Current Antibiotics Risk Becoming Useless.

[kc8tbe]

How does the EU handle antibiotic resistant bacteria? When we had an outbreak of VRE in WA, Royal Perth Hospital instituted extensive measures to beat it. So once you find it, eradicate it before the species has a chance to further evolve and develop resistance. Its standard protocol in Western Australian hospitals to isolate and eradicate MRSA (even if the patient is hospitalised for a totally unrelated complaint), and infectious diseases are consulted about resistant bacteria. Rules of prescription of antibiotics are employed, so you need the approval from the Infectious disease department to prescribe certain antibiotics (except for certain conditions). Perhaps some of our European members can shed light on this matter.

Eradicating MRSA is kind of pointless because it's a commensal organism that's extremely prevalent. I am a medical student, I work at a hospital, and as part of microbiology lab exercise I once cultered MRSA from my nose and neisseria meningitidis from my throat. I was perfectly healthy at the time, so I'm basically walking around spreading potentially lethal bacteria on everything I breath on or touch. Should we start routinely treating medical students with antibiotics to eradicate MRSA? It seems that would be counterproductive.

Lots of doctors prescribe antibiotics for common viral colds if people ask hard enough and lots of idiot mothers shop around for doctors who will prescribe antibiotics for everything a child gets, at least in the US. This is then compounded by people ceasing to take the pills because they ‘felt better’. Meanwhile I think on average less than two new antibiotics are approved each year for human use and most are just variations on existing compounds rather then something entirely new.

In Cincinnati, where antibiotic resistant tuberculosis is a problem, the city health department will bring you your TB antibiotics every day for a year and watch you take them.

The emergence of vancomycin-resistant Enterococcus (VRE) may also be related to the use of Avoparcin as an animal growth promoter. "There is fairly convincing evidence in Europe that the VRE germ probably developed in animals, pigs and chickens in particular, and this was acquired by the general population through the food chain,"

This. Giving animals antibiotics when they're sick is one thing. Routinely using low, sub-sterilizing doses of antibiotics as a growth promotoer is asking for trouble, especially in species like pigs that share a lot of pathogenic bacteria with humans.

Chilling news indeed. I know a lot of people who sleep around and then "pop a pill" if something happens, this is going to be bad once it starts happening to common STD's. Are there any other treatment alternatives to severe bacterial infections?

This is stupid. Plenty of STDs are already "resistant" to antibiotics -- think herpes, HPV, HIV, hepatitis C, etc.

Antibacterial hand soap does indeed remove "99.9% of all germs".
So does normal, non-antibiotic hand soap. Without actually producing antibiotic-resistant bacteria.
Which is why the majority (or even all, i think) of German hospitals no longer use antibiotic hand soap. It's no more effective than normal soap and doesn't replace the need for a proper disinfectant.

Indeed. Antibiotic soap is pretty pointless outside of a doctor's office -- just use alcohol, iodine, chlorohexidine, or any other antibacterial agent instead. In the states, triclosan is a very common antibacterial/antibiotic agent used in everything from bath soap to tooth paste. However, because triclosan isn't related to anything we give humans systemically (it's too toxic), it wouldn't really be a huge tragedy if bacteria started developing resistance to it.

[mr friendly guy]

Eradicating MRSA is kind of pointless because it's a commensal organism that's extremely prevalent.

Its not eradicated in the community per se, its done in the hospital. The selection pressures of MRSA in the community is going to be less. The prevalence of MRSA varies between hospitals. This study suggests its less prevalent in Western Australia (where I work) than other parts of my country.

I am a medical student, I work at a hospital, and as part of microbiology lab exercise I once cultered MRSA from my nose and neisseria meningitidis from my throat.
I was perfectly healthy at the time, so I'm basically walking around spreading potentially lethal bacteria on everything I breath on or touch. Should we start routinely treating medical students with antibiotics to eradicate MRSA? It seems that would be counterproductive.

If someone had Neisseria meningitis or meningocococcaemia contacts would be tested and carriage eliminated in Western Australia. It is however not screened as such in the general population. Even though lots of people can carry it without harm, its judged worth it to eradicate it in this circumstance.

BTW what makes you think we eradicated MRSA carriage via antibiotics, as oppose to antiseptic body washes?
Here is Control of Methicillin-Resistant Staphylococcus Aureus (MRSA) and Epidemic MRSA (EMRSA) in Hospitals for Western Australia.

The relevant decolonisation protocol is linked to that site, but for your convenience its here. As you can see its done with things like Mupirocin, chlorhexidine etc.

This is stupid. Plenty of STDs are already "resistant" to antibiotics -- think herpes, HPV, HIV, hepatitis C, etc.

None of those examples are actually bacteria, hence antibiotics aren't going to work anyway. So going back to cosmicalstorm's original point about antibiotic resistance STDS, it would be a waste of money using antibiotics, but I doubt they will make these STDs more resistant.

[kc8tbe]

Its not eradicated in the community per se, its done in the hospital. The selection pressures of MRSA in the community is going to be less. The prevalence of MRSA varies between hospitals. This study suggests its less prevalent in Western Australia (where I work) than other parts of my country.

I'll take the study's word for it. Obviously, it make sense to use disinfectants, masks, gowns, gloves, etc. to prevent patients from getting MRSA and isolate patients who already have it. The idea of "eradicating" it from a hospital seems difficult, though, because even if you managed to do it, a doctor or nurse colonized with MRSA from the community could reintroduce it to the hospital the very next day.

This is stupid. Plenty of STDs are already "resistant" to antibiotics -- think herpes, HPV, HIV, hepatitis C, etc.

None of those examples are actually bacteria, hence antibiotics aren't going to work anyway. So going back to cosmicalstorm's original point about antibiotic resistance STDS, it would be a waste of money using antibiotics, but I doubt they will make these STDs more resistant.

My point exactly -- it's very foolish to have unprotected sex and then assume you can use antibiotics if you contract an STD, because even without true antibiotic resistance many common STDs are already "antibiotic resistant" by virtue of being viruses. As for something like gonorrhea becoming resistant, I suppose this wouldn't be an issue provided the infection is resolved before the infected person has unprotected sex again. So, I agree, the risk is low.

[mr friendly guy]

The risk of reinfection really depends on a) how prevalent MRSA is in the community and b) how well we institute infection control protocols to stop health workers becoming carriers (after treating patients who are carriers).

B is pretty self explanatory, isolation, having medical staff gowning up etc. Point A is harder to discern. Staph aureus is obviously a commensal organism, but how much staph is the MRSA variety. Especially if antibiotics are used less frequently in the community. Given that MRSA was reported in hospitals way before in the community I wouldn't be surprise if the prevalence is lower.

I am not going to pour time researching that, but a quick and dirty google search does link to some articles where the prevalence can be as high as 30% in our Indigenous communities (not really shocking considering the state of Indigenous health) but can be as low as 0.9% in some government vets, and much higher in those that work with horses.

[Serafina]

Indeed. Antibiotic soap is pretty pointless outside of a doctor's office -- just use alcohol, iodine, chlorohexidine, or any other antibacterial agent instead. In the states, triclosan is a very common antibacterial/antibiotic agent used in everything from bath soap to tooth paste. However, because triclosan isn't related to anything we give humans systemically (it's too toxic), it wouldn't really be a huge tragedy if bacteria started developing resistance to it.

I'm pretty sure that it is also pointless INSIDE a doctors office (which is why hospitals and such no longer use it): A doctor will have a proper disinfectant around anyway (alcohol based or such) and antibiotic soap wouldn't do anything in addition - except give a false sense of security, and increase the odds of having resistant strains around.

[Alyrium Denryle]

In the early 2000s I read that the figure was about 2 billion USD and rising fast. The 'average' new drug cost about 500 million in R&D at the same time. Antibiotics are expensive to research because you have to test them against such a wide range of conditions and germs and specifically seek out the antibiotic resistant germs to see if your new drug has any advantage. This is unlike most drugs which are targeting one specific thing. Also the scary thing is, between 1962 and 2000 no completely new type of antibiotic was discovered at all. That wasn't for lack of trying, its just very hard to do.

That, my dear friend, is why scientists have started cheating. Bioprospecting has become a big deal, and much much cheaper than creating new drugs ex nihlo. Normally what you have to do is identify an active site on a microbe or microbe group you want to attack, use computer modeling (or an overworked organic chemist) to create a shitload of candidate drugs that can bind to and disrupt that active site in some way (be it cell lysing, disruption of cell division etc). Then you make them all, and test them all on bacterial/viral/fungal cultures. If one works (and you will be lucky if one does) you test against human tissue cultures. It can take thousands of different attempts to come up with something that is toxic to the microbe but that wont just kill our cells. Then you send them to pre-clinical animal model trials etc. At the end of the day, you start with 10k or more candidate compounds and maybe, just maybe, it will work inside us.

Now you take a frog. These little guys live in areas teaming with bacteria and have thin, permeable and easily damaged skin. We can be pretty sure they have stuff on that skin that can kill things. And that does not include the neurotoxic secretions that can have OTHER medical benefits (for example, some of the toxins in poison dart frogs are more effective painkillers than opiates and are not addictive. They are going through clinical trials). You swab its skin (or put them in a mild skin irritant that makes them exude more of their skin mucous), fractionate down the various organic compounds, ID them, and test the tiny samples you purify against microbial cultures. You also need to test for cytotoxicity in human tissue, but your Positive Results Per Unit Effort... Much higher. As is the result per unit funding. Huge portions of the money for drug development comes in this early stage because normally, you have to guzzle fucktons of money on those >10k initial compounds for one drug. Skip that stage, and give yourself a few dozen effective candidates right from the starting gate.

They also have a much better chance of not being toxic in vivo because they are already being made by an organism with a similar physiology and immune system to us. Oh look. New drug classes. And, getting your starting compounds is easy. Go outside, down the street to a pond, and wait for it to rain. Then grab a net from the back of your car and go to town.

[kc8tbe]

Now we just need to house a large population of such antibiotic-producing frogs, and we need to constantly swap them with exudate from patients who have been treated with the frog antibiotics. The ones that live will produce the next generation of frog antibiotics that can kill the first generation of frog antibiotic-resistant bacteria

[Broomstick]

Health chief warns: age of safe medicine is ending
Antibiotic crisis will make routine operations impossible and a scratched knee could be fatal

The world is entering an era where injuries as common as a child's scratched knee could kill, where patients entering hospital gamble with their lives and where routine operations such as a hip replacement become too dangerous to carry out, the head of the World Health Organisation (WHO) has warned.

This sort of doom-crying really annoys me. YES, antibiotic resistance is a serious, even life-threatening issue but medicine existed prior to antibiotics, it will continue in a hypothetical post-antibiotic future (and it's not going to be completely without antibiotics in any case). My father, who is still alive, started his pharmacy/chemist career when penicillin was a new and experimental drug, it wasn't that long ago.

Worst case we go back to older methods - sterilization with non-antibiotic substances (bleach, heat, UV, other chemicals already mentioned). Scratched knees will still be mostly too benign to see a doctor about, although how infections are managed likely would change. For that matter, scratched knees are potentially fatal now, and in some circumstances even today doctors use excision of infected tissue and other non "chemotherapy" techniques to treat serious and complicated infections (I have a 4 cm scar along my jaw line from such an excision that occurred alongside antibiotic treatment).

How can people take antibiotics for trivial stuff without a doctor's prescription?

In the US, the usual way this happens is that someone gets a script for a legitimate reason but doesn't finish it, saving the "extra" pills for "just in case". Then, later, either that person takes those pills for another, no-doctor-involved situation, or passes them on to someone else. The possibility of said pills being either improperly stored and/or expired just adds to the excitement.

MRSA (sorry "mercer" for the Americans ) is a skin infection,

Actually, over here it's pronounced more as "mersuh", except for certain areas on the East Coast. No terminal "r" sound.

We don't just get the super germs from antibiotics, we also get them from the massive use of disinfectants on everything

Resistence from cleaning solutions? Seriously? So people in the First World clean and sterilize rooms using antibiotics? What the bloody fuck of a method is that.

Because outside, you know, people sterilize rooms with UV sterilizators and, uh... clean spirit. Maybe supertoxic acid solutions, too. That's about it.

Same here, actually - I suspect Sea Skimmer hasn't done his research. Bleach is so much cheaper it's the usual go-to for large area disinfection, not antibiotics. I suspect he's confusing many cleaning solutions with some heavily-marketed-to-idiots-in-suburbia handsoaps and the like.

I know my relations buy antibacterial hand soap.

^ and some of those do use antibiotics and are part of the problem.

A large number of cleaners advertise as killing 99.9% of germs on surfaces...

That does not, however, require antibiotics. Alcohols and bleaches can do that, and they are not antibiotics nor do they promote antibiotic resistance.

The waterless hand cleaner I buy for work, for example, is alcohol based (which has the nice effect of removing some of the oils and colored polishes I also use). The cleaning wipes we use work with bleach. They are both useful for keeping the place clean, reducing transmission between us and our customers, and have the benefit of also killing many types of fungus which aren't touched by antibiotics anyhow. None of them, however, promote antibiotic resistance. Basically, you can disinfect without adding to the problem. I wish more people would do this in an intelligent manner.

[FireNexus]

It's worth pointing out that those hand soaps and whatnot contain triclosan, a biocide that is unrelated to clinically-used antibiotics. A quick google perusal found at least one abstract that wasn't able to find a link between antibiotic resistance and triclosan resistance.

link

[Alyrium Denryle]

Now we just need to house a large population of such antibiotic-producing frogs, and we need to constantly swap them with exudate from patients who have been treated with the frog antibiotics. The ones that live will produce the next generation of frog antibiotics that can kill the first generation of frog antibiotic-resistant bacteria

Do not make me beat you. Natural selection has already done exactly this over the last 300ish million years.

[kc8tbe]

Twice now it seems I need to use [sarcasm][/sarcasm] in this thread.