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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."
what happens when the bugs become resistant to these two drugs as well?
The higher the technology, the sharper that two-edged sword.
Um, doesn't marriage do the same thing?
Just asking, because it would certainly save a lot of money if we just get these bacteria to marry.
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So, the few bugs that escape this new form of microbial torture will simply become stronger and even more resistant. Great. I am not a biologist, but are there any other ways of getting around this war of escalation?
Maybe scientists could find some other critter that the bugs like better, like cockroaches or the small dogs that live in women's purses.
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.
... except for that fraction of a percent that's immune to the drug and can breed anyway, and then we start all over again.
William of Ockham had no beard. The most likely explanation is that it was chewed off by squirrels every morning.
You didn't read the whole article. The drugs were initially tested for the property of blocking the transfer of genes for multiple drug resistance. But they were surprised to find that it specifically killed those bacteria which had already received the upgrade package. Multiple drug resistance is evidently a specific trick - not multiple resistances to multiple drugs, but a single resistance mechanism that blocks nearly all drugs, and that can be passed from one species of bacteria to others. These newly-tested but available drugs kill any bacteria which have adopted that mechanism.
"with their freedom lost all virtue lose" - Milton
...also a proven way to virtually extinguish one's sex life.
Always a concern, but the trend in medicine over the past decade or so has been to reduce the number of times we prescribe, even as we increase both the dose and duration of care when we do pull the trigger. Antibiotic resistance has been strongly linked to inadequate dosing (killing only the susceptible bugs, while letting the borderline-resistant clones reinforce themselves), as well as to courses too short or patient noncompliance.
Patients are part of the problem too, since there is a tendency (cultural in some cases, personal in others) to demand that a doctor "do something" to fix the problem. Antibiotics were perceived for a long time as something harmless to give in those circumstances, but that perception is fading fast. If anything, the trend now is to err on the side of letting things play out a little more to see if antibiotic therapy is really needed.
This has also caused physicians to have to explain the situation better. I know for myself that when I am explaining to a suspicious parent the reason that I'm not going to give their child an antibiotic for their viral infection, I don't waste a lot of time explaining resistance. If they already understand resistance, they're not asking for antibiotics. If they don't, it just sounds like I'm making things up. I focus instead on side effects and cost, and my typical (true) statement is "about all I can do with antibiotics would be to give your child diarrhea to go with her cold." This is surprisingly effective, especially in the parents of non-potty-trained toddlers.
None of which stops me from pulling out the stops when I'm faced with a septic kid or a real infection that needs to be nuked. In those cases, though, I'm very careful to make sure that the regimen I use is appropriate, considering the resistance patterns and the risk of making them worse.
Now if we could only get the idiots who lace animal feed with antibiotics to do the same. Ever wonder where resistant strains start? Hint: it ain't just in the hospitals.
Just a nitpick, but anti-biotics don't really help fight against viruses.
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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.
A polar bear is a cartesian bear after a coordinate transform.
In other news, Viagra has been shown to reduce bone lose in old men.
No comment,
OwenDMoney
It's easy to be a sceptic and ask about 'and what about when the bugs become resistant to this'. As a person who had his life ruined by MRSA, I know too well the impact these types of infection have on individuals and families. Anything that can extend the reach of antibiotics (particularly the less toxic ones - I was only 2 or 3 days off being killed by the antibiotic that beat my infection) and decrease the chance of resistance is a good thing.
Hopefully this won't be used promiscuously, and I hope they'll work out the interactions with other treatments, as quite often treatment is multi-modal.
I wouldn't wish what I go through due to MRSA on anyone (except my stepfather, but that's another story altogether.
Yep. I've got patients who do the same (I live in an area where we have a lot of Hispanic immigrants, legal and otherwise). Nothing I can do about it except to talk with them, which I do. I try to encourage them to be reasonable and to take an entire course when they start one (nothing's worse than an occasional antibiotic pill). I have mixed success, but I don't expect perfection and I think my attitude helps the situation. I do get a lot of "do you suggest I start this" kinds of calls and questions and I treat those calls as victories.
This gets me into the whole doctor-as-gatekeeper-for-pills thing that drives me nuts. I challenge colleagues once in a while: in an environment where all medications were available at retail, could they still justify their fees? Could they market themselves well enough to avoid starvation? I think I could, because of the kind of medicine I practice (and because I can sometimes go a dozen patients between giving a prescription), but it's definitely something honest physicians should be asking themselves.
In the no-Rx-required environment, though, there's no question that resistance emerges rapidly. Fortunately, the antibiotics available in Mexico are a small subset of the ones we use here, and most of the ones that patients can buy OTC have broad therapeutic indices (overdose doesn't hurt you much) and are from antibiotic classes (penicillins, macrolides) where we have later-generation alternatives that avoid the common resistances. It's a fluid situation, though, and one that has infectious disease specialists always a little on edge.
...but until you've had an opportunity to get up close and personal with CA-MRSA, you DO NOT know how much fun you are missing.
Starts out like an ingrown hair or pimple. Might even be a spider bite. Then it gets angry. Take a large marble...light it on fire and have it surgically planted underneath, say, two layers of skin. Day three and the redness is now inches in diameter and the bump is still growing and...damn! It hurts! Burns like hell! Pimple my ass! Get that thing out of there! You can't sleep from the pain and you find yourself wondering which would be the better method to dig it out: kitchen cutlery or claw-hammer. In any case, if you don't have a doctor lance it, you're going to have to do it yourself.
Day four and it is open, draining and talk about cheese!! The stuff draining from the now open wound is so toxic, it blisters the surrounding skin. Makes it a bit difficult to remember to trash your clothes, bedsheets, etc., but at least the burning has lessened...a bit.
Ten or twelve days later, after finally getting on an anti-biotic (tetracycline?) that can put up a fight, the fluid draining out is almost stopped, the redness is almost gone and a bit of scar tissue is starting to form. Good news is, now that you know the routine, you can put up a slightly better fight next time - and there will be a next time...unless you died from this incident, of course. You did wash your hands before you helped your kids get dressed this morning, right...?
As a doctor, I want links to studies, good studies, not just anecdotal evidence.