Existing Drugs Fight Antibiotic-Resistant Bugs

sciencehabit writes "Medical experts have been powerless to stop the rise of antibiotic-resistant bacteria and are increasingly desperate to develop novel drugs. But a new study finds that smarter use of current antibiotics could offer a solution. Researchers were able to keep resistant bacteria from thriving by alternating antibiotics to specifically exploit the vulnerabilities that come along with resistance—a strategy that could extend the lifespan of existing drugs to continue fighting even the most persistent pathogens."

Comments

Perhaps if

[Anonymous Coward]

I was thinking somewhat along the idea, written in summary. We could battle resistance with somekind of phasing of antibiotics in and out of use.. For example we could phase out one type of antibiotic for say decade, then bring it back and phase out another. Could this work?

Re:Perhaps if

[muridae]

10 years seems too long to me, actually. The problem is, a patient has an infection that's resistant to 'cillins or 'mycins or 'floaxins or 'sporins or what ever. Instead of throwing the biggest drug available at it (say it's resistant to all 'cillins) then throw something weak from another family (keflex or something on those lines). Don't throw Vanc/Gent at it, or Rocephin. But make sure the infection is dead dead. Not just in hiding and building a resistance to that new antibiotic too, treat with the full regimen and retest afterwards! And for gods sakes, drill it into the patients heads to take all X days worth, don't skip just because 'you feel better'!

Having just gone through this over 3 years, it's easy to say and harder to do. Bacteria hide (UTIs are bad about this, so are cysts), and when they do they can build up resistance and patients want the strong stuff so it kills it fast. But, and this is a bit of pt side talking, I wish I got the weaker meds first so the later infections weren't resistant to everything but Vanc/Gent/Strepto+Linazolid. Having on two drugs types available post-surgery (both 'of last resort' types) was a pain in the ass.

Second thing to do is for hospitals to be a little more cautious. Every antibiotic flavor for two years left my gut bacteria resistant to nearly everything. So, post surgery, and abscess appeared. Guess how many it was resistant to? Linazolid is the first antibiotic I've met that was more expensive, by weight, than gold. And that was the active drug weight, not the horse pill the crammed it in to!

For the curious, psuedomonas a started it and several idiot docs didn't call infectious disease to learn that omnicef and ampicillin wouldn't work; but they made everything else resistant. Then 4 PICC (well, 3 PICC and one PIC that got a little misplaced) for 3rd gen cefs' which are anti-psudo drugs. All the while, entero was getting resistant to all of those (lucky they killed all the e. coli or I'd have been toast).

Re:Perhaps if

[smpoole7]

> phase out one type of antibiotic for a decade ...

Nice idea in theory, but remember that infection types aren't monolithic. In your region, a given bacterium might have developed a strong resistance to amoxicillin, while in the next city over, they've become resistant to something else. Now add travel to the mix: a guy with methicillin-resistant germs flies across country, then shares his infection with the folks in that region.

NOW add in the fact that these things are most commonly spread in hospitals by overworked staff not washing their hands each and every time they visit a patient's room. One study I read several years ago found that the keyboards on the computers were loaded with MRSA, for example -- which could easily have been controlled with a puff of Lysol and a bottle of hand sanitizer.

At any rate, the article's premise makes sense to me. My doctor told me a few years ago that these things seemed to move in cycles: bacteria would became resistant to one antibiotic, then another ... but it might eventually go full circle. He said he was having a lot of success treating some patients with plain ol' penicillin and doxycycline again.

Re:Perhaps if

[sjames]

New law, if you get an infection from the hospital, your stay is free. Just watch how fast they find the resources to sanitize everything.

Another strategy

[Anonymous Coward]

Don't use them unless they are necessary.

Re:Another strategy

[ruir]

Seem quite simple, doesnt it? The fact that cattle, fish and shrimp feed in asia have huge amounts of antibiotics as a "preventive" measure to keep the animal from going sick, and the resistance the bacteria gain dealing in that sick field, and whatever trickles up the food chain doesnt seem to bother anyone, has long money is made. And nobody will care until it is too late. Big pharma also doesnt care, quite by the contrary the patents have long expired, and antibiotics are bought by the shovel, as soon as they stop working they will have then gov "fund" to further develop very expensive nanomeds. This seems like a stupid plot from a bad scifi movie.

Re:Another strategy

[Sockatume]

If only "pharma can't be bothered to create new antibiotics" were the issue. As it stands antibiotic development is a very active, very well funded private and public research effort. (As you'd expect from a field where whoever gets there first becomes unspeakably wealthy, there are an awful lot of startups.) It's just not turning up anything.

There, fixed that for ya

[cbope]

"*Big Pharma Companies* have been powerless to stop the rise of antibiotic-resistant bacteria and are increasingly desperate to develop novel drugs."

Here's a hint: Stop indiscriminately throwing antibiotics at everything that moves. It's precisely the over-use of these drugs that has created the problem in the first place.

Re:The bacteria are like the Borg.

[Lloyd_Bryant]

Except that bacteria don't adapt to a "strategy". They adapt to the conditions at exist at the moment, with no consideration of the future implications of that adaptation. Because, you know, bacteria aren't intelligent.

Re:The bacteria are like the Borg.

[Thanshin]

Because, you know, bacteria aren't intelligent.

Have you considered that maybe it's you who just doesn't go to the kind of places the smart bacteria frequent?

Copper cladded work surfaces and fittings

[flyingfsck]

Probably the biggest mistake we made the last century was to change away from using copper and brass in hospitals, to stainless steel and chrome - turns out that copper cladded work surfaces is a very effective way to control bugs in hospitals and they don't get resistant to it.

Asia is out of control

[nickserv]

Over prescription of antibiotics is a huge problem here in Asia mostly due to cultural face saving practices. In the West when you go see a doctor you are sometimes, probably not often enough, told to just go home, stay hydrated, rest and that you don't need any medication because there's no medication that can really help.

In Asia however, when someone sees a doctor they expect to go home with something. Even though the doctor's advice is 'respected' it would be a loss of face for a patient seeking treatment to be told to just to go home and rest, no medication is needed. It's hard for Westerners to understand, and IMHO serves very little purpose in today's society, but Asians would view coming home from a doctor without medication as the doctor not doing their job. Also, by not providing some kind of medication the doctor is basically, in the Asian mind, telling the patient "you are wrong, there's nothing wrong with you" which would be a big loss of face for the patient.

There's also a cultural service and purchasing custom that applies but it's much more esoteric and difficult to describe. Briefly, there's an expression "buy 10 buns, get 11 bags" because everyone is conditioned that a transaction is not complete until the goods or services are delivered well and completely packaged. It's a nice polite custom and all but you should see the dumbfounded look on many vendors' faces when I tell them I do not want a plastic bag for my purchase(s). It may sound irrelevant but it comes into play at the doctor's office in terms of, the service transaction is not complete until medicine is delivered.

So, doctors here are not able to go against the cultural grain, even though they know medically and scientifically that antibiotics will do more harm (in the long run) than good, the cultural conditioning is too strong so they always prescribe and 9 times out of 10 it's antibiotics. I was a paramedic in the US for years and I know treatments are highly relative to cultures. I've got no problem with cupping or coining or other 'treatments' that appear to be absurd when viewed through the filter of my culture but, none of those practices have an international impact.

Over prescription of antibiotics is a very significant international problem and Asia is doing the world a huge disservice by allowing it's cultural customs to influence medicine to such a degree in this matter.

Re:phaser ... done in days

[muridae]

That assumes that chronic UTIs have a few days to do a 'reset'. I've had one recurrent for 2 years (psuedo a, it's resistance to 'cillins is a bit different) and would go from not knowing it's active to being near septic in hours (we thought it was a different infection for the first year, til someone put 2 and 2 together to wonder how the same strange bacteria was sticking around). Cipro isn't too bad used right, though I find they push it too fast through small IVs and blow veins. And the expensive stuff . . . I dunno, Linazolid had fewer side effects than dying, but the effect on my family's wallet till insurance decided that 5 days wasn't enough and the Dr was right about 10 was painful; somewhere between 300 and 500 a day for pills...had a bloody PICC, should have gotten the cheaper liquid but I think the docs forgot about it. (linazolid was for what was left after the anti-psuedos and a idiot hospitalist (didn't call infectious disease for 6 days to figure out that omnicef or recephen or gent weren't going to work) made everything else resistant. When you sneak a look at a culture resistance check and see only drugs of last resort listed, and only 4 of them will work, you get a little panic-y.

Re:The bacteria are like the Borg.

[TheCarp]

Actually it is a bit messier than that: http://en.wikipedia.org/wiki/Horizontal_gene_transfer

So the genes for antibiotic resistance don't even have to be evolved by the same organism, nor must they remain there, they can spread separately from the pathogen. The germs you fight may not even be the main resevoir for those genes.

I actually wonder how long it will be before someone engineers a slutty bacterium that is very successful at gene transfer with its own kind and load it up with genes for antibiotic vulnerability. Hell it wouldn't even need to be a traditional antibiotic.... anything you can program it to recognize and trigger cell death should do the trick.

It would be kind of like air dropping syphlitic hookers on the enemy.

It's not just an Asia thing

[Zontar_Thing_From_Ve]

Seem quite simple, doesnt it? The fact that cattle, fish and shrimp feed in asia have huge amounts of antibiotics as a "preventive" measure to keep the animal from going sick, and the resistance the bacteria gain dealing in that sick field, and whatever trickles up the food chain doesnt seem to bother anyone, has long money is made. And nobody will care until it is too late. Big pharma also doesnt care, quite by the contrary the patents have long expired, and antibiotics are bought by the shovel, as soon as they stop working they will have then gov "fund" to further develop very expensive nanomeds. This seems like a stupid plot from a bad scifi movie.

This isn't just an Asia thing. You have described at exactly how food production in the USA works. I'm sure that there are other countries where it's the same. Food production in the USA is Big Business and Big Business always gets what it wants. What they want is zero loss and the way to achieve this is to use high amounts of pesticides that kill any bug that dares to get near produce and feed antibiotics to animals to keep them alive long enough to slaughter them.

Re:The bacteria are like the Borg.

[Samantha Wright]

Fortunately, it's even messier than that: https://en.wikipedia.org/wiki/SOS_response

This is the phenomenon the researchers are exploiting. Not every antibiotic resistance comes from a neatly-packed, horizontally-transferable gene; often, the bacterium is instead evolving alternatives to perform common tasks like the binding of ribosome cofactors. The most transferable antibiotic resistance genes are often enzymes that degrades the antibiotic. These can be overwhelmed; just hit the bacteria with several drugs at the same time. HGT of new-and-improved constitutive genes certainly still happens, but it's much less common, and may not be compatible across species. (As an extreme example, we only recently started finding cases where the ribosomal 16S gene was transferred, and both instances were within the same genus.)

So... there are definitely some strains, like MRSA, that have evolved to be ruthless killing machines, and these are particularly dangerous because their DNA can be taken up by other bacteria, but at present they represent a small percentage of all potential hospital-borne pathogens. They kill a lot (MRSA is believed to be the fourth largest cause of death in the US and kills over a hundred thousand people a year), but because the resistance comes from all of these key constitutive genes that have co-evolved, they mostly stay put. This is why a lot of research now focuses on preventing biofilm formation.