We're losing the war against drug-resistant infections faster than we thought

I’m really glad this article acknowledges that better access to antibiotics is probably the best solution to the problem. I’ve actually heard people argue the opposite.

Many people, even doctors will blame patients for creating antibiotics resistant strains. While it’s true that a resistant strain can develop and spread due to an individual’s actions, those strains will gradually lose their resistance once no longer exposed to antibiotics, so it’s probably better have antibiotics be accessible drugs everywhere to prevent any initial spread and just trust people won’t use them chronically for no reason. Though I’d argue lack of access to antibiotics contributes more to the spread of disease then careless patients stuffing down their mouths, it really depends on what type of bacteria it is. Patients with viruses often misdiagnose themselves as needing antibiotics and that’s another reason it’s not over the counter, that builds resistant bacteria, not inside the patient but in the external environment due to excretion in urine etc.

Doctors will often chide patients for not taking the whole bottle of antibiotics once they stop feeling symptoms as if this gives more opportunity for the resistant strain to spread. It’s true it’s probably safer to totally ensure you are free of disease before stopping a medication, but increasing the overall level of antibiotics in the environment boosts resistance in every case. As people on this thread have pointed out the mass use of antibiotics in cattle farming is going to contribute significantly to resistance because it permanently increases the amount of antibiotics in the environment. Other than stopping that not much can be done to prevent this

It’s kind of a non-issue on an individual level as resistant strains lose resistance over relatively short periods time, once no longer exposed to the antibiotic, people just assume if the bacteria evolved an advantageous trait it will never lose that trait even though it’s no longer advantageous once it’s environment returns to normal.

> those strains will gradually lose their resistance once no longer exposed to antibiotics,

I've never heard this. Can you cite an example or source for this? How could we be losing if medicine can afford to "wait out" a strain? MRSA's been around 80 years. Call me skeptical.

> Can you cite an example or source for this?

“We previously reconstructed a 1,000-year-old remedy containing onion, garlic, wine, and bile salts, known as ‘Bald’s eyesalve’, and showed it had promising antibacterial activity. In this current paper, we have found this bactericidal activity extends to a range of Gram-negative and Gram-positive wound pathogens in planktonic culture and, crucially, that this activity is maintained against Acinetobacter baumannii, Stenotrophomonas maltophilia, Staphylococcus aureus, Staphylococcus epidermidis and Streptococcus pyogenes in a soft-tissue wound biofilm model” [1].

> How could we be losing if medicine can afford to "wait out" a strain?

In general, “mutations that confer larger” resistance “are more costly” in terms of fitness [2].

Absent the selection pressure of a particular antibiotic, the bugs without that resistance generally outcompete the ones weaving chainmail against Tomahawks.

[1] https://www.nature.com/articles/s41598-020-69273-8

[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC4380921/

To prove the claim we need to see that the salve is useful and that it used to be less useful because of resistance. Is that proven somewhere? This just looks like a "new" antibiotic.

And the more important part is losing resistance in a meaningful timeframe, much smaller than 1000 years. Also the relevant genes can't be easy to reactivate.

> we need to see that the salve is useful and that it used to be less useful because of resistance. Is that proven somewhere?

No proof, but when I came across this it was suspected the treatment fell out of use due to resistance.

> those strains will gradually lose their resistance once no longer exposed to antibiotics

No, they do not. Bacteria eventually optimize and streamline genes that confer resistance, and they stay around basically forever in a small reservoir of bacteria. So once you start using the antibiotics again, these streamlined genes almost immediately reappear.

My dog has been getting UTIs her whole life, ever since she was a pup. The vet kept prescribing the same antibiotic over and over again. We would do the full 10 days of treatment, the symptoms would be alleviated for a couple weeks, and then they gradually showed up again over the course of a few weeks to a month.

They kept insisting asking if we did give it twice a day, are we sure we did the full course, did we respect the 12h interval, etc. The vets told us this (we saw about 6 different vets at the clinic), the person manning the phone berated us, the nurse welcoming us again repeated the same thing.

Eventually I asked to see the test results (the cultures). It was clear that another antibiotic was effective, and that the one they were giving us wasn’t (it was about 25% better than the control). I asked why we couldn’t get the other one, and it turned out it was difficult to get in our country because it was only approved for humans.

We had to get a dispensation from the health ministry to import it from a neighbouring country. It was a mess of a process that took weeks.

Blaming patients is so ingrained that we were being gaslit into giving our pet an ineffective treatment and made to feel like we were doing something wrong all along.

The majority of antibiotics are not consumed by humans though, but by the animals raised to be eaten.

Another problem is that there is scarcely any place left in the world where disease-causing bacteria can survive for long without being exposed to some amount of antibiotics. Modern farms and hospitals are contaminating the entire environment with antibiotics. So there's always a bit of selection pressure that favors those with resistance genes.

A few years ago, a North Korean soldier was shot several times as he dashed across the border in plain sight of other soldiers. After he arrived in the South, the surgeon who treated his wounds reported an unusually high effectiveness of antibiotics administered to him. The bacteria on his skin and in his guts had been exposed to little to no antibiotics before.

Is it still the case? I mean sure, it was going on on such scale that the joke was "chicken soup is best for sickness as it already contains antibiotics" but surely it was already banned in most countries?

> better access to antibiotics is probably the best solution

This is an incredibly poor read. New antibiotics are a necessity of greater resistance but this magic conveyor belt of novel antibiotics isn't the best solution; preserving the efficacy of our existing drugs is.

Honestly not sure how to reply to the rest of this. Antibiotics being over-the-counter does not create higher resistance. Bacteria can't pass in urine as they are [far] too big. Inappropriate farm antibiotics are a real problem but it's the same problem with the same solution. And bacteria only lose resistance if the resistance causes a disadvantage in low-antibiotic environments. Many resistances do not, and so persist.

Your doctors aren't making this up. Take full courses, don't use antibiotics when they're not needed. Yes, it's just kicking the ball down the field, but it's essential.

Salves are antibiotic in the sense that they are antimicrobial. Bald's is effective in the same way that bleach, chlorhexidine, iodine, etc are. They are for external and external wound use and have no function against an existing deep or systemic infection.

Sure in North America and Europe but it’s s to ok intensive in India, Australia, China, Thailand and many other countries. Sadly viruses have no border.

https://ourworldindata.org/antibiotics-livestock