the bacterial population as they are more
or less neutral.

~~~
Retric
The human immune system can deal with a huge range of things just fine. So,
the metabolic weight from antibiotic resistance is inherently useful for
Humans.

Antibiotic resistant bacteria do kill people, but most often as secondary
infections due to a compromised immune system. Further, even if the primary
infection has near total resistance suppressing secondary infections is still
extremely useful.

~~~
aaron_m04
Are you saying the adaptations bacteria make to become resistant to
antibiotics causes them to be easier targets for the immune system? Do you
have a link I could read more about this?

~~~
Retric
Yes, but not always, and not necessarily for long.

"While the cost of resistance is highly variable, such resistance mutations or
genes often come with a fitness cost that _reduces the rate of bacterial
proliferation_ (Dahlberg & Chao, 2003; Melnyk et al, 2015)."
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5371735/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5371735/)

"The success of resistant mutants critically depends on rapid counterbalancing
of the decreased fitness by acquiring compensatory mutations (Levin et al,
1997; Marciano et al, 2007), which in most cases restore normal growth while
preserving resistance to the antibiotics (Marcusson et al, 2009). The number
and variety of compensatory mutations required to successfully compensate
fitness cost varies with organism (Palmer & Kishony, 2013, 2014; Cheng et al,
2014) and the particular environmental conditions under which compensation
occurs (Testerman et al, 2006; Hoffman et al, 2010; Toprak et al, 2012;
Lindsey et al, 2013)."

Basically, resistance become extremely important so anything that works get's
adapted. But, after that point the search for mutations that reduce cost shows
up. The second stage also depends on continuous exposure to antibiotics as
reverting the mutation in a population is relatively simple.

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sliken
Norway seems to have a particularly enlightened approach to antibiotics.

In particular not using antibiotics as a growth stimulant (common on farms),
reserving certain antibiotics for human use, and training doctors and vets on
their use.

More info at: [https://www.regjeringen.no/en/aktuelt/norways-battle-
against...](https://www.regjeringen.no/en/aktuelt/norways-battle-against-
antimicrobial-resistance-in-the-agricultural-sector/id2554750/)

Same site mentioned Germany users 50x more antibiotics in their meat
preparation than Norway.

[https://www.regjeringen.no/en/aktuelt/norway-takes-the-
lead-...](https://www.regjeringen.no/en/aktuelt/norway-takes-the-lead-on-
antibiotic-resistance/id2561185/)

Related article on fighting "super bugs" like MSRA:
[http://www.spokesman.com/stories/2010/jan/03/norways-mrsa-
so...](http://www.spokesman.com/stories/2010/jan/03/norways-mrsa-solution/#/0)

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NeoBasilisk
Restricting the use of antibiotics in farm animals needs to happen ASAP.

~~~
urda
Unlikely that China would comply though, and they are a major contributor to
the rising Super Bug problem because of it.

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Fragoel2
The wikipedia page about antibiotics resistance
([https://en.wikipedia.org/wiki/Antimicrobial_resistance](https://en.wikipedia.org/wiki/Antimicrobial_resistance))
adds some interesting points on why we are falling behind on the race for the
discovery of new antibiotics. The TLDR is it's currently not economically
convenient for big pharmaceutical companies to invest in antibiotics research
but several measures have been taken in order to make it better and,
hopefully, will allow us to catch up on the race.

------
Zeppelin15
I Heard something controversial on the radio the other day. Don't finish your
antibiotic course. Stop when you feel better.

The rational was: Bacteria becoming resistant due to a treatment has only ever
been proven for a handful of conditions( TB , HIV syphilis, and so on). The
other bacteria are ether resistant or they aren't prolonging the treatment
does not encourage a resistant mutation.

By prolonging your treatment with antibiotics you create an environment in
which antibiotic resistant bacteria, both the good and bad kind, can replicate
easier. Due to Horizontal gene transfer good bacteria can transfer their
antibiotic resistance to bad bacteria.

This advice is in stark contradiction to the Fleming quote.

I heard it on the radio and can't remember the sources, but it makes sense to
my non medical mind.

*edit added sources.

Found the journal entry if anyone cares :
[https://www.bmj.com/content/358/bmj.j3418](https://www.bmj.com/content/358/bmj.j3418)

Article about journal entry :
[https://edition.cnn.com/2017/07/27/health/antibiotics-
course...](https://edition.cnn.com/2017/07/27/health/antibiotics-course-
advice-study/index.html)

~~~
JTbane
Very bad advice- you should either finish the entire course or not take
antibiotics at all, otherwise you're gonna help the superbugs along.

~~~
darpa_escapee
Meat production is orders of magnitude more effective at producing antibiotic
resistant strains.

