• alec posted an update 8 months, 3 weeks ago

    Have we reached a tipping point where antibiotic become as useful as a chocolate fire guard?

    http://www.bbc.co.uk/news/health-43571120

    • Carefully targeted ABs will continue to a highly effective treatment many serious bacterial infections.

    • “He … picked up the superbug after a sexual encounter with a woman in south-east Asia.”

      Yeah, that’s the story he’s sticking to.

    • Not long ago my life was saved through a course of antibiotics, so I’m towards the view that they serve a useful purpose.

    • Not yet at tipping point but if large swathes of the agricultural sector keep shovelling tens of thousands of tonnes of ABs into the food chain every year, we’ll soon get there.

      When it happens we’ll have a lot more than STI’s and chest infections to worry about. For a start lots of cancer treatments and many types of elective surgery will become far too risky to be tenable.

    • No, nowhere close and we have lots of possible promising avenues for developing new ones which will need to be used more responsibly. Doing so is economically, politically and technically very difficult but not impossible.

      • It might help if they weren’t freely available without prescription in much of Europe and the rest of the world.

        • I was treated in a Swiss hospital for cuts in the summer. After being patched up, I had the following conversation with the doctor

          Doctor “Do you want antibiotics”

          Me “I don’t think so, do I need them?”

          Doctor “No….ah, your British. Like the Swiss you use antibiotics wisely. The French and Italians always ask”

          • For once (every rule has an exception), the eu could really interfere in a beneficial way. Ban whole herd preventative antibiotic use and make them prescription only in the whole of the eu. Then start applying pressure through the WHO globally. I think we might regret this more than climate change in a few decades.

          • On a related note, I had a work colleague with an infection try to fulfil his (USA issued) prescription in Holland… the Dutch doctor politely explained that the surgical grade antibiotic perscribed was equivalent to a bazooka to kill a butterfly and adjusted the prescription.

            ABs do seem highly overprescribed in some countries.

    • Easy availability is a big problem; you can walk into a pharmacy in Africa and buy one or two tablets. People don’t see why they should buy and finish an entire course, which is a waste of their precious cash.

      Anybody who fears the pharmaceutical industry will not solve the problem has no understanding of the money that’s at stake. An executive from AstraZeneca told me they are well down the road to developing viruses, which will infect those bacteria and kill them.

    • Use within farming in southern Europe is off the scale and completely ignored in farm legislation by the eu. The chemical and medical sector are the biggest eu lobbyists though.

      Apart from the fact there is a knock effect to us medically in future resistance, I wouldn’t eat the meat from most European countries.

      • One tonne of amoxicillin would provide over 95,000 courses (note courses, not doses). Conservative estimates currently put the agricultural sector as using over 100,000 tonnes of ABs. The vast majority of this usage isn’t targeted, it’s prophylactic as even very minor infections have a relatively large impact on weight gain in livestock. It’s worth remembering that there isn’t necessarily a cut off between animal disease and human, the worries about avian bird flu haven’t gone away. Also worth noting that active AB’s are excreted so the problem isn’t contained within the dosed animal.

        Meat consumption is on the up in large developing countries like China and India. China’s meat consumption has gone from about 15 kg p.a, per person in the 80’s to 65kg today and a projected increase to 95kg by 2030. This problem is obviously going to get worse.

        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5120092/

    • The economic problem with developing antibiotics is that for there to be a return for a business they have to sell in volume before the patent expires yet no responsible regulator will allow a powerful novel antibiotic to be used for anything but the hardest cases so we need a new model for funding development and extracting value.

      The political problem is spending billions on a development program for something we’ll ideally hardly ever use, we probably also need to do it in collaboration and regulate collaboratively and globally. So far we show little appetite for that kind of spending except oddly on doomsday weapons and we’re currently stepping away from large scale regulatory collaboration. There are alternative approaches but none of them really an easy sell to business or electorates.

      One part of the technical problem is apparently culturing the organisms we’ve not really looked at closely yet but that are suspected to produce promising compounds, things like microbes found in soil do not survive well outside their ecosystem so isolating them for study and exploitation is proving difficult.

      That summarises poorly all I can remember form a lecture I attended a few years back.