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Will medical science one day be screwed?

Jacob_Wallace

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In my medical microbiology class, I learned that bacteria are becoming more and more resistant to antibiotics to the point where many antibiotics are basically trash now.

Are we backing ourselves into a corner where one day, nothing will work and we won't be able to effectively eliminate any bacterial infection?
 

Osulagh

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Ah... no.

I'm no expert, but I've been told it's like a war--each side grows stronger and strong as they fight. Yes, many antibiotics have become obsolete, but it doesn't mean new ones aren't. If new a bacteria pops with resistance to our current antiboitics, then we just make a new one to combat it. And if antibiotics don't work, we have many other means to combat bateria--like nanomedicine, such as IBM's Ninja polymers:http://www.research.ibm.com/articles/nanomedicine.shtml#fbid=LRz_1xIeDTa

And, I think I should remind you that antibiotics are helpers in the war to fight infection; our own bodies fight all infections equally. As the bacteria evolve, we too can.
 

veinglory

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It's possible. We need to find a whole new class of anti-microbials because we are hitting the limits of just making the variants of the ones we have. It is not a forgone conclusion that these substances exist, or that we will discover them. And if it is a direct contest of evolution, bacteria will ultimately win as they can adapt far quicker than a complex mammal and we provide the perfect training ground in modern society with high international travel and many low level source of anti-microbials. There are companies working on this problem and the smaller ones might be out best bet--and they need investors.
 
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cornflake

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In my medical microbiology class, I learned that bacteria are becoming more and more resistant to antibiotics to the point where many antibiotics are basically trash now.

Are we backing ourselves into a corner where one day, nothing will work and we won't be able to effectively eliminate any bacterial infection?

It's not any, but we've been headed this way for quite a while, and the slide shows no signs of abating, as far as I know. It's also not medical science, it's us, when we find ourselves back in basically the pre-antibiotic world.

We're not developing many new antibiotics (the last new ones are also nasty as heck), as they're not big money, and keep getting outrun, we keep using antibacterial crap and giving out first-line antibiotics for random crap, giving antibiotics to livestock as a matter of course, and bacteria keep on trucking.
 

waylander

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Not too many people are researching new antibacterials. Of the major pharma companies, I believe only GSK are doing any. The reason - there's no money in it. If you come up with a new class of antibacterials, they're going to be used only for the most difficult cases thus you're not going to sell much of it. Still costs a sh#tload of money to develop though.
 

blacbird

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Oh, but wait. Evolution is "only a theory." Which is a basic tenet of the dominant element in one of the two major political parties in the U.S. Add to that a fervent desire to limit Federal spending on everything but military defense, and where do you think research on this problem is going to go?

I'd guess into the equivalent of three small rooms in my house, used for specialized purposes.

caw
 

buirechain

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In addition to the limited research into antibiotics, we are finding some new ways to fight bacteria. Among these are bacteriophages (or just phages) which are viruses that target bacteria. They're a little harder to use because they have to be targeted to a specific kind of bacteria (which mean doctors need to know what type of bacteria a patient has), but the fact that antibiotics can attack a broad spectrum of bacteria has actually made it easier for bacteria to gain resistance to antibiotics.

The biggest problem hasn't been that evolution helps bacteria defeat antibiotics, it's that we've done a poor job keeping up our part of the fight. After discovering penicillin, Alexander Fleming told people that we'd have a problem with resistance if we weren't careful. But instead of listening, antibiotics have been over prescribed--often to patients who aren't sick because of bacteria (they do not work on viruses), or simply to farm animals to promote growth (which hasn't even been show to work).

Even where they're medically helpful, we could be doing more to at least slow the development of resistance. First, if we prescribed multiple antibiotics at the same time, it could wipe out more of the bacteria in the body, instead of leaving behind a handful, not enough to leave us sick, but enough to allow resistance to evolve. Second, one of the biggest problems (and this is harder to solve) is that patients don't always take their antibiotics as long as they're supposed to. They stop when they're feeling better, but before they've killed the bacteria they're targeting.

So if we're careful, the new antibiotics could have longer lives than the old ones (and penicillin is still occasionally useful). But, here's where it gets really cool, it's been shown (at least in the lab) that bacteria that have been treated with phages are then more susceptible to antibiotics, even if the bacteria have grown resistant to those antibiotics. In short, what we need to do is be really smart about how we use our drugs.

Another reason the future might not be all that bleak is that resistance can be lost. Carrying around and using the genes for resistance comes at a fitness cost for bacteria--one that is well rewarded if they encounter the antibiotic they're resistant to. But it's possible--again if we're very careful--that bacteria could lose resistance if an antibiotic isn't used for a while (a long while). We've seen something similar with drug resistant strains of malaria (malaria is a single celled parasite, but not a form of bacteria) where resistance has been reigned in because the anti-malarial hasn't been used. (That's more complicated than I can quickly describe, and the process will be harder for antibiotic resistance)

TLDR: Things don't look as bleak as they did even ten years ago, but we need to be very smart about how we use these drugs.
 

robjvargas

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Oh, but wait. Evolution is "only a theory." Which is a basic tenet of the dominant element in one of the two major political parties in the U.S.

Isn't it interesting how politics, especially false politics, gets injected into a scientific question?

Microbes are evolving all the time. In effect, we do it to them. We use these cleaners that eliminate "99.9%" of germs. Which means, of course, that the 0.1% remaining, is resistant to that germ-killing agent. Are we then surprised when it no longer works?

I get a chuckle that, in one aisle of the store where I buy groceries, there are items designed to kill microorganisms, while a few aisles over, we have probiotic items designed to re-introduce them into our lives.

I know, I know. It's a question of which microorganism. Still looks funny to me.
 

areteus

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A company I used to work for was (more than 10 years ago) investigating alternatives to antibiotics using different enzyme pathways as targets which do not appear in human cells (therefore in theory no or very few side effects) but I have no idea how far that research went or if they a) made a viable product and b) sold it to a big pharma to market and develop...

It is a war and one which has to be continually fought. A pre antibiotic age however should still be easier to survive for mankind because we still understand more about pathogens and how they work than we did then. And bear in mind the big issues we face are viruses (HIV, ebola etc) which have nothing to do with antibiotics.
 

buirechain

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It is a war and one which has to be continually fought. A pre antibiotic age however should still be easier to survive for mankind because we still understand more about pathogens and how they work than we did then. And bear in mind the big issues we face are viruses (HIV, ebola etc) which have nothing to do with antibiotics.

The reason why viruses present the big issues is mostly down to the fact that we don't have anything like antibiotics for them. Even so, there are a number of serious bacterial threats--though more so for the developing world. Tuberculosis, a bacterial disease, kills over a million people a year, not that much less than HIV aids (though there is some overlap). There's little question that if we somehow completely lost the use of antibiotics, bacterial diseases would easily rival the danger of viral ones.

I wouldn't call Ebola a big issue, though; it's deadly if you catch it, but it doesn't spread well; despite this being Ebola's biggest outbreak it still quite small; compare the current known cases of 2127 to last years pertussis numbers just for the US: 24 thousand. And pertussis is a disease that has both a vaccine (even if it's under used) and an effective treatment (antibiotics). A better healthcare system and more trust in that system can (and has in the past) effectively stopped Ebola in its tracks. (There's a reason the west suffers significantly less from infectious diseases, and it only has so much to do with access to vaccines and good treatments. The hospitals are better designed to slow the spread. As areteus said, we understand pathogens much better today, unfortunately developing countries don't always have the resources to put that knowledge into practice.)

HIV certainly is a big concern. It's interesting though because it has a similarly problem to the antibiotic resistance ones. There are a number of anti-retrovirals; HIV can quickly build resistance, which is why the standard treatment today combines multiple anti-retrovirals into one pills, to significantly slow how quickly HIV builds resistance.
 

areteus

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Oh yes, the main issue with viruses is that antivirals are no where near as good as antibacterials in treating the disease... The recent discovery about Tamiflu being a prime example of this. Flu is actually a fairly major killer by itself (Spanish flu killed more in 1918 worldwide than the first world war according to some stats I read recently when researching for the course I teach on this), though mainly in the elderly and immune compromised.

The trick for antibiotics is to keep trying different methods and hope they don't adapt too quickly.
 

AVS

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I have nothing to offer here. But I am just awed at the depth of knowledge and expertise available on AW. Very impressive. Just wanted to give a hat tip to the right expert at the right time.
 

Roxxsmom

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A major issue here is the slow rate at which new antibiotics are being developed. This is partially because the development of a new antibiotic takes a lot of research and development, and when a new drug hits the market, it must be held in careful reserve and only used when it's really needed. This limits its profitability during the years when the drug company that developed it holds its patent.

And of course, antibiotics are usually only taken for relatively short periods of time. So even if the drug company can charge a lot for them, the patients are usually "cured" after ten days or so. A drug that treats a disease like diabetes or high blood pressure is much more profitable in both the short and long term.

So pharmaceuticals would rather spend their R&D dollars on drugs that will treat relatively common chronic diseases. This is also why some diseases that are less common, like ALS, don't have much in the way of useful treatments.

Another possible issue is a need for "lateral thinking," that is, an entirely different approach to treating microbial disease. This would likely be something that builds on grounds up basic research into the evolution and biology of microbes in general, research that is more theoretical. There's less interest in funding basic this is how life works research these days. It's regarded as a waste of the taxpayers dollars to give scientists generous grants to do theoretical research that may or may not be "useful" years or decades from now.

This is the problem with relying on the private sector do do everything, in my opinion.

It's definitely true that our knowledge of sanitation and so in is going to be beneficial in the future. If one good thing has come from antibiotic resistance, it's been that hospitals and health care providers are paying more attention to things like meticulous hand washing, cleanliness, and aseptic technique. Antibiotics or no, it's better to prevent an infection than to treat one.
 
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