A Post-Antibiotic Future Is Looming (www.cbc.ca)

New submitter radaos writes: A gene enabling resistance to polymyxins, the antibiotics of last resort, has been found to be widespread in pigs and already present in some hospital patients. The research, from South China Agricultural University, has been published in The Lancet. According to research Jian-Hua Liu, "Our results reveal the emergence of the first polymyxin resistance gene that is readily passed between common bacteria such as Escherichia coli and Klesbsiella pneumoniae, suggesting that the progression from extensive drug resistance to pandrug resistance is inevitable." Work on alternatives is progressing — Dr. Richard James, former director of the University of Nottingham's center for healthcare associated infections, writes, "Until last month I was still pessimistic about our chances of avoiding the antibiotics nightmare. But that changed when I attended a workshop in Beijing on a new approach to antibiotic development based on bacteriocins – protein antibiotics produced by bacteria to kill closely related species, and exquisitely narrow-spectrum."

Comments

Questions...

[Feral Nerd]

A gene enabling resistance to polymyxins, the antibiotics of last resort, has been found to be widespread in pigs and already present in some hospital patients.

Is that a roundabout way of saying that some complete and utter moron has been feeding the antibiotic of last resort to pigs in order to boost his profit margins and the resulting resistant bacteria are now spreading to humans? I could be wrong about that of course since I am not a bacteriologist, so for what other reason would polymyxins resistance be widespread in Chinese pigs and now spreading to humans?

Re:Questions...

[dgatwood]

It's the tragedy of the commons. You have a group of sociopathic businesspeople who consider their profits more important than the survival of the human race, so they give prophylactic antibiotics to animals that aren't even sick. The downfall of humanity will be greed.

The cause of the post-antibiotic future

[Misagon]

The reason why antibiotic-resistant strains have been forming and allowed to be a problem is that people have been misusing antibiotics.

A small scale problem is that antibiotics have been used by human patients that would not benefit from them. Other patients have stopped or cut down on using antibiotics when they have started to feel well - but before the strain has been fully eradicated. In some countries, antibiotics have even been available over the counter without prescription.

A large scale problem is the over-used of antibiotics in agriculture. Livestock are given antibiotics in their feed as a precaution, and this is still going on on a large scale in most Western countries.
Antibiotics-resistant strains are widespread, even the norm in many parts of the world.
Seriously, this has to stop! We need to treat this problem seriously. If a resistant strain of bacteria is found on a farm then that farm should be put in quarantine and the stock of animals should be destroyed, like what happened when Mad Cow Disease - but instead this is seen as normal. Diseased eggs and meat are the norm, and I am not talking about third-world countries. I am talking about Western Europe and the USA.

Not exactly just as a precaution

[PeterM from Berkeley]

Antibiotics are not fed to animals solely as a precaution. Animals that are fed antibiotics gain more weight, faster. This works on people too. Feed people antibiotics and they gain weight.

California, in the USA, recently banned such agricultural use of antibiotics and so have some countries in Europe.

It really is as someone said, greed/lust for profits/need to compete with others using antibiotics is the real reason why resistance is showing up.

-PM

30,000 or more dead in the USA per year

[PeterM from Berkeley]

Dead from antibiotics resistant bacterial infections. 3,000 people died in 9/11 in one particular year.

USA spent $2T on subsequent wars.

So it seems that $100T is "justified" in spending to combat antibiotic resistance, right? (Frankly, I'd be happy to see $20B increase.)

And it pretty much has to be Government supported investment, the market case just isn't there for a drug company to develop new antibiotics. How do you make your billions back from a drug which people just take for a little while, while they are sick?

Drug companies just want to develop drugs that make them lots of money, drugs that people will take every day or will take in huge quantities. So if a drug company DOES develop an antibiotic, they'll soon sell it for agricultural use to help animals gain weight--that's the only way they can ever make money.

Free market economics pretty much dictate that antibiotics will be misused if developed at all, that is why we have to have PUBLIC investment in new antibiotics.

-PeterM

The trouble with non-antibiotics

[goombah99]

Replacing antibiotics with proteins and possibly phage is a doomed proposition if done as a simple substitution. The advantage that antibiotics have that proteins can never match is they are low molecular weight chemicals. thus you don't have to give someone a high mass dose, it can be absorbed in the gut or membranes, and it can get into cells. Furthermore proteins are relatively easy to decompose without inventing any custom hardware, they are also easy to recognize specifically (which is also why they can provoke an immune response if not properly humanized). Thus proteins are not substitutes and start out with many many orders of magnitude handicap in molecular weight and accessibility. Therefore to overcome that one needs to exploit protein therapies in different ways. proteins are good at things like catalysis. The intital activity of a chemical is stochiometric in which one chemical binds one receptor. But an enzyme can turn over many many reactions, so one can, if used right, have a manyfold activity. (on the otherhand, this advanage is not clear cut, since the receptors bound by standard chemicals may amplify the signal as well, and many desired targets medical for proteins will be stochiometric binders not catalytic enzymes). A big big advantage of proteins is their potential for specificity which will both diminish their side effects and could concentrate them into a specific target area. Imagine for instance protein therapeutic which only affected a certain pathogen and left the other bacteria in your gut alone. Finally, if the protein is large enough then it can remain in the circulatory system longer before the body removes it. But that also means higher molecular weight which can be bad.

Phage are even higher molecular weight. But they can reproduce. And presumably they might be tailored to only infect the bad bacteria as their host for reproduction. But they also might become antigens and your own body would clear them.

Both of these therapies have killer applications and are not to be dismissed. Their extreme specificty will completely change medicine even more than antibiotics did. But they are not in the near future any sort of replacement for antibiotics.

You underestimate the power of greed

[PeterM from Berkeley]

Sorry to say it, but "most industrialized countries" feed antibiotics to animals routinely.

There are only a FEW industrialized countries which ban this, notably in Europe, notably NOT in North America (though the Republic of California just enacted a ban.)

It's NOT just a third world practice! Routine feeding of antibiotics to animals makes them gain weight faster. Market win! Industrial farmers LOVE using antibiotics.

Your mistake was underestimating the force of greed-induced stupid.

--PM

Affordable Care Act

[golodh]

Lets remember that, unfortunately, the ACA is the very best that could be achieved after about 20 years of US political football games concerning national health insurance.

Remember how it was being villified by certain luminaries as leading to "Death Panels"? And when certain folks tried to kill it for being "unconstitutional"? That's the level of sanity of the political environment it was conceived in.

And even now we get posts from people who somehow don't like it (for whatever reason) but who still shy away yanking collective health insurance from a couple of milion people. Couldn't be their sense of ethics getting in the way. They're not like that. Something to do with political fallout I guess.

For better or worse, the insurance companies are simply the privatised face of national health insurance. And privatised means "for-profit". Which in turn means "maximise revenue and minimise expense". Bad news for anyone taking out or trying to claim on insurance. Fair enough. So what's your alternative? Want to set up an NHS-style system in the US? Perhaps sen. Bernie Sanders will look on that idea with favour, but absolutely no-one else will. Also be prepared to be branded a Communist, Socialist, Atheist, Satanist, Jihadist, Terrorist or simply all-round Un-American. Just a warning.

You might want to think about imposing more regulation on those insurance companies. Such as more financial transparency. Or some sort of nation-wide re-insurance. Well, good luck with either idea.

Sorry but in the mean time the ACA is what we've got. Lets try to smooth out its rough edges while we mull over what to replace it with, shall we?

Re:Yeah, that's the problem

[The Real Dr John]

The US is the only highly developed nation without national universal health coverage as a human right. Here in the US it is much more important for insurance companies to be highly profitable than it is to take care of everyone. And as long as voters keep putting the corporate controlled politicians in office, we will continue to get corporate controlled legislation.