We cannot be complacent about drug resistant bacteria

We cannot be complacent about drug resistant bacteria

This little cartoon, courtesy of xkcd, highlights a problem we have had for some time, but which is getting worse–highly antibiotic-resistant bacteria. Soon after the first antibiotics appeared, especially penicillin, doctors noticed the phenomenon of developing bacterial resistance to them. The cause is evolution in action. The replication time for bacteria is extremely fast, as short as twenty minutes in some cases. So the process of evolution, of random mutation and passing new traits on to offspring, happens in minutes rather than years.

Say a population of bacteria is 99.99% susceptible to being killed by an antibiotic, or sensitive. When the antibiotic has done its work there are 0.01% of the bacteria left. If their resistance to the antibiotic is heritable, they will pass that on to their offspring. Before too long, if the antibiotic is still present in the system and nothing else intervenes, all of the bacteria will be resistant. An important thing that can intervene is that the body has its own ways of killing bacteria on its own without the help of antibiotics. If the burden of infection is low, as when antibiotics kill nearly all the bacteria, our natural infection-fighting system can do the rest.

It’s been known for a long time how to at least slow down the process of bacteria acquiring antibiotic resistance — limit the use of antibiotics to when they are really needed, and use the ordinary, simple antibiotics whenever possible. So if a germ is sensitive to many antibiotics, which is often the case, use the simple one. This reserves our newest, most powerful drugs for when we really need them, which is when they are the only ones to which the germ is sensitive. In addition, don’t use antibiotics when they don’t do any good, such as with viral infection.

A recent article in the New England Journal of Medicine, “Preventing lethal hospital outbreaks of antibiotic-resistant bacteria,” describes how we are doing. It is a vital question, because bacteria resistant to many, and sometimes all, antibiotics are killers. It’s a particular problem in hospitals, which you can think of as gathering together many sick and vulnerable people in one spot. It’s a set-up for disaster if a highly resistant bacterial strain gets loose, and is why hospitals themselves can be dangerous places — you can acquire an infection there you didn’t come in with, called nosocomial infections. Reducing the problem means limiting the use of antibiotics only to those cases in which they are really necessary and choosing the correct antibiotic. It also means strict isolation and handwashing techniques for caregivers of patients infected with these bacteria to limit the spread to others.

This problem is not going to go away. It will probably get worse. Although researchers are always working to develop new antibiotics to stay one jump ahead of the bacteria, we can’t count on this approach, either.

Antibiotics have been miracle drugs since the 1940s, saving millions of lives. If we are complacent about the issue of resistance, we will be back in the dark days before that.

Christopher Johnson is a pediatric intensive care physician and author of Your Critically Ill Child: Life and Death Choices Parents Must Face, How to Talk to Your Child’s Doctor: A Handbook for Parents, and How Your Child Heals: An Inside Look At Common Childhood Ailments.  He blogs at his self-titled site, Christopher Johnson, MD.

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  • http://twitter.com/FerkhamPasha Ferkham pasha

    Bacteria evolving

  • maryhirzel

    No. This is not a matter of simple evolution, unless one counts the evolution of the government enforced monopoly of pharmaceutical medicine. (Am I allowed to say “facist medicine” here?)

    I am painfully aware of the horrendous – yes, tyrannical! – challenges facing physicians who do not follow “standards of care,” but, if only some could find it in themselves to think like scientists again, instead of assuming that what they have been taught in their pharmaceutically co-opted med schools is the latest, greatest and “only” truth, and any naysayer is, without question or investigation, a “quack,” we might be in a much different place than waking up every morning to read how Heroic Medicine has chopped off another limb or two to “save” a poor child’s life.

    Bull.

    And, not to mention the pain that the Hero must suffer, watching/performing such carnage, only to lose in the end.

    Despite warnings from physicians and scientists since, at least the 19th century, the cavalier use of patentable “Miracle Drugs,” beginning with penicillin, has done incremental damage to the immune systems of the entire world’s population. We now seem to be admitting that, without explicitly saying so, with all the “new” discoveries about the importance of the microbiome and it’s critical importance to immune function.

    Then you add the fact that it’s been crucial (to industry bottom line) to avoid validly testing the efficacy of high dose IV Vitamin C to treat all manner of infections fungal, bacterial and viral, and we’re left with nothing but amputation, when the dead-end of antibiotic use finally becomes undeniable.

    So, if you’re serious about not being complacent about the maiming and death of innocents who trust you, spend an hour reading this: http://tinyurl.com/aswfvda – if only to slam me in the comment section here, in a fully informed manner.

    Of course, you can’t take Klenner at face value, nor can you try this out in a professional setting. The great scientist physicians who did that sort of thing in the past would, today, find themselves disgraced and behind bars.

    But you can try it on yourself. Or you can infect me with MRSA and try it on me. I’m perfect willing. I won’t tell. :-)

    And, no, it won’t hurt you one bit, unless you have a relatively rare (genetic) G6PD deficiency (screen first). No, it won’t give you kidney stones…..but even if that myth were true, patients might prefer kidney stones to serial amputation….huh?

    Frankly, I can’t imagine why I’ve spent the time to write this, as I know it won’t do one bit of good. It’s just hard to watch the excruciating, slow death of Heroic Medicine.

    You good, caring, well-meaning physicians have been turned into accomplices in crimes against humanity, and I genuinely feel for any of you who manage to wake up to that.

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