# The antibiotic apocalypse - how scared should we be? **URL:** \ **Category:** Factual Questions\ **Created:** [February 3, 2013, 12:02am UTC](https://boards.straightdope.com/t/the-antibiotic-apocalypse-how-scared-should-we-be/649164 "2013-02-03T00:02:20Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![Mdcastle](https://avatars.discourse-cdn.com/v4/letter/m/958977/32.png) [@Mdcastle](https://boards.straightdope.com/u/Mdcastle)\ **Post date:** [February 3, 2013, 4:56pm UTC](https://boards.straightdope.com/t/the-antibiotic-apocalypse-how-scared-should-we-be/649164/21 "2013-02-03T16:56:11Z")
Since we have a gazillion different antibiotics now, what would happen if we simply decided to retire X number for Y years. Would bacteria lose resistance? ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [February 3, 2013, 5:46pm UTC](https://boards.straightdope.com/t/the-antibiotic-apocalypse-how-scared-should-we-be/649164/22 "2013-02-03T17:46:22Z")
Likely not, unless there was some significant survival/reproductive cost to maintaining it. And there would only need be a small segment of the population that had maintained it to allow that resistance to spread rapidly across the world once the antibiotic was used again. That is also part of it of course. We are competing not against bacteria in one body, or one town, or one country; a beneficial (from the bacteria POV) any where in the world now has the potential to spread every pretty quickly. ---
**Author:** ![The\_Second\_Stone](https://avatars.discourse-cdn.com/v4/letter/t/bbe5ce/32.png) [@The\_Second\_Stone](https://boards.straightdope.com/u/The_Second_Stone)\ **Post date:** [February 3, 2013, 6:01pm UTC](https://boards.straightdope.com/t/the-antibiotic-apocalypse-how-scared-should-we-be/649164/23 "2013-02-03T18:01:00Z")
> [@deltasigma](#): > > It’s worth mentioning that we haven’t exactly been asleep at the wheel either. > > I think there is a general impression that our only type of immunity is the “acquired” kind that you get from being exposed to and hopefully surviving an infection. But we also have an older [“innate” immune system](http://en.wikipedia.org/wiki/Innate_immune_system) that can mount a response to almost any microbial threat - assuming that we’re healthy. This includes a whole host of strategies from macrophage cells that use chemical warfare to literally dissolve the enemy in a bath of highly reactive chemicals to things like [antimicrobial polypeptides such as cathelicidins](http://en.wikipedia.org/wiki/Cathelicidin) (which you need vitamin D to produce btw and may be part of the reason flu is more common in winter when there is less sun). > > This isn’t to say that multi-drug resistant bugs aren’t a problem, just that we’re far from defenseless if we do what we can to stay as healthy as we can. Agreed. However it is considered a tragedy every time the bacteria get the upper hand and kill us. We can kill 10^20 or more bacteria cells and they don’t even blink. ---
**Author:** ![bump](https://avatars.discourse-cdn.com/v4/letter/b/7c8e57/32.png) [@bump](https://boards.straightdope.com/u/bump)\ **Post date:** [February 3, 2013, 7:38pm UTC](https://boards.straightdope.com/t/the-antibiotic-apocalypse-how-scared-should-we-be/649164/24 "2013-02-03T19:38:11Z")
Another thing to consider (this is speculation, mind you) is that it’s entirely possible that the mutations that are handy in making bacteria resistant to various sorts of antibiotics are only an advantage when somewhat regularly exposed to them, and may be a disadvantage when not exposed regularly. In other words, if certain antibiotics aren’t used so much, it’s possible that the general bacterial populations may become susceptible to them again, at least until they’re overused again. ---
**Author:** ![smiling\_bandit](https://avatars.discourse-cdn.com/v4/letter/s/e9a140/32.png) [@smiling\_bandit](https://boards.straightdope.com/u/smiling_bandit)\ **Post date:** [February 3, 2013, 7:46pm UTC](https://boards.straightdope.com/t/the-antibiotic-apocalypse-how-scared-should-we-be/649164/25 "2013-02-03T19:46:14Z")
> [@DSeid](#): > > That has been part of the problem to date. Antibiotics are just not where the money is in pharma development. Pharmas are looking for the blockbuster product and that means something people will take every day for the rest of their lives. A product that you take for three to ten days at a time, rarely The chances and advantages of success are the bigger issue here. We’re not longer in the “find a new antibiotic and save thousands of lives” era. It’s more like “spend decades and billions and maybe find a slight variant which may possible help a few people” era. Even if your company were dedicated to the task, had an army of brilliant but completely selfless scientists willing to work night and day for pennies, and all the money in the world for equipment and tests, antibiotics aren’t the best use of your dollar. It’s more of a sideline you drop some cash into on the off-chance it produces something, while you put your focus on cancer treatments, genetics, and the major life-changing or -destroying syndromes. ---
**Author:** ![Busy\_Scissors](https://avatars.discourse-cdn.com/v4/letter/b/d78d45/32.png) [@Busy\_Scissors](https://boards.straightdope.com/u/Busy_Scissors)\ **Post date:** [February 3, 2013, 8:53pm UTC](https://boards.straightdope.com/t/the-antibiotic-apocalypse-how-scared-should-we-be/649164/26 "2013-02-03T20:53:00Z")
> [@Smeghead](#): > > Our track record actually hasn’t been great on that so far. It’s been a while since my last medical micro class, so I may have a few details wrong, but IIRC, science has only invented one antibiotic that can actually be called “new” - vancomycin, I think. All the other antibiotics out there are chemical variations on chemicals that were originally isolated from nature, and that’s why resistance to them has been so common and easily adapted. Bacteria have already been fighting these chemicals, or close cousins to them, for millions of years. We’ve invented a few classes of antibiotic that are distinct from natural products (vancomycin is a natural product btw) - but you’re right that natural products dominate the antibiotic landscape. Linezolid is a prominent non-natural example that was first in class in recent times, an oxazolidinone - sees heavy use AFAIK. The quinolones (e.g. ciproflaxin) would be another class not informed by any particular natural product. Whether a natural product-derived antibiotic would see more rapid resistance than a non-natural product one I am not sure - it’s an interesting question. Resistance would seem to boil down to mutations in the bacterium target - usually a protein, disrupting binding of the antibiotic agent. That can happen with equal facility for a natural or non-natural products. We can design structural features into our antibiotics to protect against metabolic vulnerability, but that’s addressing a different question to fundamental resistance of natural v non-natural products. ---
**Author:** ![bump](https://avatars.discourse-cdn.com/v4/letter/b/7c8e57/32.png) [@bump](https://boards.straightdope.com/u/bump)\ **Post date:** [February 4, 2013, 3:32am UTC](https://boards.straightdope.com/t/the-antibiotic-apocalypse-how-scared-should-we-be/649164/27 "2013-02-04T03:32:53Z")
> [@smiling\_bandit](#): > > The chances and advantages of success are the bigger issue here. We’re not longer in the “find a new antibiotic and save thousands of lives” era. It’s more like “spend decades and billions and maybe find a slight variant which may possible help a few people” era. > > Even if your company were dedicated to the task, had an army of brilliant but completely selfless scientists willing to work night and day for pennies, and all the money in the world for equipment and tests, antibiotics aren’t the best use of your dollar. It’s more of a sideline you drop some cash into on the off-chance it produces something, while you put your focus on cancer treatments, genetics, and the major life-changing or -destroying syndromes. For now… but when adults start dying of pneumonia and gangrene, and children start dying of scarlet fever and other diseases that are easily treated, you’d better believe that antibiotic research will become potentially a very lucrative line of research. ---
**Author:** ![Nippless](https://avatars.discourse-cdn.com/v4/letter/n/df788c/32.png) [@Nippless](https://boards.straightdope.com/u/Nippless)\ **Post date:** [February 4, 2013, 12:10pm UTC](https://boards.straightdope.com/t/the-antibiotic-apocalypse-how-scared-should-we-be/649164/28 "2013-02-04T12:10:55Z")
> [@Wesley\_Clark](#): > > I don’t think it’ll be that bad. Dude. If bacteria followed your logic, it would be a breeze. But I don’t think they work that way. > [@Wesley\_Clark](#): > > Public health initiatives and innovations to prevent the spread of bacteria like sanitation, water purification, trash removal, easily laundered clothes, easily available condoms, hand washing, quarantines, etc are more important to our survival than treating people _after_ they get infected with antibiotics. Yeah and as noted in the thread, these measures are difficult enough to implement effectively in a _medical_ environment. Now you’re gonna convince hundreds of millions of Joe Soaps to do better in their own homes? For many it simply wouldn’t be possible, because they do not have first world luxuries you take for granted. > [@Wesley\_Clark](#): > > Not only that but viruses are not undergoing this rapid evolution, I don’t think. Vaccines against viruses which have killed millions will still work. Now you’re talking about viruses… the track-record of humans/viruses is not much in favor of humans… even ‘common’ cold is still common. > [@Wesley\_Clark](#): > > We need more investment in antibiotic research though. Quick someone let pfizer know about this conclusion. > [@](#): > > But I don’t think it’ll be the end of civilization by any means. In 1917 it took at least a few days for a human to get from one side of the planet to another. Nowadays it’s a matter of hours… how many people died from the 1918 outbreak? A worst-case epidemic now obviously would not end humanity, but as for its civilization… I wouldn’t be so sure. Thin veneer, not much of substance to hold it together… a few (hundred?) million deaths in a short time would hurt. To answer OP… what use is being scared or worried for this… there’s nothing you can do about it any more than a comet coming through your roof. ---
**Author:** ![Machine\_Elf](https://avatars.discourse-cdn.com/v4/letter/m/82dd89/32.png) [@Machine\_Elf](https://boards.straightdope.com/u/Machine_Elf)\ **Post date:** [February 4, 2013, 1:09pm UTC](https://boards.straightdope.com/t/the-antibiotic-apocalypse-how-scared-should-we-be/649164/29 "2013-02-04T13:09:53Z")
> [@Smeghead](#): > > Our track record actually hasn’t been great on that so far. It’s been a while since my last medical micro class, so I may have a few details wrong, but IIRC, science has only invented one antibiotic that can actually be called “new” - vancomycin, I think. And we already have [vancomycin-resistant bugs.](http://en.wikipedia.org/wiki/Vancomycin-resistant_Staphylococcus_aureus) “Antibiotic stewardship” was mentioned upthread. Part of this is being conservative in application: doctors should not hand out antibiotics to patients with viral infections just to shut them up, and patients who do receive antibiotics need to read and sign a document promising that they will finish the entire prescription (my dad, who is otherwise a smart man, has a habit of saving antibiotics :rolleyes:). But this has to be a worldwide effort. My understanding is that antibiotics are much easier for patients to get in some countries outside the US. If antibiotics can be abused _anywhere,_ then that’s where the resistant bugs will develop, and eventually they’ll spread to places where antibiotics are more carefully managed. The other part of stewardship is a globally-managed program of antibiotic rotation. Even with conservative use, resistance ot any antibiotic can be expected to develop over time. But if we stop using that antibiotic altogether, resistance would fade over time - and that antibiotic could become useful again. Worldwide cooperation and agreement on when/which antibiotics to use most and which to use least at any given time could help to accomplish this. ---
**Author:** ![deltasigma](https://avatars.discourse-cdn.com/v4/letter/d/e5b9ba/32.png) [@deltasigma](https://boards.straightdope.com/u/deltasigma)\ **Post date:** [February 4, 2013, 2:56pm UTC](https://boards.straightdope.com/t/the-antibiotic-apocalypse-how-scared-should-we-be/649164/30 "2013-02-04T14:56:34Z")
It’s probably possible to create antibiotics to which bacteria can’t develop resistance. This is the case with some [antimicrobial compounds discovered in frogs.](http://www.smh.com.au/environment/animals/hospital-hero-this-frog-has-the-makings-of-a-lifesaver-20120316-1vahu.html) > [@](#): > > The research leader, Frances Separovic, a biophysical biologist, said most antimicrobial peptides killed bacteria by puncturing or lysing (causing them to disintegrate) their membranes. This made it hard for bacteria to develop resistance to them, Professor Separovic, chemistry head at Melbourne University, said. > > ``` > ''On the other hand, most antibiotics inhibit protein synthesis in a bacteria and, over time, mutations in the bacteria lead to resistance to the antibiotics,'' she said. > > ``` The reason the peptides only kill bacteria is fascinating. > [@](#): > > They found the positively charged antimicrobial peptides were attracted to bacteria because they were negatively charged. ‘‘Specificity is really important. You don’t want the peptides attacking a red blood cell,’’ Professor Separovic said. [Another article on the topic](http://www.abc.net.au/science/articles/2012/03/19/3456896.htm) ---
**Author:** ![Trom](https://avatars.discourse-cdn.com/v4/letter/t/958977/32.png) [@Trom](https://boards.straightdope.com/u/Trom)\ **Post date:** [February 4, 2013, 3:13pm UTC](https://boards.straightdope.com/t/the-antibiotic-apocalypse-how-scared-should-we-be/649164/31 "2013-02-04T15:13:55Z")
As an actively dating single guy, I’m not too excited about the arrival of Super Gonorrhea in North America. [Link](http://www.nydailynews.com/life-style/health/north-america-super-gonorrhea-coming-article-1.1236279#ixzz2JwZ0NCQc) > [@](#): > > The only remaining oral antibiotic used for gonorrhea failed to cure the infection in nearly 7 percent of patients treated at a clinic in Toronto, Canadian researchers said on Monday in the first published study of treatment-resistant gonorrhea in North America. > > The study raised alarm among U.S. health officials, who have ordered doctors to stop prescribing the antibiotic known as cefixime because lab cultures showed gonorrhea was starting to develop resistance to the drug. ---
**Author:** ![Machine\_Elf](https://avatars.discourse-cdn.com/v4/letter/m/82dd89/32.png) [@Machine\_Elf](https://boards.straightdope.com/u/Machine_Elf)\ **Post date:** [February 4, 2013, 4:17pm UTC](https://boards.straightdope.com/t/the-antibiotic-apocalypse-how-scared-should-we-be/649164/32 "2013-02-04T16:17:01Z")
> [@deltasigma](#): > > It’s probably possible to create antibiotics to which bacteria **can’t develop resistance.** This is the case with some [antimicrobial compounds discovered in frogs.](http://www.smh.com.au/environment/animals/hospital-hero-this-frog-has-the-makings-of-a-lifesaver-20120316-1vahu.html) > > > [@](#): > > > > The research leader, Frances Separovic, a biophysical biologist, said most antimicrobial peptides killed bacteria by puncturing or lysing (causing them to disintegrate) their membranes. This made it **hard for bacteria to develop resistance** to them, Professor Separovic, chemistry head at Melbourne University, said. > > > > ‘‘On the other hand, most antibiotics inhibit protein synthesis in a bacteria and, over time, mutations in the bacteria lead to resistance to the antibiotics,’’ she said. “Can’t develop resistance” != “hard for bacteria to develop resistance.” Such drugs may be useful for a longer period of time than other antibiotics, but resistance _will_ eventually develop and so they will still require rotation if they are to become useful again in the future. ---
**Author:** ![deltasigma](https://avatars.discourse-cdn.com/v4/letter/d/e5b9ba/32.png) [@deltasigma](https://boards.straightdope.com/u/deltasigma)\ **Post date:** [February 4, 2013, 6:07pm UTC](https://boards.straightdope.com/t/the-antibiotic-apocalypse-how-scared-should-we-be/649164/33 "2013-02-04T18:07:00Z")
> [@Machine\_Elf](#): > > “Can’t develop resistance” != “hard for bacteria to develop resistance.” > > Such drugs may be useful for a longer period of time than other antibiotics, but resistance _will_ eventually develop and so they will still require rotation if they are to become useful again in the future. No. Something that lyses or punctures the cell membrane is primarily a mechanical process. That would be like saying that you can develop immunity to being hit with a hammer. ---
**Author:** ![drewtwo99](https://avatars.discourse-cdn.com/v4/letter/d/d07c76/32.png) [@drewtwo99](https://boards.straightdope.com/u/drewtwo99)\ **Post date:** [February 4, 2013, 6:07pm UTC](https://boards.straightdope.com/t/the-antibiotic-apocalypse-how-scared-should-we-be/649164/34 "2013-02-04T18:07:13Z")
Antibiotics are kind of a haphazard way to fight infections anyhow. I think a few hundred years in the future antibiotics will be studied as a sort of cute, ancient technology that really helped out mankind rapidly until genetic engineering, nano technology, or whatever other future technology comes about. Antibiotics are kind of crude and they work due to some neat tricks but they are far from the only way from preventing and fighting bacterial infections in the future. ---
**Author:** ![eschereal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/eschereal/32/18939_2.png) [@eschereal](https://boards.straightdope.com/u/eschereal)\ **Post date:** [February 4, 2013, 6:12pm UTC](https://boards.straightdope.com/t/the-antibiotic-apocalypse-how-scared-should-we-be/649164/35 "2013-02-04T18:12:18Z")
> [@Machine\_Elf](#): > > “Antibiotic stewardship” was mentioned upthread. Part of this is being conservative in application: doctors should not hand out antibiotics to patients with viral infections just to shut them up … This is plain idiotic and irresponsible. We should at least have a spectrum of placebos with convincing sounding names, like “Terptimycin” or “Pennycillin” that a doctor could prescribe to shut those people up. ---
**Author:** ![kayaker](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kayaker/32/441_2.png) [@kayaker](https://boards.straightdope.com/u/kayaker)\ **Post date:** [February 4, 2013, 6:25pm UTC](https://boards.straightdope.com/t/the-antibiotic-apocalypse-how-scared-should-we-be/649164/36 "2013-02-04T18:25:38Z")
[Addressing microbial infection via non-drug routes is a hot area of research.](http://www.alnmag.com/news/blue-light-heals-skin-soft-tissue-infection-mice) > [@](#): > > Blue light can selectively eradicate Pseudomonas aeruginosa infections of the skin and soft tissues, while preserving the outermost layer of skin, according to a proof-of-principle study led by Michael Hamblin of the Massachusetts General Hospital and the Harvard Medical School, Boston. The research is published in the journal Antimicrobial Agents and Chemotherapy. > > “Blue light is a potential non-toxic, non-antibiotic approach for treating skin and soft tissue infections, especially those caused by antibiotic resistant pathogens,” says Hamblin. > > In the study, animal models were infected with P. aeruginosa. All of the animals in the group treated with blue light survived, while in the control, 82 percent (9 out of 11) of the animals died. ---
**Author:** ![VOW](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/vow/32/3043_2.png) [@VOW](https://boards.straightdope.com/u/VOW)\ **Post date:** [February 4, 2013, 8:08pm UTC](https://boards.straightdope.com/t/the-antibiotic-apocalypse-how-scared-should-we-be/649164/37 "2013-02-04T20:08:41Z")
A few points to take into consideration: –People can develop allergic reactions to antibiotics after years of use. And once you are allergic, you are never prescribed antibiotics which can have a cross-allergic reaction. People who are allergic to penicillin are not prescribed cephalosporins. In my ancient years, I’ve now racked up allergies to sulfa and ciprofloaxin. When I get either a sinus infection or a urinary tract infection, I’m hard to treat. And oftentimes a sinus infection will take more than one course of antibiotics before it finally croaks. My record is five courses. I don’t need a superbug to kill me. I just need to run out of antibiotics for the regular bugs! –We do have many vaccines for once-deadly viral infections. Problem is, vaccines don’t do a DAMN bit of good when people refuse to take them! The thiomersal controversy was a bandwagon many hopped on, and there is an increasing percentage of the population walking around unvaccinated. I tell the ones I encounter: When your kid is incapacitated by a diphtheria epidemic, MY kid is gonna be the one taking care of the sick ones and cleaning up the mess! ~VOW ---
**Author:** ![Machine\_Elf](https://avatars.discourse-cdn.com/v4/letter/m/82dd89/32.png) [@Machine\_Elf](https://boards.straightdope.com/u/Machine_Elf)\ **Post date:** [February 4, 2013, 8:25pm UTC](https://boards.straightdope.com/t/the-antibiotic-apocalypse-how-scared-should-we-be/649164/38 "2013-02-04T20:25:18Z")
> [@deltasigma](#): > > No. Something that lyses or punctures the cell membrane is primarily a mechanical process. That would be like saying that you can develop immunity to being hit with a hammer. As a matter of fact, I have. Compared to the [banana slug,](http://en.wikipedia.org/wiki/Banana_slug) my skull protects my brain from hammer blows pretty well. Not _all_ hammer blows, but considerably more than not having a skull at all. Many other organisms have evolved resistance to various other kinds of attacks. it seems foolhardy to say unequivocally that an organism of any particular classification can’t possibly evolve over time to resist a given threat. ---
**Author:** ![deltasigma](https://avatars.discourse-cdn.com/v4/letter/d/e5b9ba/32.png) [@deltasigma](https://boards.straightdope.com/u/deltasigma)\ **Post date:** [February 4, 2013, 8:52pm UTC](https://boards.straightdope.com/t/the-antibiotic-apocalypse-how-scared-should-we-be/649164/39 "2013-02-04T20:52:13Z")
> [@Machine\_Elf](#): > > As a matter of fact, I have. Compared to the [banana slug,](http://en.wikipedia.org/wiki/Banana_slug) my skull protects my brain from hammer blows pretty well. Not _all_ hammer blows, but considerably more than not having a skull at all. > > Many other organisms have evolved resistance to various other kinds of attacks. it seems foolhardy to say unequivocally that an organism of any particular classification can’t possibly evolve over time to resist a given threat. I’m not a molecular biologist, but given the description of the mechanism, I think it’s pretty clear that bacteria would have to change their basic architecture in order to become immune. So is that possible. Maybe, but I’m pretty sure that they wouldn’t be bacteria any more. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [February 4, 2013, 10:59pm UTC](https://boards.straightdope.com/t/the-antibiotic-apocalypse-how-scared-should-we-be/649164/40 "2013-02-04T22:59:53Z")
The frog’s peptides are just one example of the already referenced innate immune system. Innate mechanisms work pretty well; the problem is that they are often fairly nonspecific. It’s enough that one’s innate system is able to attack only bacteria; differentiating between bacteria you need and pathogenic ones is a whole 'nuther thing. In general innate mechanisms therefore location specific. Hence not great as systemic antibiotics. Bacteria adapting to innate mechanisms is more difficult but generally not impossible. Change to charge of exposed bits of the cell wall and suddenly this one does not work any more. Can’t say I know how a bacteria would do that but I have great confidence that among the trillions and trillions of them out there, multiplying, multiplying, one would. Bacteria can adapt to virtually anything with enough consistent evolutionary pressure brought to bear. [Previous page](https://boards.straightdope.com/t/the-antibiotic-apocalypse-how-scared-should-we-be/649164.md?page=1) [Next page](https://boards.straightdope.com/t/the-antibiotic-apocalypse-how-scared-should-we-be/649164.md?page=3)