Resistance Rising - How Overuse Ruined Antibiotics - BBC

[hatrack]

If we can't overcome the bugs that resist antibiotic treatment, we might go back to a world where medicine seemed powerless against a whole range of conditions.

Dr Richard Bax, a former GP who now works for the pharmaceutical company Chiron, said you only have to look at the graveyards full of Victorian children who died in infancy to realise what a world without antibiotics was like.

When the first effective antibiotic, penicillin, arrived during the Second World War, it seemed like a ray of hope amidst all the wartime gloom. It looked as if we could defeat infection as decisively as we were defeating fascism.

EDIT

Richard Bax recalls the US Surgeon General's complacent claim in the 1960s that "infection had been defeated". Pharmaceutical companies found there were much bigger profits to be made from other drugs, such as those combating heart disease, which patients had to take for years on end rather than in response to a single infection. Some researchers still hope for a new generation of drugs as revolutionary as penicillin once was. Whether or not that happens, there's pressure for a major change in the way we use the antibiotics we have. But it will be hard. Kathy Holloway says we've become too used to the "quick fix" approach for everything, including infection."

EDIT

http://news.bbc.co.uk/1/hi/health/4264121.stm

[punpirate]

1. And what's happening in drugs for humans...

... is almost insignificant compared to the resistances building up in the animal and plant world that then have implications for us. The amount of animal antibiotics used by industrial agriculture (often similar to those being used on humans) finding their way into waterways is extraordinary.... *sigh*

[Maple]

2. Bug mutation

would occur no matter what we did.

Everytime someone invents a lock, someone else comes up with a way to open it.

Bugs are just as clever. But they would mutate over time anyway.

We just need some new antibiotics.

[Warpy]

3. Bug mutation has been greatly increased

by lax regulations covering antibiotic use, especially in the developing world. It's also been increased by noncompliance in the patient population.

People who don't take a full course of antibiotics are only allowing the resistant bugs to proliferate in their systems. The same antibiotic won't work the next time.

Children who grew up guzzling amoxacillin for every sniffle and earache now find it won't work for any of the infections they're getting as adults.

Drug companies aren't working on any new generation antibiotics, although they have several more limp dick drugs in the works.

Hospitals are getting to be pretty scary places to work. There have now been several cases of resistant infections that have NO treatment available.

[struggle4progress]

10. Design of new antibiotics may become an increasingly ...

... more difficult problem. Trying not to overuse existing antibiotics, rotating usage carefully, and taking related steps (to limit the development of resistant microbial populations) is important.

[necso]

4. "Pharmaceutical companies

found there were much bigger profits to be made from other drugs, such as those combating heart disease, which patients had to take for years on end rather than in response to a single infection. Some researchers still hope for a new generation of drugs as revolutionary as penicillin once was."

This quote is a tactful way of saying: What's going to kill us is the fact that, since other drugs are much more profitable, big Pharma isn't doing the necessary research on antibiotics. But we can always hope -- just like those researchers.

And it is difficult to get a good handle on extent of the problem. Still, it is a very real problem, and one that could have very serious consequences.

Add it to the list (of potentially devastating problems) that we aren't going to do anything (substantial) about.

[hatrack]

8. What do pharmaceutical companies really want?

It's simple. They want expensive drugs to help wealthy old people grow hair, look and/or feel younger, and fuck.

A vaccine for hepatitis? New malaria treatments? HAART drugs at a discount for Sub-Saharan Africa? Ah, Monseiur, you make ze joke, non?

[NNadir]

13. Well it is a rough business.

Typically the cost for developing a drug runs in the hundreds of millions of dollars.

Pharmacia spent this money developing linezolid, a new class of antibiotic that was active against VRE (vancomycin resistant enterococci and MRE (methocillin resistant entereococci.) The drug sold like shit, mostly because doctors were afraid if that they used it, and resistance developed, it would become useless and their last emergency defense would be gone.

The business result for Pharmacia was that the barbarians at Pfizer showed up at their gates, stormed their labs, killed the jobs of their employees, and nailed the doors shut. They demanded that the looted company's survivors turn to the real health issues facing the human race; that certain old fat dying republican white men can't always get it up.

[kineneb]

5. MDR -TB

"Multiple Drug Resistant" TB cases are raising, among the many nasty diseases. I have a friend who is a communicable disease nurse. We were sharing books on the medical biz, including the excellent volumes by Laurie Garrett. Lots of old diseases are now resistant to the main-line antibiotics; and because of the (lack of) profit motive, there are few new meds coming out to treat these bugs. Consider the staph infections being accidentally bred in hospitals as an example of the problem.

[TO Kid]

6. Overuse isn't the real problem

The biggest cause of increased resistance is not overuse, it's improper patient compliance. Specifically, the problem is people who stop the course of treatment when symptoms go away. Taking an antibiotic when no infection is present will not have any effect, but stopping an antibiotic while still infected can be disastrous.

Most antibiotics, especially the weaker ones, do not destroy all microbes in the body. Instead they kill most of them, reducing the infection to a level that the immune system can handle. In effect, by taking an antibiotic one is selecting for resistance. Therefore stopping it prematurely will leave an antibiotic-resistant infection in the body that will roar back with a vengeance.

[ChemEng]

7. You are half right...

Quitting the course of treatment does leave behind resistant strains, but it is still correct that treating a kid's cold with antibiotics will also help create resistant strains. Colds are viruses that antibiotics do nothing for. Doctors need to learn to tell parents NO when they ask for antibiotics.

[TO Kid]

9. About that cold thing

It's true that antibiotics do nothing for viruses, but if no bacterial infections in the body then there's nothing for the antibiotics to harden. Using antibiotics when they are not indicated my be wasteful and hazardous to the patient but they don't have anywhere near the impact of poor compliance.

[struggle4progress]

12. It's exceedingly unlikely that anyone is uncolonized by ...

... microbial pathogens: usually, however, their growth is limiteed by immune responses. So taking antibiotics, if there is no need, actually does present the danger of developing resistant cultures.

[struggle4progress]

11. Excreted drugs often appear in sewage. So overuse has ...

... the potential to create very low but possibly still biologically active levels of antibiotic in the environment, which is exactly the situation which could lead to developing further resistant strains.

It's also worth noting that increased drug use will increase the number of patients noncompliant with the therapeutic regime.