Potential Cure For Antibiotic Resistant Infections

kpw10 writes to let us know about research to be published this week that offers hope in the battle against multi-drug-resistant bacteria. "Researchers at the University of North Carolina at Chapel Hill have discovered that two drugs used to treat bone loss in old folks can both kill and short-circuit the 'sex life' of antibiotic-resistant bacteria blamed for nearly 100,000 hospital deaths across the country each year."

Comments

Okay, I'll bite ...

[ScrewMaster]

what happens when the bugs become resistant to these two drugs as well?

For a change, this is actually interesting.

[TheMohel]

I'm a skeptic about a lot of things in medicine (I live in that world), especially "wonder drugs", and the writer of TFA demonstrates his limited skills in microbiology enough to make me cringe. But the science here is going to be fun to see.

Don't get me wrong - we need to know the doses, the regimen, the side effects at antimicrobial dosing, and all the rest of the nuts-and-bolts pharmacology. On the other hand, the putative mechanism, which is to interfere with sharing of genes between bacteria, is in itself ground-breaking. Used properly (that is, not overused and used with care), this could prevent rapid resistance emergence in bacteria where the treatment itself takes weeks to months (osteomyelitis, for example, or infection with certain stubborn bugs). These drugs (etidronate and pamidronate) have their own not-insignificant side effect profile, of course, and there are no guarantees at this stage.

I'll be interested in the actual research, because TFA is filtered through a layer of ignorance and sensationalism, but it sounds interesting.

Not really that simple

[Moraelin]

Now I'm not a doctor, but it seems to me that (as is usually the case) it's not that simple. Among the things that come to mind:

1. Drug resistant bacteria aren't as much caused by taking too many antibiotics, but by taking too little of an antibiotic. People take the antibiotic for 2-3 days, then they feel better, and figure out "why bother taking the rest?" Or they take an antibiotic, it makes them feel worse, skip the rest of the treatment because they know better than the doctor. Etc.

Problem is, they have a shitload of bacteria left at that point.

Will someone decide to skip their bone loss drugs too? Probably, but I'd assume somewhat fewer.

2. The fact that it's already widely used to treat bone loss, should probably tell us that if it was that easy to develop resistance to it, it would have happened already. Not saying it's impossible to, but it might just take a lot more time.

3. The relatively fast development of resistance is massively aided by the fact that bacteria can exchange genes. (Hence the jab about inhibiting their sex life.) So basically once one develops resistance, it can pass that around.

Something that attacks that very mechanism, might slow down the rate of developing and spreading resistance a lot.

Re:Not really that simple

[ColdWetDog]

1. Drug resistant bacteria aren't as much caused by taking too many antibiotics, but by taking too little of an antibiotic. People take the antibiotic for 2-3 days, then they feel better, and figure out "why bother taking the rest?" Or they take an antibiotic, it makes them feel worse, skip the rest of the treatment because they know better than the doctor. Etc.

That's part of the problem, the bigger problem is that there are too many antibiotics being used for essentially superfluous indications such as when used in cattle feed and for clearly viral infections. In fact, the data on exactly how long one should be on antibiotics for a given infection is pretty sparse. Remember that the host immune system is playing an active role in clearing the infection - it's not just the antibiotic, and once you gain the upper hand, it's bye-bye bug.

1. Drug resistant bacteria aren't as much caused by taking too many antibiotics, but by taking too little of an antibiotic. People take the antibiotic for 2-3 days, then they feel better, and figure out "why bother taking the rest?" Or they take an antibiotic, it makes them feel worse, skip the rest of the treatment because they know better than the doctor. Etc.

Now this is interesting because you're correct - At least one of the drugs has been marketed for several years. If they prevented antibiotic resistance, it should be possible to see this given enough patients and time. The problem is that we don't have any way to really track this on a grand scale. It may be possible for organizations like Kaiser Permanente, who can track drug use and outcome data, to see this. It may also be the case that this is yet another Test Tube Marvel that has little applicability to the real world.

3. The relatively fast development of resistance is massively aided by the fact that bacteria can exchange genes. (Hence the jab about inhibiting their sex life.) So basically once one develops resistance, it can pass that around.

As far as I can tell from the terribly written summary, that's what the drugs do - prevent plasmid reproduction. The problem here is that there are several mechanisms for plasmid / gene transfer among the various species of bacteria. There may be mechanisms that are not susceptible to these drugs.

Re:Unnatural Selection

[the_humeister]

As a doctor, I want links to studies, good studies, not just anecdotal evidence.