Antibiotic resistance now 'global threat', WHO warns

http://www.bbc.co.uk/news/health-27204988

by k-mcgrady • 12 years ago

359 213 12 years ago

bbc.co.uk

swombat• 12 years ago

Whilst I totally appreciate the seriousness of this, I still don't get what exactly I can do about this. Most likely, nothing.

Therefore, much like the potentially developing WW3 in Ukraine, or Ebola outbreak in Africa, or rape culture in India, this kind of news is fairly useless. It just creates negative feelings with no positive outcome.

I'm happy to be convinced otherwise - what can I do about this?

luckyno137• 12 years ago

The best thing you can do is keep informed, and keep others around you informed. Many people don't realize this is such a rapidly progressing issue. In fact, many people may not even know that they are improperly taking their Antibiotics and what the side effects are to doing so.

If more informed I feel like the public could do a bit better at turning down Antibiotics when they aren't necessary, and using them properly when they are. Just that action would go a long way.

Edit- I would also like to add that a lot of people don't realize just how easy it is to get an infection, and education could go a long way in keeping it from happening in the first place. It reminds me of that guy on reddit with the horrible case of necrotizing fasciitis that he ended up with after retrieving a football from a koi pond. His day by day imgur chronicle was both interesting and horrifying.

midas0078• 12 years ago

It doesn't have to be that way, and waiting around for "someone else to handle it" will likely lead to a Tragedy of the Commons.

Call your representatives [US: 0,1] or regional government representative (I just called my senator, and on hold for house rep now), tell them we need an emergency crash program to develop new, tightly-regulated antibiotics so that infection doesn't become the leading cause of deaths in 2025. Because it takes years and billions to develop new antibiotics, this is something companies will not pursue on their own initiative. If not, it'll be a return to the 19th century. Good luck with that.

[0] http://www.house.gov/representatives/find/

[1] http://www.senate.gov/general/contact_information/senators_c...

goldenkey• 12 years ago

Antibiotics work on a specific mechanism of action. See here: http://en.wikipedia.org/wiki/List_of_antibiotics

New mechanisms of action are needed, more specifically, mechanisms that evolution cannot biologically defeat. Consider an agent like bleach, 99.99% effective because the makeup of a cell does not really permit it to protect against such a caustic agent. Clearly bleach can't be used as an antiobitic but I use it to illustrate the point that a evolutionary-unlikely antibiotic mechanism would be worldly profound.

timr2• 12 years ago

You're right, but here's the problem: things that are robust to evolutionary change tend to kill everything (e.g. chlorine). There's a tension between finding targets that are specific to an organism, but well conserved, so that the organism can't simply evolve away from the specific threat.

This is really the alpha and the omega of antibiotics and antiviral research: finding the specific lethal target that can't easily be changed. It's damned hard, and it's why most of our antibiotics have been generated by nature, not by rational design.

k-mcgrady3• 12 years ago

> "Whilst I totally appreciate the seriousness of this, I still don't get what exactly I can do about this. Most likely, nothing."

I think you can help by informing others. If you know a family member not completing their course of antibiotics for example explain to them why it's so important.

dfxm12• 12 years ago

If your doctor is prescribing you an antibiotic, you can ask them what the pros and cons are of taking it. If you are willing to deal with the cons, then maybe don't take the antibiotic. Usually, the con will be that you feel sick for a bit longer. Note though, that you might need them to get over whatever it is you have.

swalkergibson2• 12 years ago

This is absolutely accurate.

"People were generally aware of the link between overuse of antibiotics and increased resistance. Only 8% of respondents did not agree that if antibiotics are taken too often they are less likely to work in the future. But many people (43%) incorrectly believed that antibiotics were effective in viral conditions."

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1934431/

artmageddon• 12 years ago

I will echo lucky's sentiment - staying educated, and educating others around you, goes a big way. I know people very close to me who still believe it's okay to stop taking antibiotics the moment they feel better, rather than finishing out the entire prescription.

I'd like to believe that buying meat / other foods that aren't treated with antibiotics could make a difference as well, but I'm not sure how much impact that would have.

FooBarWidget2• 12 years ago

Not sure why swombat got downvoted, he makes good points. Heck, once in a while, an HN submission for along the lines of "Why reading news is harmful and why you shouldn't read it" goes by, and it gets upvoted a lot.

What can the general public do about this? It's not like I can go to my family physician and tell him to use less antibiotics (he already doesn't; I'm in the Netherlands), and expect to make any kind of meaningful difference. This is one of those "tragedy of the commons" kind of problems that can only be solved if everybody cooperates.

pessimizer• 12 years ago

Be educated about it, and educate others. Eventually, you will be called on to vote on something, and some intrenched interest will try to convince you that it is an encroachment of big government on the sovereignty of job creators. Good luck trying to teach them then.

exratione• 12 years ago

Donate to research groups that are working on ways of controlling bacterial and viral infections that are a step beyond the present status quo. Things like DRACO [1] spring to mind. Present day fundamental (as opposed to translational) biomedical research is very cheap in comparison to the state of things even a decade or two ago. Small fundraising groups can make a big impact now.

[1] https://en.wikipedia.org/wiki/DRACO_(antiviral)

coenhyde2• 12 years ago

Pressure your government (where ever you may be) to make responsible use of antibiotics a priority.

The misuse that terrifies me the most are antibiotics used on livestock. Particularly the antibiotics that are also used on humans. In my opinion antibiotics should not be used as a growth promoter and only used to help sick animals.

sgk284• 12 years ago

should not be used as a growth promoter and only used to help sick animals

The issue is that a lot of animals get sick from being crammed together in small areas, unable to move, while living in their own feces and urine. If we regulated animal treatment better and required certain living conditions for animals they wouldn't get sick nearly as often and wouldn't need nearly as many antibiotics.

As it stands, regulating antibiotics to be used only on sick animals wouldn't change much since an incredibly large percentage of livestock are often sick (as a consequence of living conditions).

midas0078• 12 years ago

That's one side, the other side would be a crash program to develop a spectrum of closely-guarded, last-resort antibiotics.

Slackwise• 12 years ago

The primary source of antibiotic abuse is in farm animals.

Do you really want to help? Start eating less meat, and tell others to also do so. Tell them why. Tell them to also tell others. When there is less demand for meat, then there will be less land devoted to animal feed/grazing, and more to food crops. Less animals that can be infected, less antibiotics used, etc, etc.

Want to really help solve it? Don't eat meat. Get others to stop eating meat.

Invest in faux/lab-grown meat companies. Disease free meat can be grown. We just need to make it profitable.

Honestly, this is the future. Farming like this is unsustainable, not only for the antibiotic reasons.

(I'll spare everyone the ethical/transhumanist discussion.)

azth• 12 years ago

Want to really help solve it? Don't eat meat. Get others to stop eating meat.

Why not just get meat from farms that treat their animals properly (no cramming, free-range, etc)? I don't think it should be this extreme.

pound• 12 years ago

red meat is high in iron and anemia is not nice. of course there are other sources of iron, i'm just saying that stopping eating meat should go with balancing diet.

Houshalter4• 12 years ago

That's true for pretty much all significant news. And it's not like we are helpless, it's still possible to invest in new antibiotics and strictly control the ones that still work.

vacri• 12 years ago

If given the option, you can decline antibiotics for minor ailments.

doktrin4• 12 years ago

Last year, the chief medical officer for England, Prof Dame Sally Davies, said the rise in drug-resistant infections was comparable to the threat of global warming.

Perhaps I lack proper context, but drug-resistance terrifies me significantly more than global warming. Primarily, I think, because we are still speculating about the consequences of climate change - if not so much its causes. In contrast, we know what a world without antibiotics looks like, and it's pretty horrifying.

luckyno137• 12 years ago

My concern with this line being drawn is the risk of people drawing a line between them and then transferring the overwhelming amount of skepticism of climate change to such a serious topic as this. All we need is to give the anti-vaccine nuts another reason to shit all over herd immunity.

chc• 12 years ago

Both are pretty serious topics.

ams61102• 12 years ago

I get what your're saying (I think) but vaccine != antibiotic. We're not (that I've heard) seeing the emergence of vaccine-resistant polio for example.

k-mcgrady3• 12 years ago

I agree. I recently had to take antibiotics for the first time in as long as I can remember. Without them I probably would have been in significant/debilitating pain for the foreseeable future. At the same time I happened to come across a really long detailed article about antibiotics explaining about the dangers of resistance and life before antibiotics. If we don't fix this or find an alternative solution we'll essentially be going back in time in our health care.

_dark_matter_• 12 years ago

I completely agree with you. Maybe this was a subtle way to get the public to understand the catastrophe that is global warming as well...

justin663• 12 years ago

The worst case scenario for global warming is that it's an extinction-level event and civilization ends. The worst case scenario for antibiotic resistance is that people live with the medical uncertainties our grandparents and great-grandparents lived with.

Assuming everyone understands that, it's an interesting case study in psychology as to why the second one might be scarier than the first one.

doktrin4• 12 years ago

The worst case scenario for global warming is that it's an extinction-level event and civilization ends.
Assuming everyone understands that, it's an interesting case study in psychology as to why the second one might be scarier than the first one.

It doesn't make sense to base decisions on a worst case scenario without taking probability into account.

todd3834• 12 years ago

I would bet that most people feel like global warming is a problem for their great grandchildren but antibiotic resistance could actually have a negative effect on themselves.

musicaldope• 12 years ago

Possibly because antibiotic resistance is seemingly imminent, and global warming is only a threat over a much longer timeframe. I can't say definitively whether this accurately reflects reality, but intuitively it makes sense for people to feel this way.

PeterisP3• 12 years ago

Can you cite about that worst case scenario? All that I've heard of global warming consequences is a metre or two rise in sea level, flooding of the related areas + changes in agriculture (currently fertile areas suffer, but northern countries may even increase fertility) i.e., a major pain, but nothing near extinction or civilization ending. It would happen slowly enough (over a century) and require some migration further inland (or infrastructure megaprojects - we can have cities below sea-level, see Netherlands for example), but in the long term we would have the same quality of life, just for a smaller global population due to agricultural changes.

Antibiotic resistance, on the other hand, kills our wellbeing and lifespan by making common medical procedures/surgeries impossible, and does so permanently.

differentView• 12 years ago

The worst case scenario for both is extinction.

vonmoltke4• 12 years ago

The worst case scenario for global warming is that it's an extinction-level event and civilization ends.

I don't buy that. Beginning of a new dark age with a breakdown of civilization and loss of advancements? Yes. Extinction-level event? No.

The worst case scenario for antibiotic resistance is that people live with the medical uncertainties our grandparents and great-grandparents lived with.

No, actually the worst case is that the antibiotic period breeds superbugs that are both more virulent and harder to kill than those that came before. Antibiotic resistance comes about because of unintentional selective breeding of bacteria. We don't really know what other traits we are unintentionally selecting for. We could potentially be breeding a wordwide pandemic and not realize it. Which could bring about a new dark age with a breakdown of civilization and loss of advancements.

ars5• 12 years ago

The worst case scenario for global warming is that it's an extinction-level event and civilization ends.

WHAT?? What kind of nonsense have you been reading?

The worst case is coastal flooding, some people have to move inland, and some plant and animal species go extinct. Perhaps some areas become desert (but people live in incredibly hot areas now, so those places will still be habitable).

Other plants and animals will move into the now vacant environment niches. Yes, it's a loss of a species, and yes, a loss of coastal land.

But civilization ends??

Houshalter4• 12 years ago

Well human populations have gotten significantly larger, more dense, and we have far more/faster travel. The worst case is a plague that also ends civilization.

0xdeadbeefbabe• 12 years ago

This probably won't change your religion, but malaria is worse than global warming [0]. The author is a democrat btw.

[0] http://www.ornery.org/essays/warwatch/2014-03-20-1.html

Daishiman2• 12 years ago

Primarily, I think, because we are still speculating about the consequences of climate change - if not so much its causes.

This is factually untrue. There is a greater scientific consensus on the origins of anthropogenic climate change than there is on the origins of many common diseases.

The climate change trends are very well known, the models that existed 15 years ago have worked extremely well at predicting current climate trends, and the impact in the food supply chain is being well documented, not to mention the myriad other observed changes in ocean acidity, coastal degradation, Arctic and Antarctic surface ice, Andean permafrost, and desertification, just to name a few areas studies by completely different specialties which are confirming the predictions.

thenmar2• 12 years ago

Thank you for posting this. I don't understand how climate change denialism is such a popular opinion among people who _should_ know better.

doktrin4• 12 years ago

There is a greater scientific consensus on the origins of anthropogenic climate change than there is on the origins of many common diseases.

You are misrepresenting my statement. I specifically referred to consequences, not origins.

vixin• 12 years ago

Models working well? Frankly laughable. Global temperature rising for almost 25 years at half the central rate predicted by the IPCC in 1990 and no global warming at all for half the RSS satellite record.

Since you mention consensus (is that how to do science? Maybe we should introduce elections for new theories) - but still let's proceed; only 64 (or 0.5%) of 11,944 scientific abstracts published since 1991 state that most of the global warming since 1950 is manmade.

luckyno137• 12 years ago

The threat we now are facing with these resistant strains of bacteria are the main reason I got interested in the Public Health field. I am only in my second semester, going part time, but look forward to trying to address the growing need for infectious treatment "reform."

dopkew2• 12 years ago

We may eventually need to have a compulsory hospital stay (or something else) for antibiotic treatment so that a patient treated with an antibiotic does not have any leftover resistant pathogens to transfer to the public.

Fomite5• 12 years ago

Given the amount of antibiotic resistant bugs that live in hospitals, I'm highly skeptical that longer hospital stays will result in decreased colonization with resistant species.

mullingitover2• 12 years ago

Oddly enough, I can't find a single reference to farms using antibiotics as a growth enhancer in this article. Isn't that the single biggest source of antibiotic-resistant bacteria?

luckyno137• 12 years ago

From what I understand, it isn't usually used as a growth enhancer (I may be wrong) but used because of the way livestock is maintained. When you have cows being kept standing in one place to maintain lean meat, they develop infections more so than being able to walk somewhere other than their own feces. So to keep production up and infections down, the livestock gets pumped full of antibiotics.

maxerickson2• 12 years ago

Huge amounts of ionophores [1] are used as feed additives. That class of drugs is not used therapeutically in humans. I think other antibiotics are also used quite extensively as feed additives, but I'm less clear on them. If you search on 'vancomycin feed additive', you see discussion about replacing it with other drugs.

There are health benefits to the animals (the drugs prevent 'bloat'), but they also increase the weight gain per pound of feed, which the farmer (rancher? lot manager?) is going to take into account.

[1]http://en.wikipedia.org/wiki/Ionophore

CapitalistCartr• 12 years ago

Yup. "The isolation of antibiotic-resistant Salmonella from Retail Ground Meats" in The New England Journal of Medicine. http://www.foodpoisonjournal.com/uploads/file/retailmeat.pdf

anigbrowl• 12 years ago

Agricultural use of antibiotics has definitely been an issue, but perhaps they're trying to state narrow conclusions in the name of scientific rigor. Fortunately, in the US at least, the practice is being discontinued. http://www.fda.gov/animalveterinary/guidancecomplianceenforc...

zach• 12 years ago

Not everyone is so sanguine about the effect of the FDA's action. For example, NY Times food writer Mark Bittman:

http://www.nytimes.com/2013/12/18/opinion/bittman-the-fdas-n...

In California, though, there is much stronger action stirring in the state legislature, although it will need far more public support to become a possibility:

http://www.sfgate.com/health/article/Ban-sought-on-animal-an...

jff• 12 years ago

Different antibiotics.

JoeAltmaier5• 12 years ago

Isn't it moot? The bugs have mutated already. Closing the barn door after the cows have left...

im3w1l• 12 years ago

A valid concern. From what I've heard though most mutations that cause antibiotics resistance are selected against in the absence of antibiotics.

digikata• 12 years ago

BTW, you can already see a shift in the industry from calling out the antibiotic use as a growth enhancement, to calling it a preemptive use to prevent sickness. It just happens that when you collect animals together in high density feedlots to fatten them up - it does create increased illness rates - in addition to being a vector for breeding and spreading resistant bacteria.

So the label has changed, but the end effect of pouring tons of antibiotics into conditions that breed resistance is still there unless we change conditions in feedlots.

melling• 12 years ago

Isn't this caused because some countries make antibiotics easily accessible without a doctor?

cstross• 12 years ago

Yes; there are perverse disincentives built into the profit mechanism underpinning the commercial pharmaceutical industry.

Patents on antibiotics last no longer than on any other type of medicine (20 years, minus the substantial time taken to test it, jump through regulatory hoops, and bring it to market -- typically 8-14 years). The cost of meeting those regulatory prerequisites is measured in the hundreds of millions of dollars in the USA alone -- more if you want to get a product license everywhere worldwide. So you need to earn back several hundred million bucks in profit in a single-digit period of years ...

But antibiotics are unprofitable. A typical AB course lasts 5-14 days after which the patient is completely cured. Compare with antidepressants or ADHD drugs -- where you get a customer for life! Which would you invest in, if you were in that business -- a product 10% of the population will use annually for a week, or a product 10% of the population will be hooked on for life?

It's not a coincidence that research into new antibiotics ground to a halt in the 1970s around the time that the regulatory barriers to entry rose so high that small and medium scale pharmaceutical companies were frozen out of the business and the surviving operators were the large conglomerates.

(Disclaimer: wearing my ex-pharmacist hat here.)

dopkew2• 12 years ago

I saw a documentary in which it was said that another disincentive to antibiotic research is that its very use causes its effectiveness (for the general population) to reduce, due to antibiotic resistance. So that it would eventually stop selling.

It is not so in the case of medicines for BP, diabetes etc.

regoldste• 12 years ago

I think it's also occurring in part because of doctors who are prescribing aggressive and often unnecessary courses of antibiotics.

I expect this is at least one explanation for why (as the article notes) antibiotics are ineffective at treating more than half of urinary tract infections caused by E. Coli. One standard treatment for persistent, recurrent UTIs in women is to prescribe a prophylactic antibiotic to be taken post-coitally, which typically means that a woman takes a pill irregularly--either every time after she has sex or once a week. This can last for years, without the doctor reevaluating the necessity of the treatment. While this is completely necessary for truly severe, recurring cases, I've seen several doctors prescribe this casually to women who don't have recurring UTIs but request it anyway. This is detrimental for the community and the patient, who has a higher risk of developing drug-resistant infections.

I think one way to address this problem is making doctors more aware of the community-wide effects of aggressive courses of treatment, informing them about alternative treatments that don't involve antibiotics, and encouraging them to use aggressive courses of antibiotics (such as prophylacticly for recurrent UTIs) as a treatment of last-resort.

swalkergibson2• 12 years ago

No doubt. This is absolutely spot-on.

The other problem that exists in the US is that the "family doctor" has an incentive to pack his schedule full of as many people as he can to collect as much money as possible. If someone comes in complaining that they have had a sore throat for a day, then they are going to get a pill; regardless of whether or not the infection is viral or bacterial. It is way, way faster to send the patient out the door with a pill that they think will make them feel better than it is to educate them about the macro effects of improper prescription of antibiotics. The only thing they care about is missing another day of work because they have a big deadline and the boss is breathing down their neck.

tomp3• 12 years ago

Not necessary; even in countries where you can't get antibiotics without prescription, doctors are prescribing them to avoid liability or to shut up annoying patients. It's a simple question of short-term gain vs. long-term loss.

denzil_correa• 12 years ago

Isn't (one of the reasons) this due to excessive use of antibiotics?

luckyno137• 12 years ago

Yes, excessive use in not only humans, but in livestock.

majkinetor5• 12 years ago

You are wrong. Excessive use in livestock contributes a lot given that 40% of worlds AB's are used for growth promotion and we eat that junk.

Orangeair• 12 years ago

Is there any particular reason we can't just create new antibiotics? Is there something inherent in the current design of antibiotics that prevents creating new versions of what we have? If so, is there an 'upper limit' of how many we can create, and have we reached it already?

pygy_• 12 years ago

It's an active research topic, and little progress has been made recently.

You'd have to find a new class of drugs that is safe for humans at the toxic dose for bacteria.

FooBarWidget2• 12 years ago

The reason is that creating antibiotics is not profitable enough, and so 15 years ago pharmas stopped most research on them.

refurb9• 12 years ago

Not sure why this was down voted because it's true. Only a few big pharma have R&D programs in the antibacterial space. As a reply above states, the current system penalizes new antibiotics by reserving them for only the most severe cases. With the cost of a new antibiotic approval in the hundreds of millions of dollars, companies put their R&D dollars into areas with better returns.

That being said, a few new legislative changes have happened and will happens (GAIN Act approved, DISARM Act being considered) that will change the economics of antibiotic research and have already prompted drug companies to get back into the field.

majc2• 12 years ago

Apparently not. This article (http://www.telegraph.co.uk/finance/newsbysector/pharmaceutic...) suggests its a case of economics. That is new antibiotics would be kept back as a last line of defence only; therefore not as profitable.

DennisP3• 12 years ago

If we were a rational species, we would recognize we're at war with another species that's killing millions of us, and spend a portion of our military budget on antibiotics research, instead of leaving it all up to the private sector.

We spend tax money on defense because it's a public good and in the absence of tax dollars there's no money in it. The same applies here.

Pxtl• 12 years ago

IANA*, but as I understand it there are fundamentally two forms of antibiotic - variations on penicillin, and variations on vancomycin. While varying the exact form of antibiotic works to a point, eventually you run into the problem that bugs become resistant to the basic underlying common mechanism within the family of antibiotics. Everyone accepts this process with penicillin-ish drugs, but when it starts happening to the vancomycin-ish drugs, that's when it gets scary, because there is no 3rd tier.

vonmoltke4• 12 years ago

There are a couple dozen classes of antibiotics, of which penicillins and glycopeptides (vancomycin) are just two. Personally, I have just been through 4 classes while trying to fight cellulitis (a penicillin, 2 lincosamides, a sulfonamide, and a tetracycline). I was probably a day or two away from being hospitalized for IV glycopeptide treatment. In my case, the problem was the speed with which the infection was progressing; I had daily appointments with my orthopedist until we found the right combination. Still, there are a variety of antibiotics that can be tried, alone or in combination. There is only a fuzzy concept of "tiers". Its more about strength and side effects.

luckyno137• 12 years ago

If this[1] research leads anywhere, we may not need totally new drugs. Only modify the existing with polymers.

[1]http://www.sciencedaily.com/releases/2014/04/140414154454.ht...

spuz• 12 years ago

Most antibiotics are not created but discovered. They are often species of fungus or other microorganisms that happen to attack certain kinds of bacteria. Take any place on earth where you might find microorganisms, grow them in a culture and then test their effects until you find one with the desired properties (kills bacteria but not human cells) and then you might be able to develop a new drug from it. The problem is we're running out of places to scoop up microorganisms from and the newest drugs are being made from fungi found deep in the most inaccessible caves underground for which bacteria above ground has not developed a resistance to. It's an evolutionary arms race which we're ultimately destined to lose which is why we need to find better ways of killing bacteria.

mullingitover2• 12 years ago

Couldn't evolution be accelerated in the lab? If the bacteria can evolve a way to thwart a fungus' defense, wouldn't it stand to reason that the fungi could evolve a new defense as well?

PeterisP3• 12 years ago

I'd go a step further - at some point, there will be NO possible new antibiotics to develop or design. At the core, the concept of antibiotics depends on bacteria having a sufficiently different metabolism than our own cells, so that some compound disrupts internal processes of bacteria without affecting the similar process of 'good' cells. We have found a couple such metabolic pathways, and have various drugs targeting them. The problem is that once bacteria become drug-resistant, i.e., mutate so that they use a bit different chemistry, most likely more similar to our cells (obtained from our own DNA?) - then you can't do that anymore.

Perhaps there are some new antibiotics to be found, perhaps there aren't; but in any case there's an end of the road somewhere. After that, only radically different mechanisms would work - vaccines, phages, nanobots, something else, but not antibiotics.

refurb9• 12 years ago

There are plenty of bacterial targets that we haven't even started to explore. Many of the current antibacterials work by interrupting cell wall synthesis. There are many different protein involved in cell wall synthesis. Stop anyone of those from working and you have a new antibiotic mechanism.

Fomite5• 12 years ago

We are creating new versions of what we have already. When you hear something referred to, for example, as a "beta-lactam antibiotic", what that actually means is a more creative version of penicillin. We tack new functional groups onto antibiotics to try to outpace resistance mechanisms, but its a stalling tactic, not a solution.

New antibiotic classes are hard to find. You need to find compounds that are lethal to bacterial cells (but not our cells) that there's no pre-existing immunity to. That's an extremely tall order, and we've run out of easy sources for those compounds.

kayoone• 12 years ago

So every few weeks we get these news but this isn't reversible anyway i guess. Does this basically mean a lot more people will die from simple infections starting 1-2 years from now ? How likely is it that new antibiotics will be developed ? By reading articles like these it sounds like we are facing a massive increase in deaths from illnesses, yet the general public doesn't seem to care much. Genuinely curious.

refurb9• 12 years ago

Does this basically mean a lot more people will die from simple infections starting 1-2 years from now ?

No, the problem is not that severe right now. In fact, some of the antibiotic resistant infections have decreased over the last few years.

This is something we need to worry about 5-10+ years from now. It is inevitable that bacteria will become resistant to current antibiotics. The only way to keep ahead of them is to create new antibiotics.

midas0078• 12 years ago

Exactly. But because of the difficulty, time and capital requirements, this is something that can't be left to the market economics. It will be too late by the time we need them because of the years it takes to develop a single new drug. This is a "going to the moon" type thing that needs to happen if we intend to survive. Because that's what's at stake.

DanBC2• 12 years ago

People are already dying from simple infections - about 25,000 people per year die in europe from anti-biotic resistant infection.

The European Centre for Disease Prevention and Control estimates that antimicrobial resistance (AMR) results each year in 25 000 deaths and related costs of over €1.5 billion in healthcare expenses and productivity losses.

http://ec.europa.eu/health/antimicrobial_resistance/policy/i...

ams61102• 12 years ago

I have long thought that humans (at least those living in the first world) had developed civilization to a point where natural selection was not really operating anymore. We can shelter ourselves, feed ourselves, and cure illnesses and injuries so well that almost all of us live to reproduce and raise our children to the point where they can take care of themselves. We haven't even had a large-scale war in the time that most of us have been alive. But on evolutionary timescales, we've really lived this way for only the blink of an eye. So maybe I'm wrong. This is a reminder that we live in a larger ecosystem that we really have a lot less control over than we might think. Nature has a way of keeping things in balance, and it's never pretty.

tokenadult2• 12 years ago

Here is a link to the World Health Organization media release[1] about the new WHO report, which links to a fact sheet summary[2] of the findings, and to the full report.[3] What's new here is the comparative data from different countries. It has been known for a while that multidrug-resistant tuberculosis is a grave problem in India,[4] for example, but the new report makes clear that antibiotic-resistant microorganisms that cause major human disease are present all over the world.

Some of the other comments posted here ask, well, what can we do about this? A submission to Hacker News from 189 days ago linked to a PBS report about the views of a Centers for Disease Control and Prevention epidemiologist in the United States[5] who advocated specific policy changes, some of which have been adopted since then. The discussion of that submission (including one of my highest-karma-ever comments[6]) provides more perspective on some biological evolution issues that are being brought up again in today's discussion here.

[1] http://www.who.int/mediacentre/news/releases/2014/amr-report...

[2] http://www.who.int/mediacentre/factsheets/fs194/en/

[3] http://www.who.int/drugresistance/documents/surveillancerepo...

[4] http://online.wsj.com/news/articles/SB1000142405270230344420...

http://articles.economictimes.indiatimes.com/2013-06-23/news...

http://www.iom.edu/Reports/2012/Facing-the-Reality-of-Drug-R...

http://www.tbcindia.nic.in/pdfs/RNTCP%20Response%20DR%20TB%2...

[5] https://news.ycombinator.com/item?id=6599040

[6] https://news.ycombinator.com/item?id=6599795

chez174• 12 years ago

In America, the number one thing you can do is stop eating factory farmed meat. That is a huge contributor to antibiotics resistance. Either eat mainly vegan or spend the few extra dollars to buy meat that isn't gross. Remember, it is MORE EXPENSIVE in the long run to buy that cheap meat. When you have a routine infection that can't be cured with antibiotics, the hospital bills will be far more then the few dollars you saved. Eat less meat. Oh, and you'll massively reduce your carbon footprint as well, and you'll use less land and water, and you'll be healthier (if you cut out red meat). It really is a no brainer.

mef• 12 years ago

Citation for these claims?

Edit: here's one article about the use of fluoroquinolones on poultry contributing to the increase of fluoroquinolones-resistant Campylobacter http://www.sciencedaily.com/releases/2012/04/120405131431.ht...

sschueller3• 12 years ago

I became allergic to penicillin because of U.S meat. I ate McDonald's almost daily for about 3-4 years.

JoeAltmaier5• 12 years ago

Doesn't the OP report mean its too late for this to matter? The bugs already exist.

ars5• 12 years ago

Remember, it is MORE EXPENSIVE in the long run to buy that cheap meat. When you have a routine infection that can't be cured with antibiotics

This is a common misconception. You can't get antibiotic resistance from eating meat that was treated with antibiotics.

The resistance occurs at the farm, and is washed into sewage etc. It does not occur in your body (from eating meat).

Avoiding meat raised with antibiotics might (slightly) help slow resistance, but it won't have any direct effect on you.

Remember it's the bacteria that become resistant not the person.

Houshalter4• 12 years ago

It's more expensive to society, not to the individual. And that's really debatable because the cattle are going to be fed antibiotics regardless whether you buy meat or not.

joelrunyon• 12 years ago

Eat less meat.

I never understand how "Stop eating factory farmed meat" means you have to "eat less meat" - why not just eat better sourced high quality meat?

It seems especially strange in a place like HN where you'd think that supporting the alternative grass-fed, non-factory farmers would be the entrepreneurial thing (and encourage more farmers to do it).

Meat is not the problem. The quality of the meat is. There are ways to solve that problem outside of eating less meat.

tokenadult2• 12 years ago

You make a bold statement in a thread that is based on a news report passing information on a new World Health Organization report. This thread includes a link to the full report,[1] and the report is a document with a good table of contents and is a searchable .PDF document besides. So you and everyone here can check my work when I say that your statement

In America, the number one thing you can do is stop eating factory farmed meat. That is a huge contributor to antibiotics resistance.

goes beyond the available evidence. But props to you for saying "In America," in that statement, because it is plain that in some other parts of the world, where the problem of antibiotic-resistant bacteria is most severe, the main cause of the problem is misuse of antibiotics in human medicine rather than meat production. (India especially is an example of that kind of problem.) More details of course can be found in the report. Methinks the statement is based just a bit too much on propaganda by vegan activists. I encourage everyone in our community of thoughtful discussion here to check the fine article and the linked references before radically altering their personal diets.

[1] http://www.who.int/drugresistance/documents/surveillancerepo...

volune• 12 years ago

time to buy an auto-clave

MichaelGG• 12 years ago

Sterilizing things you own is unlikely to help. You'd reduce any naturally acquired resistance, yet still remain vulnerable to getting infected from the entire world you cannot sanitize.

ScotterC2• 12 years ago

What are the limiters to creating new, stronger antibiotics to beat the resistant strains?

WalterSear• 12 years ago

Same as everything else: money and attention.

jacquesm• 12 years ago

The one limit seems to be that even if we did that the bacteria will evolve to become resistant against those as well. This is a game of leap-frog, we've been ahead for a while, now we'll be behind for a while and so on.

Think of it as a very slow arms race where on the one side there is intelligence and design and on the other there is the lottery driven mechanism of evolution that rewards the solver of the newly posed problem with a very large number of offspring.

The sides are surprisingly well matched and short of total eradication this is likely going to be the game for the next foreseeable future.

The bigger challenge will be to restrain ourselves to consume much more limited amounts if and when we do find antibiotics that work again in order to lengthen the time that we're 'on top'.

midas0078• 12 years ago

That's part of it, but this is something governments have to take leadership on right now. That will only happen with direct pressure. Waiting until it's the leading cause of death will be too late, because of drug development pipeline timeframes.

ScotterC2• 12 years ago

You'd think the companies behind creating this technology would welcome the never-ending arms race. They get to keep releasing products while their old ones get cannibalized for them.

DanBC2• 12 years ago

Stuff that kills bacteria has to also not kill people.

I saw a TV programme where scientists had a big tray of nutrient gel. They divided the tray into sections. The fist section was normal nutrient gel. The next contained a normal dose of antibiotic. The next section was 10x, the next section was 100x and the final section was 1000x a regular dose. This was far more than humans could tolerate. They stopped at 1000x because that was the limits of solubility - they couldn't disolve more antibiotic into the gel.

Scientists then dropped a bit of e.coli on the normal gel and set their time lapse cameras.

In just a few weeks the bacteria had evolved to live on all sections of the gel.

(This was a BBC 'Horizon' programme called "defeatng the superbugs")

arel• 12 years ago

That was a pretty shocking experiment. It's visible here 18m40s in:

http://www.dailymotion.com/video/xz0yb2_bbc-horizon-defeatin...

ronaldx3• 12 years ago

Worth noting: the bacteria at the end are not the same as the bacteria at the start.

Antibiotic acts on a particular mechanism to kill the bacteria. In order to overcome an antibiotic threat, bacteria have to either modify or drop any functions associated with that mechanism.

If any of those functions help them to infect humans, then the bacteria at the end of the process will be generally less able to infect humans.

majkinetor5• 12 years ago

Antibiotic resistance is a fact, what else can you expect given the game rules. What is less well known is that majority of people do not need antibiotics anyway and that majority of those who were taking them probably didn't need them too. Advice that recommended AB's before for stuff like otitis, helicobacter infection or even common cold (given for this disease because of opportunistic infections) is now changing without any problems, if anything, for the better.

AB's should be saved for those few moments in life where you really need them and is not something you want to do every few months like majority of people, particularly kids.

There are far better ways to strengthen your body and immune system without risks that are overwhelming with AB's (which are way better known today after we have some bits of microbiome) - nutrition and supplements. Even measures like using viruses as antibiotics are probably better then popping AB's like candies.

This news is probably beginning of the "next big big pharma thingy" that will come to rescue and will typically, yet again, use inappropriate tool for the job. The only good that will come out of it are probably not going to be, however, lives saved but science advancement.

midas0078• 12 years ago

On a personal note, my mom is still under the weather, having stuck to three different courses of antibiotics for a simple nasal infection.

It's frightening when this becomes the norm, not the exception because we're basically running out of options by natural selection moving faster than research.

We need a crash program to develop antibiotics before it's too late.

k-mcgrady3• 12 years ago

Are there any potential alternatives to antibiotics? For example could nanotechnology be used?

majkinetor5• 12 years ago

Yes, bunch of alternatives:

- bacteriophages (viruses that kill bacteria) - vitamin C for some bacteria, vitamin D, other supplements like MSM. Most must be used in megadoses for this effect. - plant AB's (onion, black pepper, curcumin, the list is enormous and probably infinite)

jmpe• 12 years ago

There's a very good documentary about bacteriophages:

http://www.youtube.com/watch?v=U6sZ7E9Hh-Y

It's history is muddied, mainly because of money & politics.

Fomite5• 12 years ago

Bacteriophages, while fun, and something I once wanted to work in, are nowhere near as "point and click" efficacious as antibiotics are, even under the most optimistic scenarios.

RV86• 12 years ago

Best case scenario is that we find a way to get back in front of the mutations, but even that would just be buying time before the bacteria adapted again. On a long time scale, it's hubris to think we can stay in front indefinitely. We'd be better off improving our relationship with/attitude toward death on the whole.

patrickdavey• 12 years ago

Yip, this is definitely a serious threat, one that will affect the rich in ways that climate change won't so immediately do. Probably a good thing in terms of finding a solution ;)

I did come across (I forget where) a very interesting talk which was outlining new techniques in antibiotics. The basic idea was that instead of straight out killing them (in which some breed resistance) instead you get in the middle of their chemical signals and basically tell them to attach before they've reached the point where the immune system won't win.

Still, bacteria being bacteria they'll probably work their way around it, but maybe rewriting your messaging system is a little harder than breeding resistance.

HarryHirsch• 12 years ago

Another worrying development: Pfizer buying Astra-Zeneca.

It's not to streamline drug development, the deal is a tax dodge in its entirety. Some lovely commentary down the hallway, in the Pipeline: http://pipeline.corante.com/archives/2014/04/28/pfizer_and_a...

Scientists worry about the cuts to NIH funding, but the cuts to pharmaceutical research are ten times more worrying - who is going to develop the compounds to replace the current set of antibiotics when they have become useless? Wall Street is entirely unequipped to deal with this question; there are things that cannot be bought with money or at market, and scientific progress is one of them.

refurb9• 12 years ago

Pfizer got out of antibacterial R&D a few years back.

And I have to take issue with your comment "scientific progress can't be bought with money". What do you call all the new drugs that have been produced in the last century? It wasn't done by the government. Yes, basic research funded by the NIH advanced basic science, but it didn't put those pills in a bottle.

Fomite5• 12 years ago

"who is going to develop the compounds to replace the current set of antibiotics when they have become useless" - Academic science. Most of the basic, foundational research in clinical medicine is done by academia, not the pharmaceutical industry.

lotsofmangos• 12 years ago

who is going to develop the compounds to replace the current set of antibiotics when they have become useless?

IBM, with nanotech PET - http://www.research.ibm.com/articles/nanomedicine.shtml#fbid...

And I know it is viruses, not bacteria, but MIT's DRACO is also pretty cool - http://www.ll.mit.edu/news/DRACO.html

lightblade• 12 years ago

Instead of developing more antibiotics, can we reengineer these disease bacterias with a kill switch built in? Then release them into the wild to compete with non-engineered species and eventually displace them?

slinkyavenger• 12 years ago

You would have to also engineer an evolutionary advantage - something that would make them likelier to survive in the wild than their non-engineered counterparts. Building in a 'kill switch' by its very nature gives engineered bacteria a huge disadvantage, meaning there'd have to be something else making them more likely to reproduce.

It would probably be a better use of time engineering the bacteria to be harmless to humans, negating the need for a course of drugs to kill it off.

jmzbond• 12 years ago

I think to make a dent in this problem we need to change many aspects of our culture and how we live: 1) that any annoying problem should have an immediate and rapid solution so that we can get on with our lives, 2) that we as people need to live in a bubble ecosystem from the rest of the natural world.

1) I stopped taking most medicines awhile ago because I realized that by relying on symptomatic relief, I wasn't actually listening to the needs of my body. Now when I feel a cold coming on, I start sleeping at 9pm, eat healthier, and reduce stress levels. Instead of popping a pill, I've learned to recognize that I'm deviating from "healthy" activity and had better get on track. The result? I haven't been sick in years and years, and am probably overall a more healthy, less stressed out person.

2) I often wonder to what degree language affects perception. Like the word dirty having such a negative stereotype yet so associated with dirt (i.e., soil). I feel like we often want such high levels of sterility that are just absurd, and do more to harm us in the long run. As part of a project, I interviewed farmers who said food safety experts are so draconian they expect cannons that shoot into the air to prevent birds from flying over with the risk of droppings. One food safety inspector commented that the farm was too "dirty." Can you imagine? I understand we don't want to get sick, there are bad things in the world, but I think we're pushing too far into the other end of the spectrum.

3rd3• 12 years ago

There are multiple kinds of antibiotics, right? Couldn’t one globally rotate the different kinds of antibiotics so that germs have a harder time adapting to it?

refurb9• 12 years ago

Not really. Resistant strains of bacterial exist everywhere. Every area in the world needs the full range of current antibacterials.

The other thing to remember is international travel. It's pretty easy for someone in North America, who has a resistant bacterial infection, to hope on a plane and spread it around Europe.

gabriel34• 12 years ago

I would like to know why wouldn't it work to simply flood hospital rooms (any time they were empty) with lethal (for bacteria) doses of non-ionizing radiation (or any kind that doesn't go through walls and don't make said walls radioactive) so that those pesky tolerant strains have a really hard time propagating

refurb9• 12 years ago

Most of the transmission of infections is from human to human contact. Yes, bacteria can reside on equipment and facilities, but we have adequate measures to deal with that.

As an interesting aside, more and more copper is being used in medical equipment as it is naturally antibacterial.

http://en.wikipedia.org/wiki/Antimicrobial_properties_of_cop...

chris_va• 12 years ago

(source: doing research into this)

For those with a computational/hacker background wanting to make a difference:

There is actually a lot of opportunity in the Computational Biology/Drug Development/Genomics space, with the caveat that it is a very difficult field (especially for company creation). It's a lot easier for CS folks to build another no-SQL database than it is to build a ML framework for, say, cancer prediction, but the opportunity is there. A lot of folks in this space come from the bio side, and teach themselves programming. Very few folks come from the CS side, and partner with the biologists. As a result, there is a giant gap between what is possible for a computer scientist and what is currently being executed. The state of the art in this space will probably make you all very sad.

I will pay $$ for engineers to work on this:

I have a side project working with an academic lab to develop a new antibiotic to target drug resistant beta lactamase (the primary protein associated with drug resistance) using a relatively novel computational approach. Sadly I've been distracted by my primary job, but if you are interested let me know. I am based in SF.

Houshalter4• 12 years ago

It's something I am interested in getting into, but I don't even know where to start.

jmcmichael• 12 years ago

One alternative to antibiotics that may work, but will have a tremendous difficulty in clearing the regulatory burden for approving new drugs and medical procedures, is bacteriophage therapy.[1]

Nobody's going to fund or approve this in the West anytime soon:

- phage therapists often use cocktails of phages to treat their patient. This type of treatment isn't even on the FDA's map - it even takes years for compounds of conventional drugs to be approved.

- phage therapists often prepare customized phage cultures to treat a specific patient's infection. The FDA would likely view this a a crime and prosecute anyone trying it.

- phage therapies have been around for over 100 years and are likely unpatentable. No drug company will fund R&D on the technique and no venture capitalist will fund a scrappy startup.

[1] http://en.wikipedia.org/wiki/Phage_therapy

DennisP3• 12 years ago

Then maybe we should change the way we regulate medical treatments. And maybe how we fund some of the research.

mvembu• 12 years ago

Homeopathy offers remedies for antibiotic resistant infections. I had a relative who had severe infection post knee replacement surgery. She was operated 4 times due to this infection as the bacteria is considered antibiotic resistant. A classical homeopath treated her to recover from the infection.

This is the bacteria that caused the post surgery infection

http://en.wikipedia.org/wiki/Acinetobacter_baumannii

Here is a relevant article on how Homeopathy provides an alternative to antibiotics

http://aurumproject.org.au/homeopathy-alternative-antibiotic...

Antibiotic resistance now 'global threat', WHO warns

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