Medicine: Back to the Middle Ages

April 1, 2011 11:59 AM

Welcome to a world where the drugs don't work - it's here, today. 'A new wave of "super superbugs" with a mutation called NDM 1, which first emerged in India, has now turned up all over the world, from Britain to New Zealand.''After Alexander Fleming's 1928 discovery of the first antibiotic, penicillin, we quickly came to assume we had the chemicals to beat bacteria. Sure, bugs evolve to develop resistance. But for decades scientists have managed to develop new medicines to stay at least one step ahead of an ever-mutating enemy. Now, though, we may be running out of road.'

'What makes the NDM 1 enzyme so dangerous is not only its ability to outflank carbapenems, the most powerful class of antibiotic drugs, but also the company it keeps -- in tough bacteria already resistant to many other antibiotics. Despite being identified only three years ago, it has already been detected in a wide variety of bugs, including many familiar pathogens such as Escherichia coli, or E. coli. In contrast to so-called Gram-positive bacteria, like MRSA, these microscopic enemies are Gram-negative, meaning they have tougher outer membranes which block out many antibiotics, and an unnerving ability to pump out others, making them much harder to take on and beat.'

'Even more alarmingly, NDM 1 is no lone threat -- it comes as part of a family. Similar enzymes in the same class, known as carbapenemases, have been detected worldwide. Just this month, the Eurosurveillance journal of the European Center for Diseases Prevention and Control reported that four separate cases of a related strain had been found in Switzerland between May 2009 and November 2010. Three had come from Italy, one from Greece.

That suggests that NDM 1 and its kin are not, in fact, the ultimate "super superbugs" but rather just the tip of the iceberg. The WHO's Mario Raviglione, who is fronting its antimicrobial campaign, is particularly worried about "superbug" forms of tuberculosis -- a disease that earned the nickname of "white plague" during Victorian times in Britain because sufferers' skin tone turned so pale.'

'Perhaps most worryingly, the world's top drug companies, faced with decreasing returns and ever more expensive and difficult science, have not only slowed their efforts to develop new antibiotics but have been quitting the field in droves.

Today, only two large companies - GlaxoSmithKline Plc and AstraZeneca Plc -- still have strong and active antibiotic research and development programmes, according to the Infectious Diseases Society of America. Back in 1990, there were nearly 20.'

posted by VikingSword (77 comments total)

It's a shame there isn't another approach such as, I dunno, using the bacteria's own viral diseases against them.
posted by localroger at 12:05 PM on April 1, 2011 [4 favorites]

I have an idea, let's dump antibiotics into livestock feed to produce cheaper meat.
posted by grobstein at 12:07 PM on April 1, 2011 [80 favorites]

Aren't those two mega pharma giants listed in the end of that quote so mega and giant because they ate/absorbed a lot of the little guys (who would otherwise still be researching and developing)?

Yeah, and what grobstein said.
posted by Glinn at 12:08 PM on April 1, 2011 [2 favorites]

Oh come on, it's not like anyone could have predicted this 40 years ago. And by the way, this is just another bunch of scientists trying to generate grant money for their pet theory!
posted by sneebler at 12:08 PM on April 1, 2011 [5 favorites]

As far as I can tell, the beta-lactamase enzymes carried by these "superbugs" have no purpose other than deactivating antibioitics. So the bacteria face an evolutionary disadvantage to making enzymes like NDM 1 enzyme in the absence of selective pressure (i.e., the corresponding antibiotics). In other words, without the antibiotics around, these superbugs will become less common.

I have an idea, let's dump antibiotics into livestock feed to produce cheaper meat.

Honest question: is that still legal?
posted by exogenous at 12:08 PM on April 1, 2011 [2 favorites]

Interesting that I was just talking with my mother and she thinks the world needs a good plague right about now since "there are too many people to support". Looks like she's going to get her wish. Too bad for her that she'll probably be one of the people to get sick and die.
posted by Old'n'Busted at 12:09 PM on April 1, 2011

We show no respect for these valuable drugs. That lack of respect is making them worthless over time. I saw an article the other day advocating prophylactic administration of Vancomycin for a particular surgical procedure. I thought it was supposed to be one of those drugs of last resort? Too bad I have lost the citation.
posted by caddis at 12:10 PM on April 1, 2011 [2 favorites]

What? Vancomycin is nasty as hell, worse than many infections.
posted by Blasdelb at 12:13 PM on April 1, 2011

I have an idea, let's dump antibiotics into livestock feed to produce cheaper meat.

Honest question: is that still legal?

Yes! In the US, anyway.
posted by grobstein at 12:14 PM on April 1, 2011 [2 favorites]

Middle Ages? No, no... a tough road for a while, maybe, at worst. Let's not let the fun of doom and gloom ruin our faith in science and human ingenuity.

Here, let's temper this with some good news, too. Watch it; you'll like it.
posted by gilrain at 12:14 PM on April 1, 2011 [1 favorite]

Honest question: is that still legal?

Yep.
posted by Glinn at 12:15 PM on April 1, 2011

I was struck by the offhand reference to how the one superbug they've identified came from India and how antibiotic overuse was common there. I've always been told that I shouldn't ask for antibiotics until and unless my cold develops into a sinus infection or bronchitis (which it has a history of doing) with the implication that my medicine-greedy self is responsible for the development of superbugs. I hadn't much considered the idea that markets like India and China, where all the people are, would make a bigger difference than the US.

Them and all the antibiotics in cattle feed, of course.
posted by immlass at 12:16 PM on April 1, 2011

Interesting that I was just talking with my mother and she thinks the world needs a good plague right about now since "there are too many people to support". Looks like she's going to get her wish. Too bad for her that she'll probably be one of the people to get sick and die.

I, too, would like to die and take 60 to 80 percent of the global population with me.
posted by Faint of Butt at 12:16 PM on April 1, 2011

I hate April Fool's Day.
posted by Phlogiston at 12:19 PM on April 1, 2011 [3 favorites]

Phlogiston: It might help resolve some of the ambiguity of the occasion to note the article in the FPP is datelined as follows:

Posted 2011/03/31 at 7:29 am EDT

So I think April Fools shenanigans can be ruled out in this case, unfortunately.
posted by saulgoodman at 12:23 PM on April 1, 2011

As far as I can tell, the beta-lactamase enzymes carried by these "superbugs" have no purpose other than deactivating antibioitics. So the bacteria face an evolutionary disadvantage to making enzymes like NDM 1 enzyme in the absence of selective pressure (i.e., the corresponding antibiotics). In other words, without the antibiotics around, these superbugs will become less common.

This is exactly correct. In the absence of antibiotics, genes that produce resistance are not conserved, and in fact they actually waste a bacteria's resources.

The idea people have of anti-biotic resistance bacteria gradually evolving and then wiping out the human race are not very likely.
posted by delmoi at 12:23 PM on April 1, 2011

Don't worry: Drugs still work. At the least, Xanax does.
posted by evidenceofabsence at 12:23 PM on April 1, 2011 [11 favorites]

I hate April Fool's Day.

I posted this April 1st, but the story is from 03/31, FYI. Just in case of misunderstanding.
posted by VikingSword at 12:27 PM on April 1, 2011

...but also the company it keeps -- in tough bacteria...

When I read this, I couldn'tt help but see a Gary Larson cartoon.
posted by mmrtnt at 12:28 PM on April 1, 2011 [6 favorites]

On preview, saulgoodman got there first.
posted by VikingSword at 12:28 PM on April 1, 2011

Perhaps most worryingly, the world's top drug companies, faced with decreasing returns and ever more expensive and difficult science, have not only slowed their efforts to develop new antibiotics but have been quitting the field in droves.

Fortunately we have something in place to research, manufacture and distribute antibiotics that can handle being a social good rather than wildly profitable...right?

...right?
posted by mittens at 12:31 PM on April 1, 2011 [9 favorites]

'Perhaps most worryingly, the world's top drug companies, faced with decreasing returns and ever more expensive and difficult science, have not only slowed their efforts to develop new antibiotics but have been quitting the field in droves.

And here is why publicly funded science is so important.
posted by knapah at 12:32 PM on April 1, 2011 [32 favorites]

Routine use of vancomycin and ceftazidime combined with pulsatile lavage can significantly reduce the rate of postoperative infection in patients with adolescent idiopathic scoliosis who undergo spinal fusion surgery, according to results presented here.

posted by caddis at 12:38 PM on April 1, 2011

Its important to keep in mind that superbug is a bit of a misnomer, just because a bug is resistant to antibiotics does not necessarily mean it is more virulent or nasty. Yet anyway...

Antibiotics over the last 60 years have served two primary purposes. The first and most obvious being to cure people who are currently sick. However the second is in a lot of ways almost as important, they are a tool for eradicating strains that sacrifice longevity in the host in exchange for virulence. Essentially, we've been directing the evolution of the microbial community around us by eliminating everything that hurts us for so long that its gotten less hurtful. As we lose this tool, not only will be unable to treat people who are sick, but the strains we can't treat will evolve to fill the nitch they did before antibiotics, they'll spread faster, cause more damage and kill more; just like they did before the 30s.
posted by Blasdelb at 12:41 PM on April 1, 2011 [1 favorite]

Perhaps most worryingly, the world's top drug companies, faced with decreasing returns and ever more expensive and difficult science, have not only slowed their efforts to develop new antibiotics but have been quitting the field in droves.

Fortunately we have something in place to research, manufacture and distribute antibiotics that can handle being a social good rather than wildly profitable...right?

...right?

Yes. The quote from the article is mostly fear-mongering. What they're not saying is that the reason so few large pharmas do this kind of research is that their cost structure doesn't allow it. In stead, the market has created a system where smaller startups do this kind of research so that the financial risks are isolated, and large pharmas buy them when (and if) they produce promising results.
posted by atbash at 12:44 PM on April 1, 2011 [1 favorite]

This is a pet peeve of mine, the devaluing of a true miracle - antibiotics. But, is it any different than what we have done to our economy, our environment?

They aren't just cutting antibiotic research, they are cutting all research (while they expand advertising of course). However, I think there are limited number of molecules that could be used for antibiotics and they have largely exhausted current methods of finding more. We will need to be smarter. Not sure who is going to be funding that research though.

snark aside: On the bright side there are other treatments coming along. Most likely they won't be as cheap or broadly applicable as antibiotics, they may however have other benefits. For example passive antibody therapy (which I work on), it had a fascinating history in tetanus treatment and is having a rebirth, minus the horses . . . .
posted by oshburghor at 12:46 PM on April 1, 2011 [1 favorite]

Some studies show that organic farming reduces the prevalence of antibiotic resistance bacteria.
posted by exogenous at 12:47 PM on April 1, 2011 [4 favorites]

A couple of points:

>...one superbug they've identified came from India and how antibiotic overuse was common there.

In India and SE Asia, and in many other countries, access to antibiotics are not as restricted as they are in the US and Europe. Many antibiotics you would need a prescription for here (i.e. pretty much all of them) are available OTC other countries. That's what leads to the overuse, when people simple grab a bunch of antibiotics when they sick, regardless if it is viral, bacterial, fungal, or allergies. Imagine if every over-protective parent in the US could buy erythomycin from CVS.

>...using the bacteria's own viral diseases against them.

Phage therapy is awesome, for certain things. The problem is that you have to know precisely which phage to use against which bacteria, since phages are highly specific about their diet; if you have multiple infections it can be even trickier. The advantage of antibiotics is that they are basically all broad-spectrum (some more than others), in that they kill whole classes of bacteria rather than a specific genus. If penicillin was the magic bullet, phages are like the sniper who only takes out white males, aged 35-40, wearing red hats.

>I saw an article the other day advocating prophylactic administration of Vancomycin for a particular surgical procedure. I thought it was supposed to be one of those drugs of last resort?

Well is was a drug of last resort, unless you have VRSA or VRE. Then you're pretty much screwed.
posted by Panjandrum at 12:49 PM on April 1, 2011 [2 favorites]

Ultimately, we may simply have to accept that antibiotics should no longer be cheap. Rather, they would become premium-priced products along the lines of targeted cancer therapies, which can cost tens of thousands of dollars a year for each patient. It would be a radical change, and price out many in the developing world, but a high price would, at least, have the advantage of deterring over-use and helping to fund research, particularly in more narrowly targeted drugs.

Did anybody notice this sweet little conclusion? Tough luck poor brown people, I guess. And of course anyone without health insurance. I wonder just how much of a sociopath you have to be to write that paragraph.

Capitalism, it does not work very well.
posted by Frowner at 12:53 PM on April 1, 2011 [18 favorites]

We're not all going to die yet.

Extremely lethal infectious agents tend to be a little self-limiting. If the host dies quickly, the likelihood of propagating the infectious agent is reduced. What's true, though, is that chronic infections are staging a comeback.

At the same time, things are not going to go back to the way they were before the 1940s. The simple reason for this is we now have a wide public understanding of what germs are, and the importance of washing them off our hands and other objects. Plus, some parts of the world have pretty clean water.
posted by zennie at 12:59 PM on April 1, 2011

Imagine if every over-protective parent in the US could buy erythomycin from CVS.

Am I wrong in thinking that, at least among the privileged classes in the US, it's actually pretty close to that, with the very slight hitch of having to call and whine at the pediatrician's PA for a few minutes first?
posted by FelliniBlank at 1:05 PM on April 1, 2011 [3 favorites]

This Metafilter post's timeliness is sad. My aunt, and one of my mother's dearest friends, is currently in an induced coma due to systemic infection from the aerobic gram-negative bacterium Acinetobacter baumannii, which I'd never heard about until very recently.

Hearing my mother's softly exclaim, "Holy shit..." over and over—while she read aloud to me about it—was heartbreaking. In total, my aunt's hospital and recovery stay since the surgery is over three months' time, and now she has pneumonia, an open wound that refused and still refuses to heal since the date of surgery, heart failure, diabetes (since getting the surgery), and kidney failure—with talk of dialysis. In other words, sepsis.

What class of drugs previously made surgeries fairly nonlethal now seems to suffer from decades of its own overuse. This is old news. Yesterday, I spent a lot of time feeling some distrust toward the doctors in charge of my aunt's care, and also fearing the worst, as she was given two to three days to live. I wish there were better healthcare for older people, and that surgeries are not recommended for people who are not in the physical condition to recover. That suggestions for getting stronger are made first, before elective surgeries are acted upon, and profited from. But, the last time I saw my aunt, doctors had discharged her from a hospital stay for dehydration and malnutrition—due to poor care at a nursing home recovery facility to which she'd been discharged—with a machine pumping fluid out of her wounds site, a wound site that had not healed in over three months. I really don't know what to think or feel.

Snark, posturing, witty quips, all unnecessary and I have none to craft.
posted by simulacra at 1:12 PM on April 1, 2011 [4 favorites]

PEOPLE NEED TO WASH THEIR DAMN HANDS
posted by infinitywaltz at 1:13 PM on April 1, 2011 [4 favorites]

Capitalism, it does not work very well.

Indeed. The clear answer to antibiotic resistance is found in Norway. But it's not practical to implement in the ridiculous US healthcare system.

Antibiotic resistance is a tragedy of the commons: the (illusory) benefits of each unnecessary use of antibiotics inure only to the individual, but the costs are borne by everyone. By contrast, the benefits of the necessary use of antibiotics are shared by everyone because public health is a public good, yet in the US the costs are borne primarily by the individual. This is completely backwards.
posted by jedicus at 1:13 PM on April 1, 2011 [23 favorites]

"Hearing my mother's softly exclaim" to "Hearing my mother softly exclaim".
posted by simulacra at 1:13 PM on April 1, 2011

Yes. The quote from the article is mostly fear-mongering. What they're not saying is that the reason so few large pharmas do this kind of research is that their cost structure doesn't allow it. In stead, the market has created a system where smaller startups do this kind of research so that the financial risks are isolated, and large pharmas buy them when (and if) they produce promising results.

It's fear-mongering to a point perhaps, but the reality is that there really aren't a lot of startups doing antibiotic research either. The problem is that antibiotics are entirely too effective for drug companies; they cure the diseases they set out to treat. The ideal situation for a drug company is a product that manages the patient's symptoms without eliminating the underlying cause, because then everyone gets to take the drug for life. In contrast, you take antibiotics for a week or two, and if all goes well, you're cured. Furthermore, there's a lot less wiggle room in demonstrating the effectiveness of an antibiotic compared to drugs like antidepressants or arthritis drugs: you can pour the thing on a dish of bacteria and see what happens. That increases the risk the drug won't be approved, which means it's less likely to be researched.

It's not that the pharmaceutical companies are outright evil, but it's simply not in their interest to spend millions to develop a product that patients only use for a short time any more than it's in a dairy farmer's interest to encourage his customers to keep their own cows in their backyards when he can keep selling them milk every week. They can get a better return on investment for that R&D money by working on a new erectile dysfunction pill or ADHD meds or multi-thousand dollar cancer treatments instead of antibiotics.
posted by zachlipton at 1:18 PM on April 1, 2011 [3 favorites]

What part does hand sanitizer play in all of this? I've heard widespread use of hand-sanitizer contributes to these 'superbug' but is that true? At my school there are dispensers all over the place and I swear some people keep their hands more sanitized than the surface of the moon.
posted by fuq at 1:27 PM on April 1, 2011

The problem is that antibiotics are entirely too effective for drug companies; they cure the diseases they set out to treat.

That's edging towards tin-foil hat territory. You are right that there is more money to be made in drugs for chronic diseases, but the real problem in developing new antibiotics is that we've pretty much run out of easy to identify candidates; we've long ago hit "Peak Antibiotics," so to speak.

There are (no matter how you slice them) less than a dozen different classes of antibiotics, with varying levels of effectiveness and usefulness. Just about all of those classes were discovered not years, but decades ago. While they worked, there was no incentive to undertake the laborious task of searching through myriad soil bacteria trying to find the one that excretes a certain antimicrobial compound that a drug company can then synthesize. It has only been in the past decade that anyone has started doing serious research into finding new classes for use.

Yes, drug companies are intrinsically greedy (profit-oriented is the term I'm sure they'd prefer), so they ignored making new drugs when the market was already saturated with effective alternatives. Now that those alternatives need alternative though, the profit margin isn't so marginal. The drug companies now know that whoever puts out the next penicillin is going to make a goddamn mint. Sadly, as the article notes, most companies have let their R&D wings deteriorate, so a lot of companies are waiting for someone else to make the Next Big Thing, so they can make the Next Big Knock-Off.
posted by Panjandrum at 1:33 PM on April 1, 2011 [3 favorites]

What part does hand sanitizer play in all of this? I've heard widespread use of hand-sanitizer contributes to these 'superbug' but is that true?

Alcohol is a good thing that kills a lot of bacteria, and there's no indication that I've heard of that bacteria are becoming resistant to being killed by alcohol. The problem is that you can't administer alcohol internally in anywhere near enough concentration to kill the bacteria without killing the person just as dead.

As far as antibiotic soaps with Triclosan, I don't know if there is anything with resistance. But in the same case, you can't just take triclosan either for your bronchitis.
posted by chimaera at 1:40 PM on April 1, 2011 [1 favorite]

Antibiotic use in humans is a big red herring for the evolution of resistance. Routine use of antibiotics in animal feed needs to be outlawed. You couldn't devise a better way to breed resistant bacteria if you tried. Losing all of our antibiotics is not worth $2.99 chicken breasts.

Just about all of those classes were discovered not years, but decades ago.

And we've been feeding drug members of all these classes to farm animals continuously (not just a one or two week regimen) for years. Although the human version of an antibiotic may not be available for farm use, a close relative is usually available that works through the same mechanism. When resistance inevitably arises, the same genes usually inactivate all the related antibiotics in the same chemical class.

If you care at all about antibiotic resistance, or have lost a loved one to a bacterial infection, please call your member of congress and ask them to support the Preservation of Antibiotics for Medical Treatment Act.
posted by benzenedream at 1:42 PM on April 1, 2011 [16 favorites]

No need to worry about the "antibiotics in animal feed" thing, guys; evolution isn't real anyways.
posted by nhamann at 1:51 PM on April 1, 2011 [1 favorite]

Imagine if every over-protective parent in the US could buy erythomycin from CVS.

It's a lot easier than you migh think.

You learn a lot of tricks when you are poor and without health insurance.
posted by roquetuen at 1:55 PM on April 1, 2011 [20 favorites]

The Antibiotic Paradox

the takeaways from that article:
-the easy drugs were discovered a generation ago; now that the low hanging fruit has been plucked newer discoveries come with more difficulty
-Pharma has redirected much of its resources into potentially more profitable chronic disease states.
- government research might be one answer
posted by caddis at 1:59 PM on April 1, 2011 [1 favorite]

Yes, drug companies are intrinsically greedy (profit-oriented is the term I'm sure they'd prefer), so they ignored making new drugs when the market was already saturated with effective alternatives. Now that those alternatives need alternative though, the profit margin isn't so marginal. The drug companies now know that whoever puts out the next penicillin is going to make a goddamn mint. Sadly, as the article notes, most companies have let their R&D wings deteriorate, so a lot of companies are waiting for someone else to make the Next Big Thing, so they can make the Next Big Knock-Off.

R&D is an extremely volatile part of big pharma. Huge risk and huge reward. Manufacturing is far more stable. So it's pretty obvious that antibiotic research is best done by the Centers for Disease Control, with formulae thrown into the public domain. Big pharma will be more than happy to produce new drugs at small margins if they don't have to pay for the R&D. And if the CDC gets approved to do it, the pharmaceutical companies will probably be more than happy to supply the names of the qualified personnel they laid off over the years.
posted by ocschwar at 2:41 PM on April 1, 2011 [1 favorite]

Watch it; you'll like it.
It is really good news!
posted by francesca too at 3:07 PM on April 1, 2011

Am I wrong in thinking that, at least among the privileged classes in the US, it's actually pretty close to that, with the very slight hitch of having to call and whine at the pediatrician's PA for a few minutes first?

Not at my clinic, not even with the super-privileged insurance that we used to have and my kids still have. (Forget a cadillac plan, that shit's a damn helicopter.) They will flat refuse to prescribe antibiotics, particularly for children, without good weighty evidence.

I'm currently recovering from pneumonia, basically the sickest I've ever been in my whole life. I didn't have to go into the hospital, but I didn't escape it by much. It was azythromycin-resistant and I had to go on Levaquin, which has some fairly creepy side effects. While trying to piece together how I got SO sick SO fast, my doctors and I realized that the sinus infection / bronchitis I'd taken back-to-back Z-packs for in January never actually went away; it just brooded away in my lungs and my sinuses for six weeks, leaving me just sick enough to dismiss it as the Winter Crud + not getting enough sleep because I have a four-month-old baby. Then the baby got croup one night and I had to rush him to the hospital. I lost a whole night's sleep, and I went rapidly downhill from there; literally 48 hours later I was in terrible shape.

Thank God for the Levaquin and its shitty side effects. It doesn't get prescribed super-routinely, because people see things like "tendon rupture" and "permanent peripheral neuropathy" and get skittish. And I've learned my lesson. Don't just take the medicine until it's gone, take it until you're all better.
posted by KathrynT at 3:23 PM on April 1, 2011 [1 favorite]

Here is a link to the Union of Concerned Scientists about HR 965 the Preservation of Antibiotics for Medical Treatment Act.


I know that my own life started splintering apart after watching my brother die from MRSA.


He is with me... every day.
posted by PROD_TPSL at 3:32 PM on April 1, 2011 [5 favorites]

What part does hand sanitizer play in all of this? I've heard widespread use of hand-sanitizer contributes to these 'superbug' but is that true?

There are many kinds of hand sanitizer. Some use antibiotics (usually triclosan); some use alcohol. Using alcohol-based sanitizer isn't going to contribute to any increased resistance, but antibiotics are another matter. I don't know if the amazingly widespread use of triclosan in hand soap and sanitizer is a significant part of the overall resistance problem or not, but it's not a good thing.

FWIW, soap and water is quite effective, and works on a lot of bugs that triclosan (or even alcohol) doesn't. Also, it gets your hands clean!

Remember antibiotics only work on bacteria (and not even on all bacteria), they have no effect at all on viruses.

As far as antibiotic soaps with Triclosan, I don't know if there is anything with resistance

Yep, things develop resistance to triclosan. (Bacteria who've been selected for triclosan resistance sometimes end up with resistance to other antibiotics, even. pdf)
posted by hattifattener at 3:39 PM on April 1, 2011 [1 favorite]

evidenceofabsence: "Don't worry: Drugs still work. At the least, Xanax does."

Yeah, for a second there I needed another Paxil.
posted by Splunge at 3:49 PM on April 1, 2011

Is there a way to encourage development less antibiotic resistance bacteria strain? It seems to me that the current way of treating with antibiotic created a strong selective pressure for emergence of "superbugs". It's a losing battle because we can't develop antibiotics fast enough to overcome these new defenses. These "superbugs" are metabolically very inefficient compare to normal strain of bacteria. What need to be done to encourage survival of normal strain of bacteria?
posted by Carius at 4:03 PM on April 1, 2011

In India and SE Asia, and in many other countries, access to antibiotics are not as restricted as they are in the US and Europe. Many antibiotics you would need a prescription for here (i.e. pretty much all of them) are available OTC other countries. That's what leads to the overuse, when people simple grab a bunch of antibiotics when they sick, regardless if it is viral, bacterial, fungal, or allergies. Imagine if every over-protective parent in the US could buy erythomycin from CVS.

And other superbugs seem to originate in hospitals. But no, it's the big evil american meat producers.

Here is how you don't get superbugs: take all the pills that are prescribed, and encourage hospitals to practice the basic sanitation that restaurants have to.
posted by gjc at 4:04 PM on April 1, 2011 [1 favorite]

Re: hand sanitizer. Used properly, they contribute nothing to bacterial resistance. But almost nobody uses it properly, IE, on hands that are already mostly clean. Smearing the bacteria around in nice smelling goop does not make ones hands any more sanitary, and can theoretically contribute to bugs that are resistant.
posted by gjc at 4:07 PM on April 1, 2011

"It just shouldn't have happened," says Jules, as the pair nurse their own aching limbs after running a half-marathon. "It was his knee -- that's not something he should have died from."

As if we are entitled to be free of death or to choose how it comes.
posted by Ironmouth at 4:09 PM on April 1, 2011 [1 favorite]

And other superbugs seem to originate in hospitals. But no, it's the big evil american meat producers.

I'm not sure what PETA rant you are responding to, but continuous antibiotic feeding occurs in many countries not just the US (I believe Europe banned much farm antibiotic usage in 2006).

Promiscuous use of human antibiotics is part of the problem, but one-time doses of antibiotics at their prescribed (effective) doses are not the optimal way to breed resistance, since the bacteria will actually die. The ideal way to breed resistance is very low doses that don't outright kill the bacteria, administered continuously (or in short cycles), then gradually increasing the doses over a long period of time.

Obviously handing out antibiotics like candy to humans is a bad idea, and should be stopped as well. I'm just tired of seeing people blame the resistance problem on fairly valid uses, like prophylactic doses of antibiotics before surgery, or a viral infection that has a strong chance of turning into a bacterial infection. These are not the majority of the problem and we should tackle the worst causes of resistance first.
posted by benzenedream at 4:48 PM on April 1, 2011 [1 favorite]

From wikipedia, but it seems to be well sourced:

In agriculture, antibacterials are often used to promote weight gain in livestock animals. More than 70% of the antibacterials used in U.S. are given to livestock animals in the absence of infectious diseases.[59] This practice has been associated with the emergence of antibacterial-resistant strains of bacteria including Salmonella spp., Campylobacter spp., Escherichia coli, and Enterococcus spp.[60][61] The emergence of antibacterial resistance has prompted restrictions on antibacterial use in the UK in the 1970 (Swann report 1969), and the EU has banned the use of antibacterials as growth-promotional agents since 2003.[62]

It seems surprising that overuse of bacteria isn't more of an international diplomatic issue. Not just regarding the US, of course.
posted by Marlinspike at 4:48 PM on April 1, 2011

"Phage therapy is awesome, for certain things. The problem is that you have to know precisely which phage to use against which bacteria, since phages are highly specific about their diet; if you have multiple infections it can be even trickier. The advantage of antibiotics is that they are basically all broad-spectrum (some more than others), in that they kill whole classes of bacteria rather than a specific genus. If penicillin was the magic bullet, phages are like the sniper who only takes out white males, aged 35-40, wearing red hats."

There are currently three treatment strategies for using phages to combat disease in spite of this. The first is to pre-generate cocktails of large numbers of phages as they do in the Republic of Georgia at the Eliava Institute and BioChimPharm. At Eliava, they have three cocktails of phages which they update every 6 months against strains that they collect from around the country. The first is intestiphage, which targets 20 different types of gastrointestinal diseases. One well-controlled trial of the concept was conducted in Tbilisi on 30,769 children back in the sixties, neighborhoods were split up with one side of each street treated prophylactically with a phage cocktail and the other a placebo. The result was a 3.8-fold decrease in dysentery incidence. A second cocktail, pyophage, is made against Staphylococcus, Streptococcus, Pseudomonas, Proteus, E. coli, and Enterococcus, the 6 major causes of purulent infections, it is used prophylactically on a routine bases during surgery and for severe burns as well as against actively purulent wounds (like MRSA) with a high success rate*. During the the most recent couple of wars there, soldiers carried spray bottles of phage for gunshot wounds and maintained shockingly low infection rates. The third is a relatively new one against prostititis.

There is also what they do in Wroclaw, Poland at the Hirszfeld Institute of Immunology and Experimental Therapy. There they treat intractable infections resistant to all other treatment methods with phage preparations that are specifically designed for the strain causing the infection. They have success rates that range between 50% and 100% of cases, depending on the type of infection, and publish their findings in English.** They suspect that the relatively low success rates with some kinds of infections has to do with the fact that most infections, by the time they see them, have had months, and more often years, to develop solid biofilms and avascular hiding places.

The solution favored by Western companies including Intralytics, Omnilytics and others at the moment is to isolate ~5 phages with unusually broad host ranges. By your analogy, a city full of clones of one guy suddenly flooded with 10⁸ crazed omniscient snipers who hate people who love chocolate, another 10⁸ who can't stand people who don't follow traffic laws perfectly, another 10⁸ who despise people who can successfully do 5 pushups, 10⁸ more who love murdering people who secretly pick their noses, and another 10⁸ who hate folks who have ever left their dog's poop without scooping it. A cocktail like this is now being used in just about all pre-cooked "ready to eat meats" (think baloney) on grocery store shelves now to prevent Lysteria and prolong shelf life. There is also this really exciting study going on right now with T4-like phages.

*Kutter EM. Bacteriophage therapy: past and present. In: Schaecter M, ed. Encyclopedia of Microbiology. Oxford: Elsevier, 2009:258-66.

**Górski A, Miedzybrodzki R, Borysowski J, Weber-Dabrowska B, Lobocka M, Fortuna W, et al. Bacteriophage therapy for the treatment of infections. Curr Opin Investig Drugs 2009; 10:766-74.

Here is some good reading on the subject if you have journal access, feel free to MeMail me with an email address if you don't. For the purposes of academic discussion of course

1. Loc-Carrillo C, Abedon ST. Pros and cons of phage therapy. Bacteriophage 2011; In Press
2. Sulakvelidze A, Kutter E. Bacteriophage therapy in humans. In: Kutter E, Sulakvelidze A, eds. Bacteriophages: Biology and Application. Boca Raton, Florida: CRC Press, 2005:381-436.
3. Brüssow H. Phage therapy: the Western perspective. In: Mc Grath S, van Sinderen D, eds. Bacteriophage: Genetics and Microbiology. Norfolk, UK: Caister Academic Press, 2007:159-92.
4. Chanishvili N, Sharp R. A Literature Review of the Practical Application of Bacteriophage Research. Tbilisi, Georgia: Eliava Institute, 2009.
5. Summers WC. History of phage research and phage therapy. In: Waldor M, Friedman D, Adhya S, eds. Phages: Their Role in Bacterial Pathogenesis and Biotechnology. Washington DC: ASM Press, 2005

I suppose I should also disclaim that I am on the board of a non-profit built to provide charitable funds to phage research as well as train surgeons in how to incorporate phages into debridement procedures.
posted by Blasdelb at 5:13 PM on April 1, 2011 [26 favorites]

Though antibiotic use in farming is certainly a problem, carbapenems and their derivatives are not used in any livestock as far as I know. If someone has evidence to the contrary, post it. The selective pressure that drove this particular mutation resulted entirely from carbapenem use in humans, and any impact from antibiotic use in livestock would be at best second order or indirect.
posted by drpynchon at 5:13 PM on April 1, 2011 [2 favorites]

"Though antibiotic use in farming is certainly a problem, carbapenems and their derivatives are not used in any livestock as far as I know. If someone has evidence to the contrary, post it. The selective pressure that drove this particular mutation resulted entirely from carbapenem use in humans, and any impact from antibiotic use in livestock would be at best second order or indirect."

As far as I know, Carbapenems are not widely available in India, and certainly would not be prone to abuse as they are given intravenously. Even assuming that NDM-1 originated in India, which is a point of significant contention, it almost certainly evolved in response to one of the many other families of β-lactam antibiotics that it provides resistance to.
posted by Blasdelb at 5:27 PM on April 1, 2011

Certainly agree on all your points Blasdelb, though anecdotally, my understanding is that carbapenems (imipenem and meropenem, though perhaps not yet doripenem) are actually in wide use at large urban hospitals in India at this time. Data on this is lacking however. Regardless, NDM-1 is NOT the first carbapenemase described. If I'm not mistaken, we've been dealing with this for about 15 years now, with the first isolate being described in the U.S.

The resistance of gram negative rods to broad-spectrum largely intravenous agents however is being mischaracterized here. This seems much less likely to be a problem born on the streets or farms than it is a problem originating in intensive care units. Antibiotics abuse is still a significant problem by health care practitioners requiring stewardship.
posted by drpynchon at 6:02 PM on April 1, 2011 [2 favorites]

Big Pharma, Big Agriculture, all American, and probably other business, care about short-term, say 10 years max, profit. Of course they give chickens and cattle antibiotics; it increases weight effectively. We usually look to government for regulation and protection, but in the US, at least, elections function like big business, and there's little ability to plan for the long term. Yet another reason science education and investment is critical. But don't hold your breath.
posted by theora55 at 6:50 PM on April 1, 2011 [2 favorites]

The problem is that you can't administer alcohol internally in anywhere near enough concentration to kill the bacteria without killing the person just as dead.

THIS IS NOT YET CONCLUSIVELY PROVEN; MY OWN "EXPERIMENTS" IN THIS DIRECTION CONTINUE.

RESULTS APPEAR PROMISING DESPITE THE SMALL SAMPLE SIZE.
posted by infinitywaltz at 8:27 PM on April 1, 2011 [5 favorites]

The notion that there should be a disassociation between the development of these drugs and a pricing structure seems to ignore the plight of the researchers and all that comes with bringing drugs to market - namely, all involved have to eat too and eating costs capital that is not in the form of incremental bacteriophage development on an agar media. Might as well go ahead and start your anarcho-syndicalist commune with the expectation that like it will be this place where everybody trades there talents for other peoples talents man, totally groovy.

Long ago I read the banned book Hitman, which gave details about how to be a successful for-hire hitman. Suggested price for a single hit was $30,000 at a minimum. The rationale is that you may not have another hit anytime soon and the cost of doing a hit can run very high at times for all of the scouting and trade craft that goes into it.

Developing drugs is similar - you have ostensibly the best researchers on the globe scouring the world for new drug sources or analyzing viruses and bacteria for thousands of hours and attempting to synthesize counters with zero guarantee of success and an overwhelming chance of failure. So in any given year you are looking at millions of dollars and time and energy down the drain because a certain line of bacterophages did not survive in your media. That process is about as creativity and labor intensive as anything ever done by man - especially under the stress of "superbugs" - suggesting it could be a public good is about as fairytale a thought as a taco that craps ice cream.
posted by AndrewKemendo at 8:47 PM on April 1, 2011 [1 favorite]

Yeah, in a world that values public goods for shit, that's true. Worlds that value public goods for shit don't necessarily last, though.
posted by saulgoodman at 8:55 PM on April 1, 2011

let's dump antibiotics into livestock feed to produce cheaper meat.

Sure why not, we used up several hundred million years worth of oil in a century.

One might look at it as just one more reason to avoid too much time with the maddening crowd.
posted by Twang at 12:40 AM on April 2, 2011

Someone mefi-mailed me links to some more studies on organic farming and antibiotic resistance I thought I would share:

http://www.ncbi.nlm.nih.gov/pubmed/20074013
http://www.ncbi.nlm.nih.gov/pubmed/19846639
http://www.ncbi.nlm.nih.gov/pubmed/18417664
http://www.ncbi.nlm.nih.gov/pubmed/17600485
http://www.ncbi.nlm.nih.gov/pubmed/19436585
posted by exogenous at 4:49 AM on April 2, 2011 [1 favorite]

One of my friends just informed me that living in a city built from my imagination now solidly beats any other hell they could conceive of...
posted by Blasdelb at 1:02 PM on April 2, 2011

I just love the idea there are a whole bunch of different ways my lifestyle supports callous individuals and organizations who might end up causing worldwide chaos and death in the name of making a profit. Thank god I don't eat beef or set ER policy; antibiotic-immune superbugs are one humanity-gets-wiped-out scenario I think I can say I'm not actively contributing to.
posted by tehloki at 3:19 PM on April 2, 2011

Medical antibiotics have only existed for less than a century while humanity has been around for tens or hundreds of thousands of years. Bacteria didn't wipe out humanity before antibiotics so it's unlikely to wipe out humanity even if antibiotics lose all effectiveness. Not that the lack of effective antibiotics is a situation we shouldn't avoid if at all possible, but it isn't an end of civilization type event.
posted by Justinian at 10:03 PM on April 2, 2011 [1 favorite]

"...but it isn't an end of civilization type event."

Umm... while an untreatable infectious diseases could not be a total extinction event, at least not on a global level, they are more than capable of ending civilizations, heralding cultural extinction, and of death on a scale almost outside living memory.

Each of these disasters found smaller communities and wiped them from the Earth, while many of them ended centuries old civilizations
posted by Blasdelb at 11:54 AM on April 3, 2011 [2 favorites]

That may be true but it has little to do with what I wrote. Most of the things you list are viral, not bacterial. Confusing the two may be common but seems sub optimal when speaking of antibiotic resistant bacteria. Secondly, none have anything at all to do with a humanity-gets-wiped-out scenario. Something can be bad without being the end of humanity.
posted by Justinian at 3:28 PM on April 3, 2011

Why are you talking about extinction and end-of-civilization scenarios anyway, Justinian? It's kind of a strawman.
posted by hattifattener at 6:49 PM on April 3, 2011

That was kind of the tone of the article linked in the post.
posted by exogenous at 7:38 PM on April 3, 2011

Why are you talking about extinction and end-of-civilization scenarios anyway, Justinian? It's kind of a strawman.

If by "strawman" you mean "directly referenced in the comment I was replying to, which appears immediately before my comment in this very thread" then you are correct.
posted by Justinian at 9:37 PM on April 3, 2011 [1 favorite]

Oh, uh. I guess that is what I mean by "strawman". Nevermind.
posted by hattifattener at 9:43 PM on April 3, 2011 [2 favorites]

Saw this on my morning feed trawl and thought of this thread: Superbug gene rife in Delhi water supply.
posted by immlass at 8:22 AM on April 7, 2011

To be fair, i AM made of straw.
posted by tehloki at 4:06 PM on April 7, 2011

World Health Day update: Use an antibiotic, pay a fee?
posted by homunculus at 9:10 AM on April 10, 2011