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?

Why use Drugs?

[filesiteguy]

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

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.

Re:Why use Drugs?

[AuMatar]

There are no male and female bacteria. Therefor that would be gay marriage. Do you support gay marriage? Why do you hate Jesus and America?

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.

Re:For a change, this is actually interesting.

[The Elephant]

This article provides a more thorough and scientific explanation. http://www.sciencedaily.com/releases/2007/07/07070 9171636.htm

Re:short term solution

[wytcld]

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.

Let the bacteria read slashdot

[loteck]

...also a proven way to virtually extinguish one's sex life.

Re:Unnatural Selection

[TheMohel]

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.

Bacteria != viruses

[mattcasters]

Just a nitpick, but anti-biotics don't really help fight against viruses.

Re:Bacteria != viruses

[ColdWetDog]

In cases of a viral infection, antibiotics are prescribed to wipe out bacteria that keep the immune system tied up and busy.

Huh? That's not even wrong. There is no reason to use antibiotics in a viral infection. Period. Now, there are a couple of real life caveats to this: Firstly, viral infections can alter host defenses (usually by trashing the lining of the respiratory system - essentially making holes in it - which allow bacteria to invade. The classic case is Haemophilus Influenza pneumonia that occurs after an influenza infection. Secondly and more commonly, a doctor may not know if the infection is viral or bacterial and antibiotics are often (likely too often) added empirically.

But bacteria "don't keep the immune system busy".

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.