Saturday, June 04, 2016

248.2 - Not Good News: "End of the road" for antibiotics in sight?

Not Good News: "End of the road" for antibiotics in sight?

So to keep things in balance, we have some not good news.

Something that doctors and other medical professionals have been fearing for some time has happened: a so-called "superbug," this one resistant to antibiotics of last resort, has been found in the US.

It was only a matter of time, of course, before such bacteria were found here since they had already been found in China, Europe, and elsewhere.

Strains of bacteria gain resistance to antibiotics in one of two ways: One is by plain old evolution, where due to genetic variations some are not killed by some antibiotic and so go on to reproduce until they are the dominant form of that particular bacteria and that antibiotic no longer works on them.

That, however, doesn't mean other that antibiotics don't work and such resistance can only be carried within that bacteria's particular strain. But what can happen is that this same family of bacteria, through that same process of evolution, can acquire resistance to the next antibiotic used to treat it and so over time you can have families of bacteria resistant to a number of different antibiotics.

The other means for transfer resistance is through a plasmid, a small piece of DNA carrying a gene for resistance to some antibiotic. Plasmids can make copies of themselves and transfer their genes not only to other bacteria in the same family but can "jump" to other families of bacteria, in essence "infecting" them with their DNA and so giving them resistance to that antibiotic without the need for evolution.

The superbug just found, a type of E. coli, has this type of gene. It is resistant to a drug called colistin, which is the antibiotic of last resort for particularly dangerous types of superbugs, including a family of bacteria known as carbapenem-resistant Enterobacteriaceae - CRE, for short - which health officials have dubbed "nightmare bacteria" because in some instances, these infections have mortality rates of up to 50 percent; half of patients who become infected die.

The particular strain of E. coli involved here is still treatable by other antibiotics, but the fear is that its resistance to colistin will be spread via plasmids to other bacteria - which could result in there being an entire family of dangerous diseases for which there is no effective treatment.

I don't want to get too long or complex, so let me cut to the chase. What does all this mean, in the final analysis? It means, in the words of Tom Frieden, Director of the Centers for Disease Control (CDC), "The end of the road isn't very far away for antibiotics."

"I've been there for TB patients," he said. "I've cared for patients for whom there are no drugs left. It is a feeling of such horror and helplessness. This is not where we need to be."

But it is where we are headed.

And dammit, we have - as is so true in so many ways - we have done this to ourselves. According to a new and major study, nearly a third of antibiotics prescribed in the United States are not needed. Most of those are for conditions such as colds, sore throats, bronchitis, flu, and other illnesses which are caused by viruses, not bacteria - so antibiotics don't even work on them. But what such over-prescribing does do is help the bacteria develop resistance.

What's more, human use pales in comparison to the massive amounts of antibiotics routinely given to livestock both here and abroad for the sake of agribusiness profits.

We are headed for a situation where within a couple of decades, even sooner, people will be dying of diseases which are now curable, dying not because they lack effective access to medicine but because there is no effective medicine for them to access.

And it will be our own damn fault.

Sources cited in links:

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