It’s refreshing to see a major news outlet discussing collateral damage and not just resistance. Over the past decade, 99% of the time antibiotic overuse is covered and warned about it’s always only in regards to resistance.
It’s a good article that also doesn’t spread the common misinformation of “just take some probiotics and fermented foods after antibiotics and you’re good to go”.
Swallowing an antibiotic is like carpet-bombing the trillions of microorganisms that live in the gut, killing not just the bad but the good too, said Dr. Martin Blaser, author of the book “Missing Microbes” and director of the Center for Advanced Biotechnology and Medicine at Rutgers University.
“I think the health profession in general has systematically overestimated the value of antibiotics and underestimated the cost,” Dr. Blaser said.
No shit. And it has spread like a virus to the general populace as well. The majority of people seem mentally addicted to antibiotics and think they’re going to die if they don’t get an antibiotic for every minor issue.
- Find out if you really need an antibiotic.
- Ask for the shortest course.
- Rethink probiotics.
I appreciate the NYT for finally helping spread this.
Just yesterday people on Lemmy were cheering about AI discovering new antibiotics. When I shared info about the concerns of collateral damage, the responses were more unintelligent and close-minded than on reddit. Extremely depressing.
For more info on this subject there’s a wiki and forum at https://humanmicrobiome.info.
I tried to find other studies going into this in more detail, especially in regards to targetted antibiotics.
Am I correct in assuming that the future hence lies in getting antibiotics far more target-specific? I don’t know how it is in other parts of the world, but over here broad-spectrum antibiotics are already used as a last-ditch effort, usually when there’s no time to truly figure out what a patient is suffering from because of their extremely bad overall state. But I assume broader antibiotics are more common around the world?
IMO the future lies in replacing antibiotics with adding instead of subtracting: phages/phage cocktails, FMT, etc. There’s also a massive amount of antibiotic overuse for a variety of reasons, including public ignorance about their necessity (lack of) and harms, and emotional thinking and lack of consequences for people in the medical system.
Phages were given up on because antibiotics were an easier solution and the consequences aren’t always immediately obvious. But that decision has likely played a major role in getting to the current chronic disease crisis.
Sounds interesting.
I will say that having had two eye infections, one resulting in a surgery and the other being solved with antibiotics before it got to bad, give me all the antibiotics, I don’t care, before you make me get that surgery again. Straight outta Saw, that shit. But that’s an edge case of course.
The trouble is that, as a whole, antibiotics that work against resistant organisms are inherently more broad. Bacteria develop resistance by either mutating the target site of an antibiotic, decreasing/removing the expression of a target site, increasing removal of the drug from the bacterial cell, or preventing entrance to the cell.
These changes are relatively antibiotic agnostic (in the sense that they do not target one specific antibiotic, they target a general chemical structure which is shared among a class of antibiotics), and in most cases, if you develop a drug which is able to circumvent one of these problems, it will continue to work on the wild-type bacteria of that species (by definition making it broader). I am unaware of any antimicrobial which is effective against drug-resistant organism which has no efficacy against the wild-type of that organism.
I agree with the other poster that phage therapy likely represents a future avenue for antimicrobial resistance. Unfortunately antibiotics will (at least for the foreseeable future) be required as to effectively use phage therapy you must identify the organism and then select appropriate phages which will kill the bacteria, which takes time that a sick patient may not have without antibiotics. We also haven’t quite figured out how to keep our immune system from eradicating the bacteriophages, particularly for infections requiring longer treatment such as endocarditis.
There is a currently existing technology which allows for genetic identification of bacteria and fungi in positive blood cultures approximately 1 day faster than classical methods of culture and biochemical testing. There is active research into changing these tests slightly to be able to function on other body fluids (pus, pulmonary secretions, urine, etc) as well as to be able to function on fresh blood samples instead of waiting 1-2 days for the culture to become positive from bacterial growth, but these technologies are not ready for clinical use, and until they are, broad spectrum antibiotics will be a necessity.
as to effectively use phage therapy you must identify the organism and then select appropriate phages which will kill the bacteria, which takes time that a sick patient may not have without antibiotics
Phage cocktails, FMT, etc… Also, we should get better at speeding that process up if we fund research for it, but we’ve been instead continuing to rely on antibiotics.
We also haven’t quite figured out how to keep our immune system from eradicating the bacteriophages
Citation? I don’t recall that being a thing… phages are ubiquitous in the human body. As much or more so than bacteria. They are the natural way bacteria are kept in check.
Section 2, first paragraph. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6956183/
At their core phages are viruses, there is no reason to expect the host immune system to not recognize them as foreign and attempt to eradicate them outside the GI tract, where most serious infections occur. The GI tract, skin, and to some extent the lower UG tract will likely tolerate these through mechanisms we tolerate colonizing bacterial flora, but colonization, even with antibiotic resistant organisms, is not a primary indication for empiric treatment for eradication. In fact there are some studies that attempting to sterilize the UG tract in colonized asymptomatic women promote symptomatic UTI.
These colonizations become problematic when growth becomes unchecked and infection develops, or they seed infection into another compartment. There is no reason to think something as foreign as a bacteriophage wouldn’t be recognized as foreign in a sterile space (kidneys for pyelonephritis, liver abscess from migrated gut flora, endocarditis, etc) where these serious infections occur.
This ties in nicely with your suggestion of phage cocktail therapy. Yes, that can expedite the delivery of phages, however excessive use of phages could result in anti-phage antibodies, limiting future treatment in a method similar to the development of anti-drug antibodies in epoeitin analogues, insulin therapy, antivenin, and anti-inflammatory antibody therapies like adalimumab (Humira)
