[TudoBem]

This is seriously fucked up. It could permanently change the way I do things.

http://news.yahoo.com/gonorrhea-could-jo...00481.html


The arms race between humanity and disease-causing bacteria is drawing to a close and the bacteria are winning. The latest evidence: gonorrhea is becoming resistant to all standard antibiotic treatment.

Gonorrhea is one of the most common sexually transmitted diseases in the world with about 600,000 cases diagnosed in the U.S. each year. A few years ago, investigators started seeing cases of infection that did not easily respond to treatment with a group of drugs called cephalosporins, which are currently the last line of defense against this particular infection. Now, the number of drug-resistant cases has grown so much in the U.S. and elsewhere that gonorrheal infection may soon become untreatable, according to doctors writing in the February 9 issue of the New England Journal of Medicine.

If it seems to you that the drumbeat of bad news with respect to antibiotic resistance has become louder and more insistent in the past few years, you would be right:

Researchers reported in January that they had for the first time collected samples of E. coli bacteria from the Antarctic with particularly dangerous drug-resistance genes. The dispersal of drug resistance genes via E. coli is particularly worrisome because that bacterium lives normally in the human intestine along with thousands of other species of bacteria. From that fertile ground, there s practically no stopping the widespread dissemination of bacterial resistance genes.

Meanwhile reports surfaced in India of several cases of totally untreatable tuberculosis although further investigation suggested that they may have merely been extensively drug-resistant TB.

Hospitals in New York City are now struggling with how to deal with a deadly pneumonia that resists treatment with powerful, last-resort antibiotics called carbapenems, as reported by Maryn McKenna in a feature for Scientific American, entitled The Enemy Within: A New Pattern of Antibiotic Resistance (preview version here). Indeed, figuring out how to deal with the problem is the subject of an upcoming seminar on carbapenem resistance, at the New York Academy of Science on February 17.

Scientific American has actually written a fair amount on the problem of antibiotic resistance in all its guises. Check out our in-depth report on the Crisis of Antibiotic Resistance, which I just pulled together, for more detail.

[TudoBem]

Incidentally, 3 years ago when I was living in Spain I contracted a very aggressive strain of pneumonia that led to sepsis and kidney failure. I was hospitalized in the ICU, and didn't respond to any standard antibiotic treatment. Fortunately, a cocktail of 3 of the most potent last line antibiotics was given to me by IV, and I recovered, and after a couple weeks of utter soul sucking misery, left the hospital.
I don't think there is any way to avoid a very very scary future, even if you were to go live on a remote island in the South Pacific, and live off the land and have no contact whatsoever with humans. There would still be ways for the mutated bacteria to get to you. I guess I'm going to have to look into making a private space station.

[Charlie Foxtrot]

And in my opinion the worst is even if you don't ever take any antibiotics you can get a super strain of one of these bacteria. I feel is is not fair, at all, and needs to be fixed now. How about everyone stops taking antibiotics, for good?
Or maybe stop feeding them to livestock with every meal, just to keep them from maybe getting a mild illness. The drive for comfort and profit seems to be catching up with humanity.
Complete stopping may be an impractical way to go about things but then again I don't think mutating strains of bacteria to the point we can't kill them is too swift either.
I personally feel people are so used to pampering and feeling great all the time that we have possibly created the method of our own extinction. Just my .02...

[Caligula]

Antibiotics need to be regulated more heavily or they'll end up not working at all.

In many third world countries you can buy that shit over the counter.

People will take them just because they feel they need to clear out their systems for no good reason.

[Tuthmosis]

You have hand sanitizer ("Purell"), anti-bacterial soaps, and all that shit to thank--I'm convinced of it.

[Screwston]

This is scary. What happens to your dick if you never get rid of it?

[Charlie Foxtrot]

(02-09-2012 01:01 PM)Caligula Wrote:  

Antibiotics need to be regulated more heavily or they'll end up not working at all.

In many third world countries you can buy that shit over the counter.

People will take them just because they feel they need to clear out their systems for no good reason.

Exactly, here in Peru you can buy ciprofloxcine, not sure of the spelling there, for about .05$ US, each. With no prescription...

[Caligula]

(02-09-2012 01:33 PM)Charlie Foxtrot Wrote:  

(02-09-2012 01:01 PM)Caligula Wrote:  

Antibiotics need to be regulated more heavily or they'll end up not working at all.

In many third world countries you can buy that shit over the counter.

People will take them just because they feel they need to clear out their systems for no good reason.

Exactly, here in Peru you can buy ciprofloxcine, not sure of the spelling there, for about .05$ US, each. With no prescription...

There's no easy solution because with poor medical infrastructure it's a good thing that life-saving drugs are available on the cheap to poor people.

[WanderingSoul]

(02-09-2012 01:27 PM)houston Wrote:  

This is scary. What happens to your dick if you never get rid of it?

This is what I was wondering. Will your body eventually cycle it out, or does your dick straight fall off? Terrible thoughts lol.

[La Familia]

This is what happens when doctors and patients get careless--doctors prescribe antibiotics unnecessarily, patients do not finish their entire prescription, patients saving their last pills or giving them to their sick friends. It was inevitable; however, now is the best time to take a chance on newer forms of antibiotic treatment. That, or they start cycling antibiotics to keep the bacteria "guessing" each generation.

[gringochileno]

This is one of those problems that has multiple causes and will require multiple solutions. Just off the top of my head I can think of several:

• Antibiotic use in livestock needs to be stopped completely or heavily restricted. I bet some of you didn't know that 70% of antibiotics are used in livestock, almost all of which are given to healthy animals because it promotes their growth, not because they're sick. The research suggests that this may be the single most important factor driving the development of resistance. It may make meat a little bit more expensive but the alternative is unimaginably large loss of life. Europe has already done this to a large extent and they haven't imploded from it.
• Drug companies have little incentive to put money into R&D for new antibiotics. Antibiotics don't tend to be very good money-makers because you prescribe them once, finish the course, and then you're done with them. The big bucks are in medications for chronic diseases which have to be taken for years or even a lifetime, and as you can guess a disproportionate amount of funding goes into researching new medications of this kind at the expense of drugs that are sorely needed but not as profitable. The result is that there are very few new antibiotics coming online while resistance continues to march forward. I think we need an aggressive program of subsidies to counteract this similar to the orphan drug program that provides funding for treating very rare diseases.
• Patients are really bad at taking antibiotics. Most prescribed courses of antibiotics aren't completed properly, which means you only kill the most susceptible bacteria and select for resistant organisms. Often patients will get standard antibiotics for a common infection, stop taking them when they feel better, and then end up in the hospital with a resistant strain that we need to pull out second- or third-line agents to defeat. Do this enough times and eventually you'll get bugs that not even our biggest guns can kill. Developing once-daily extended release dosings of drugs that are easier to adhere to, as well as improved education on the importance of finishing every course of antibiotics once it's started, may help mitigate this.
• Doctors prescribe a lot of inappropriate antibiotics. The classic example of this is someone who comes in with a cough for a week or so. This is 90% likely to be a viral infection that antibiotics can't treat, but patients often have their heart set on walking out of there with some pills, and too often doctors will take the easy way out and just write a prescription rather than take the time to explain why antibiotics aren't needed, which is likely to just piss off the patient anyway.
• We do a very poor job of protecting our second-line and "last resort" antibiotics, especially in hospital settings. Resistance to powerful drugs like fluoroquinolones and vancomycin is developing rapidly because we're too quick to deploy them empirically in hospitalized patients, when a less powerful agent would do the job most of the time. If we don't save these drugs for when they're really needed they'll lose their effectiveness.
• We use the same antibiotics over and over again. There's some evidence that doing coordinated "crop rotation," where drugs are periodically taken out of use and replaced with equivalent agents to allow susceptibility to go down, can slow the development of resistance. Obviously this is hard to coordinate when you don't have an advanced healthcare infrastructure.
  

(02-09-2012 12:55 PM)Charlie Foxtrot Wrote:  

And in my opinion the worst is even if you don't ever take any antibiotics you can get a super strain of one of these bacteria. I feel is is not fair, at all, and needs to be fixed now. How about everyone stops taking antibiotics, for good?

That would kind of defeat the purpose, wouldn't it? The whole point of combating antibiotic resistance is to make it so we can still use these drugs and not go back to the pre-antibiotic era when common infections (the kind you would never worry about today) were one of the leading causes of death. You seriously would not want to do that--antibiotics are one of the single greatest discoveries in human history in terms of the number of lives saved and the improvement to quality of life (the only things I can think of that beat them out are vaccines and sanitation).

(02-09-2012 01:17 PM)Tuthmosis Wrote:  

You have hand sanitizer ("Purell"), anti-bacterial soaps, and all that shit to thank--I'm convinced of it.

Those actually haven't been shown to increase resistance. The concern with anti-bacterial soaps is that they can kill the "good" bacteria that are naturally present and leave room for opportunistic infections to set in.

The fact that this is a multifaceted problem, many of whose causes are very widespread and hard to deal with, is what makes the issue of antibiotic resistance so challenging. At the same time, it's absolutely critical that we take steps to slow the development of resistance because the emergence of bacteria that resist all of our drugs is one of the greatest public health threats we face. It doesn't get nearly enough attention and the fact that anyone opposes obvious actions like stopping routine antibiotic use in livestock is completely absurd.

[Caligula]

Nice breakdown gringochileno, you clearly know your stuff.

[Chad Daring]

My mom is a nurse and one of the things she used to drill into me was FINISH medication. So many people "feel better" then stop and the strains start to get wildly OP, as Gringo pointed out. This isn't an arms race its natural selection. The bacteria are just smarter then most humans.

[WesternCancer]

(02-09-2012 01:01 PM)Caligula Wrote:  

Antibiotics need to be regulated more heavily or they'll end up not working at all.

In many third world countries you can buy that shit over the counter.

People will take them just because they feel they need to clear out their systems for no good reason.

Exactly. One of my profs last year showed some statistics from thailand and the resistance went from 0-5% to a level so high taking antibiotics is pointless in only a few years. People need to understand that you can't just throw antibiotics at everything and you'll magically get better.

[altman]

As a scientific professional, let me state that this is something everyone should be cautious about. Anyone in the game community who blows this off as something only affecting gays and poor people is an idiot. While there's only a 0.5% chance in men and about a 2% chance in women of gonorrhea worsening to life-threatening conditions, many survivors of it end up becoming sterile from urethral scarring or other forms of damage.

For me, someone who wants to have kids at some point, sterility is as bad as death.

[WesternCancer]

also to add to gringochileno's point

"Drug companies have little incentive to put money into R&D for new antibiotics. Antibiotics don't tend to be very good money-makers because you prescribe them once, finish the course, and then you're done with them. The big bucks are in medications for chronic diseases which have to be taken for years or even a lifetime, and as you can guess a disproportionate amount of funding goes into researching new medications of this kind at the expense of drugs that are sorely needed but not as profitable. The result is that there are very few new antibiotics coming online while resistance continues to march forward. I think we need an aggressive program of subsidies to counteract this similar to the orphan drug program that provides funding for treating very rare diseases."

Its also not worth it in many cases for drug companies to make antibiotics because bacteria will become resistant so quickly to it due to the other points mentioned. The extreme amount of money it costs to produce a new antibiotic causes them to just not put much money into research, because of this people give the antibiotic companies bad reps claiming its greed. If they can't make an antibiotic that is useful for a long enough period to warrant the production of more/new antibiotics there is no point to make new ones. The company will fail and any other possible beneficial drug they could have made won't be made.

[gringochileno]

(02-13-2012 11:53 PM)WesternCancer Wrote:  

also to add to gringochileno's point

"Drug companies have little incentive to put money into R&D for new antibiotics. Antibiotics don't tend to be very good money-makers because you prescribe them once, finish the course, and then you're done with them. The big bucks are in medications for chronic diseases which have to be taken for years or even a lifetime, and as you can guess a disproportionate amount of funding goes into researching new medications of this kind at the expense of drugs that are sorely needed but not as profitable. The result is that there are very few new antibiotics coming online while resistance continues to march forward. I think we need an aggressive program of subsidies to counteract this similar to the orphan drug program that provides funding for treating very rare diseases."

Its also not worth it in many cases for drug companies to make antibiotics because bacteria will become resistant so quickly to it due to the other points mentioned. The extreme amount of money it costs to produce a new antibiotic causes them to just not put much money into research, because of this people give the antibiotic companies bad reps claiming its greed. If they can't make an antibiotic that is useful for a long enough period to warrant the production of more/new antibiotics there is no point to make new ones. The company will fail and any other possible beneficial drug they could have made won't be made.

Quite right. It actually gets worse, though. The new antibiotics that come out are usually used extremely sparingly as "drugs of last resort" in order to keep resistance from developing. Of course, patent protection only lasts for so many years, so by curbing the drugs' usage at first we severely limit the amount of money the pharmaceutical company can make on them since they're not able to sell enough of the drug during the patent protection period to recoup their R&D expenses. Ironically, more responsible usage practices designed to preserve the drugs' effectiveness winds up diminishing the incentive to develop new drugs. Yet another reason why the need for new antibiotics will always outstrip the incentive for companies to develop them without an aggressive subsidy program.