Medically inclined 'dopers...what's the deal with post-anti-biotic

For years I’ve been hearing about anti-biotic resistant bacteria, pan resistant strains and how more and more anti-biotics are becoming less and less effective. Also, that new anti-biotic drugs are very difficult to make and that new ones are very rare. So…what’s the deal? When do they think this will become a serious threat? What does the post-anti-biotic world look like? Back to the bad old days when an infection means a high probability of death? Is there any thing on the horizon that could mitigate this?

New antibiotics aren’t particularly difficult to make, but they’re not the most profitable drugs to make. So there hasn’t been a huge amount of research and development into them, because we’re just beginning to cross the threshold of panresistant bacteria. There are four panresistant that I know of, in China and Europe, and they’re not terribly widespread. Our challenge at this point hasn’t been that nothing works, it’s been finding the antibiotics that will still work against the bacteria you’ve got.

When (not if) panresistant bacteria become more widespread, one expects that research will step up a notch, because then demand (and thus profit) will be higher.

This is the problem with a profit driven business model for medications. Demand generally increases before production meets it. And in the gap, people die.

Here is recent thread on the issue.

I remember years ago reading about how the Soviets used bacteriophages instead of antibiotics. These are viruses that attack bacteria. So that’s one option.

Another obvious solution: If people are actually going to start dying of infections due to a lack of effective antibiotics (which apparently is really already starting to happen), then those patients (or more specifically, their insurance companies) will surely pay $750 a pill to save their lives, which would easily finance and incentivize further research. But where are you going to find a pharm CEO so foul of soul as to charge $750 a pill, ostensibly to finance further research? That would be utterly outlandish!

Oh, wait a minute . . .

Another approach is to try to find some altogether new kind of antibiotic that works in some manner utterly different from any theory-of-antibiotics we’ve seen so far. Possibly, even a new theory-of-antibiotics that bacteria can’t develop resistance to.

A couple of fairly recent articles I spotted with a quick google search:

From a Pile of Dirt, Researchers Discover New Antibiotic, Karen Weintraub, MIT Technology Review, January 7, 2015:

TL;DR: The relevant breakthrough here is that new “microfluidic device” which enables them to grow more kinds of soil bacteria in the laboratory, than they had been able to do before.

New Type of Drug Kills Antibiotic-Resistant Bacteria, Katherine Bourzac, MIT Technology Review, April 5, 2011:

ETA: Wonder how those nanoparticles would work, that they could poke holes in bacteria without poking holes in you too?

So, everyone seems to be asserting that it’s not a real problem but that it’s only a greed issue from Big Pharma that is causing a seemingly artificial scenario. Can I get some cites on that from mainstream sources, since this is GQ and all? I don’t see a lot of cites in the linked earlier thread either, just a lot of folks asserting that it’s so, that we COULD find new anti-biotics but that it’s pharma companies who just don’t see the profit.

And, by the way, I never said anything about “greed.” Unless you think trying to run a profitable business is de facto “greed.”

This isn’t really the forum for that discussion.

From what doctor friends have told me, the real problem is not likely to be that bacteria become to antibiotics what a tank hull is to bullets. But that they have to use stronger and more drugs, in higher dosage for longer periods. With the attendant side effects (antibiotics apparently are not good and easy in long term use). People who would have been sent home with a course of antibiotics, might now have to stay in hospital for treatment. More side effects. Some surgeries might no longer be possible.

Some doctors are going back to some old antibiotics whose use has fallen off, because the newly mutated bacteria are less likely to be resistant to those. Most of these are the old sulfa drugs that fell into disuse because they had to be taken several times a day and/or often had unpleasant side effects. That’s also the case with erythromycin and some of the older penicillins and cephalosporins.

I’ve used Keflex (a cephalosporin) in the past without any unpleasant side-effects that I’ve noticed. Is that still in use? Is it still an effective med? Is it something I should ever want to use again?

I especially want to have useful antibiotic options available in case I need them again that can be used instead of, e.g., Cipro or Levaquin or the like, since I NEVER EVER want to be treated with ANY fluoroquinolone! Them’s are DANGEROUS!

Yes, it’s still in use. I see it prescribed for scary infections that the doctor wants to start treating right away, rather than things that can wait two or three days while they test a sample to see what’s growing.

That’s the benefit and the drawback to cephalosprins…they’re broad spectrum. They kill a lot of stuff. So if the doctor doesn’t know what’s causing your infection, there’s a pretty good chance that a cephalosporin will kill it. But it’s also going to kill other bacteria in you that aren’t causing infections right now. So they tend to cause a lot of GI upset, they alter the gut flora and increase the risk of C. diff infections, and they (broad spectrum antibiotics) contribute the most to antibiotic resistance because they affect so many different kinds of bacteria.

I’m allergic to Bactrim and Cipro, so when I got a UTI a few months ago, I was more concerned about what I would be given than the fact that I was sick. The NP at the walk-in clinic gave me cephalexin, which caused NO side effects and in fact “cured” my infection after just 2 doses, and it nailed a sinus infection that I could feel brewing. :cool: I did, however, take it for the full 10 days.

Bactrim, whether PO or IV, is in fact one of the drugs that’s making something of a comeback.

Yes, they are renowned for some potential nasty side effects, but I have had both many times with only a little nausea, and even the nausea I only get sometimes.

Also called Septra, in case anyone out there in SDMB-land has been prescribed it. (I’ve also had that a number of times).

In case you are wondering, being a self-catheterizing paraplegic I get A LOT of bladder infections.

Hadn’t seen it trimethoprim/sulfamethoxazole referred to as Septra in ages!

I wince whenever I see Bactrim for a UTI. Yeah, it’s super popular. It also seems to be about as effective as cranberry juice* and Tic-Tacs. :rolleyes:

Haven’t seen that one, but I’ve seen the combo (trimethoprim and sulfamethoxazole) prescribed as two medications given at once. Any idea why there’s that miniscule dose of docusate in Septra? It’s listed as an “inactive ingredient”, and it’s certainly a much much lower dose than used as a stool softener. What’s it for?

Blech. I bet. Sorry. :frowning:
*Cranberry juice is not effective for treating UTIs. It may have some utility in preventing recurrent UTIs, but it won’t cure one once it’s started. (Tic Tacs probably aren’t effective either.)

Technically, docusate is a soap, so it’s probably in there to help the tablet dissolve faster.

Oooooooh… you may be right. Interesting!

Not sure how not particularly difficult to make new antibiotics are but the issue of trying to incentivize their development is being addressed somewhat:

The need however is greater for better antibiotic stewardship than for more and more new antibiotics. One infectious disease expert once famously put it: “The development of new antibiotics without having mechanisms to insure their appropriate use is much like supplying your alcoholic patients with a finer brandy.”

The move to use antibiotics much more sparingly, to not call every 7 day green URI with a headache a “sinus infection”, let alone treating colds with antibiotics, to demand a positive strep test before treating a sore throat, to at least discuss the value of “watchful waiting” for otitis media instead of automatically treating them, and then to treat them, and community acquired pneumonia, with simple Amox instead of expensivolosporin or -penum, is having a greater impact than new drugs will have, and that is with less than the best implementation so far.

FWIW, in peds I still see UTIs sensitive to Bactrim (TMP/SMX) the vast majority of the time. So long it works locally at least 80% of the time (which it still does in most communities I believe) it really should be first line pending culture results rather than facilitating the quicker emergence of uropathogens with resistance to a host of other antibiotics.

Immunizations against pneumococcus etc. also has made a huge impact. Cutting down on the routine use of antibiotics in the food chain will help too.