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Biotech Science

Potential Cure For Antibiotic Resistant Infections 127

Posted by kdawson
from the early-days-but-promising dept.
kpw10 writes to let us know about research to be published this week that offers hope in the battle against multi-drug-resistant bacteria. "Researchers at the University of North Carolina at Chapel Hill have discovered that two drugs used to treat bone loss in old folks can both kill and short-circuit the 'sex life' of antibiotic-resistant bacteria blamed for nearly 100,000 hospital deaths across the country each year."
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Potential Cure For Antibiotic Resistant Infections

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  • by ScrewMaster (602015) on Tuesday July 10, 2007 @06:02PM (#19818871)
    what happens when the bugs become resistant to these two drugs as well?
    • by Anonymous Coward on Tuesday July 10, 2007 @06:05PM (#19818901)
      you use an itty-bitty hammer.
    • by VorpalEdge (967279) on Tuesday July 10, 2007 @06:07PM (#19818945)
      Then we find new drugs.

      At the very least, I would not be surprised if the constantly mutating virus is actually opening itself up to new attack vectors that we just haven't found yet.
      • Bacteria != viruses (Score:5, Informative)

        by mattcasters (67972) on Tuesday July 10, 2007 @07:00PM (#19819531) Homepage
        Just a nitpick, but anti-biotics don't really help fight against viruses.

        • by Telcontar (819) on Tuesday July 10, 2007 @09:30PM (#19820685) Homepage
          They help indirectly: In cases of a viral infection, antibiotics are prescribed to wipe out bacteria that keep the immune system tied up and busy. While those bacteria were not strong enough to make you sick, antibiotics are a defense on that front, allowing your immune system to focus on viruses.

          Of course, antibiotics also kill useful bacteria (e.g. those that help you to digest milk and salad), so antibiotics are not really a good idea against a common cold.
          • by ColdWetDog (752185) on Tuesday July 10, 2007 @10:08PM (#19820971) Homepage

            In cases of a viral infection, antibiotics are prescribed to wipe out bacteria that keep the immune system tied up and busy.

            Huh? That's not even wrong. There is no reason to use antibiotics in a viral infection. Period. Now, there are a couple of real life caveats to this: Firstly, viral infections can alter host defenses (usually by trashing the lining of the respiratory system - essentially making holes in it - which allow bacteria to invade. The classic case is Haemophilus Influenza pneumonia that occurs after an influenza infection. Secondly and more commonly, a doctor may not know if the infection is viral or bacterial and antibiotics are often (likely too often) added empirically.

            But bacteria "don't keep the immune system busy".

      • by IndustrialComplex (975015) on Wednesday July 11, 2007 @09:58AM (#19824781)
        I would bet that the same method by which bacteria become resistant to drugs also causes them to lose that resistance after a period of time.

        Granted that strain would have to be NOT exposed to the antibiotic for a long enough timeframe for it to lose it's resistance (enough time for the mutations that don't have the resistance to become the majority).

        This is probably a high estimate, but I would imagine that if you banned penicillin for 200 years or so, you would wind up finding that the strains that were resistant are resistant no more. This of course assumes that you(society) could go 200 years w/o penicillin.
        • by joto (134244) on Thursday July 12, 2007 @02:10AM (#19835011)
          Actually, you don't need 200 years, as bacteria reproduce rapidly. Assuming the infection is non-lethal, and you can afford to stay off medication for a few months, the bacteria population will almost certainly no longer be antibiotica-resistant after this time. But then again, if you can live with the infection for that long, why bother treating it at all?
    • by tloh (451585) on Tuesday July 10, 2007 @06:09PM (#19818967)
      prepare for the headline - "Netcraft confirms it: The human race is dying."
    • by frovingslosh (582462) on Tuesday July 10, 2007 @06:09PM (#19818975)
      The problem that is said to cause drug resistant bacteria is over use - too many people taking the drug when they don't really need it to kill bacteria. And in this case the "cure" we're being offered is a drug that's in even wider use, now it will not only be used to treat the resistant drugs but will continue to be used widely to treat bone loss in old people (senile citizens). So it's not just a matter of what happens when the bugs become resistant, but that the resistance is on a fast track!
      • From what I see, the drug stops the bacteria from reproducing, meaning that the quick lifespan of the bacteria won't help it adapt, since it won't be able to pass on resistant traits.
        • by mooingyak (720677) on Tuesday July 10, 2007 @06:17PM (#19819079)
          ... except for that fraction of a percent that's immune to the drug and can breed anyway, and then we start all over again.
          • by Knara (9377) on Tuesday July 10, 2007 @07:07PM (#19819605)
            I dunno, wouldn't pretty much every one of the bacteria have to reproduce the exact same way?
            • by poopdeville (841677) on Tuesday July 10, 2007 @08:29PM (#19820237)
              More-or-less. There are certainly variations, but there might be critical points in the process that are the same across all bacteria. If a drug targets those, we win. Evolution could help bacteria survive, but there wouldn't be any evolutionary pressure to change this aspect of bacterial reproduction outside exposure to the antibiotic.

              An analogy might be something like VX nerve gas and human evolution. We might some day evolve so that VX nerve gas won't affect our nervous systems, but it won't be through exposure to VX, since we basically die instantly if we're exposed. On the other hand, it seems unlikely that we would evolve that way.
              • by cluckshot (658931) on Wednesday July 11, 2007 @09:00AM (#19824203)

                Hang on there! This logic of combinations of drugs and such has been tried for a long time. The results always rapidly decline in value. Even if this combination works for now, it will fail in a short period of time.

                There is a better way! the USA Laser [usalaser.biz] guys have a tool that could best be described as the Atom Bomb of medicine. It is a very simple system that exposes a person to an intense short duration flash from an IR laser. This device does several wonderful things. The first is that it essentially sterilizes the exposed zone of the person from most bacteria and virus agents. This is really profound and very nearly instantaneous. The next effect is by photoelectric effect it takes the cells of the person in the area exposed and drives them up to full operational energy essentially stopping any tissue destruction cascades.

                This process causes nearly instant reduction of edema in exposed tissue. Yes our soldiers exposed to traumatic brain injury could be healed this way because the laser is intense enough to shine right through a person's head. This system also supports rapid tissue healing at rates in the order of 10 times normal. Tissue differentiation to the correct tissue type rather than scar or adhesion types is also greatly improved.

                Antibiotics are well named. They are anti-life. This problem with using them in treatment means that their use is a trade off between the death they cause in a patient vs the death they cause in the infectious agent. Wouldn't something better be a good idea?

              • by joto (134244) on Thursday July 12, 2007 @02:23AM (#19835055)

                An analogy might be something like VX nerve gas and human evolution. We might some day evolve so that VX nerve gas won't affect our nervous systems, but it won't be through exposure to VX, since we basically die instantly if we're exposed. On the other hand, it seems unlikely that we would evolve that way.

                Not true. VX gas in small enough doses doesn't kill. Let's assume a doomsday scenario where the evil robots in the future use VX gas to keep humans away. More or less the entire planet is routinely "cleansed" with VX gas, but unfortunately for the robots, a few relatively unexposed spots still exists where human tribes survive. During that time, there will be evolutionary pressure among humans for increased tolerance towards VX gas. Humans who tolerate more VX gas will be able to survive in more exposed areas, and can therefore live outside the safe-zones. Increasing the tolerance even further allow humans to come even closer to the robots. And this process continues untill the robots start using some other chemical agent to ward of humans.

            • by Winckle (870180) <mark.winckle@co@uk> on Tuesday July 10, 2007 @08:29PM (#19820239) Homepage
              Bacteria can reproduce both sexually and asexualy, also they exchange plasmids of DNA.

              Life will find a way to survive.
        • by cin62 (1050660) on Wednesday July 11, 2007 @11:31AM (#19825791)
          Bacteria can take up "free" DNA that's somewhere in the environment (possibly a residue of a dead bacteria). So basically the resistant bacteria does not need to be alive to pass on the resistance genes. http://en.wikipedia.org/wiki/Transformation_(genet ics) [wikipedia.org]
      • by Moraelin (679338) on Tuesday July 10, 2007 @07:05PM (#19819585) Journal
        Now I'm not a doctor, but it seems to me that (as is usually the case) it's not that simple. Among the things that come to mind:

        1. Drug resistant bacteria aren't as much caused by taking too many antibiotics, but by taking too little of an antibiotic. People take the antibiotic for 2-3 days, then they feel better, and figure out "why bother taking the rest?" Or they take an antibiotic, it makes them feel worse, skip the rest of the treatment because they know better than the doctor. Etc.

        Problem is, they have a shitload of bacteria left at that point.

        Will someone decide to skip their bone loss drugs too? Probably, but I'd assume somewhat fewer.

        2. The fact that it's already widely used to treat bone loss, should probably tell us that if it was that easy to develop resistance to it, it would have happened already. Not saying it's impossible to, but it might just take a lot more time.

        3. The relatively fast development of resistance is massively aided by the fact that bacteria can exchange genes. (Hence the jab about inhibiting their sex life.) So basically once one develops resistance, it can pass that around.

        Something that attacks that very mechanism, might slow down the rate of developing and spreading resistance a lot.
        • by a-zarkon! (1030790) on Tuesday July 10, 2007 @08:39PM (#19820309)
          To add on to point 1 above: Any evidence or anecdotes regarding people who can't afford a full course of antibiotics or who complete a course of antibiotic xxx but find themselves still sick and can't pay for a second round with antibiotic yyy? Looking at the prices of prescriptions (even the copay on some of this stuff with insurance) I can easily see where there could be tough decisions for low/fixed income types.
          • by IndustrialComplex (975015) on Wednesday July 11, 2007 @10:04AM (#19824827)
            Thankfully I haven't had to deal with too many prescription medications yet. I'm relatively healthy.

            However, aren't most of the 'expensive' drugs the ones that are more cosmetic? Things like Viagra, or the sleeping meds, or anti-allergy types?

            I have always thought that the antibiotic type drugs were relatively inexpensive. Am I off on this assumption?
            • by Uzuri (906298) on Friday July 13, 2007 @04:28PM (#19852795)
              They always try to put you on the newest ones, which are more expensive. If you buck that, and tell them that that won't work for you, you can usually get an incredibly cheap generic.

              But you need backbone, and when you're sick... well, you generally don't have the energy to argue with the doctor.
        • by ColdWetDog (752185) on Tuesday July 10, 2007 @10:22PM (#19821037) Homepage

          1. Drug resistant bacteria aren't as much caused by taking too many antibiotics, but by taking too little of an antibiotic. People take the antibiotic for 2-3 days, then they feel better, and figure out "why bother taking the rest?" Or they take an antibiotic, it makes them feel worse, skip the rest of the treatment because they know better than the doctor. Etc.

          That's part of the problem, the bigger problem is that there are too many antibiotics being used for essentially superfluous indications such as when used in cattle feed and for clearly viral infections. In fact, the data on exactly how long one should be on antibiotics for a given infection is pretty sparse. Remember that the host immune system is playing an active role in clearing the infection - it's not just the antibiotic, and once you gain the upper hand, it's bye-bye bug.

          1. Drug resistant bacteria aren't as much caused by taking too many antibiotics, but by taking too little of an antibiotic. People take the antibiotic for 2-3 days, then they feel better, and figure out "why bother taking the rest?" Or they take an antibiotic, it makes them feel worse, skip the rest of the treatment because they know better than the doctor. Etc.

          Now this is interesting because you're correct - At least one of the drugs has been marketed for several years. If they prevented antibiotic resistance, it should be possible to see this given enough patients and time. The problem is that we don't have any way to really track this on a grand scale. It may be possible for organizations like Kaiser Permanente, who can track drug use and outcome data, to see this. It may also be the case that this is yet another Test Tube Marvel that has little applicability to the real world.

          3. The relatively fast development of resistance is massively aided by the fact that bacteria can exchange genes. (Hence the jab about inhibiting their sex life.) So basically once one develops resistance, it can pass that around.

          As far as I can tell from the terribly written summary, that's what the drugs do - prevent plasmid reproduction. The problem here is that there are several mechanisms for plasmid / gene transfer among the various species of bacteria. There may be mechanisms that are not susceptible to these drugs.

        • by ji777 (1107063) on Wednesday July 11, 2007 @08:46AM (#19824091)

          2. The fact that it's already widely used to treat bone loss, should probably tell us that if it was that easy to develop resistance to it, it would have happened already. Not saying it's impossible to, but it might just take a lot more time.
          Or it simply suggests that normal flora bacteria found in everyone have already developed resistance... Everyone has bacteria that should be there as part of a healthy system. It's just not noticed since it's not detrimental. If the normal flora have developed resistance then there is nothing to prevent other bacteria from doing so as well. And just a bit of clarification: Resistance doesn't really happen as a result of treatment. Resistant or partially resistant bacteria exist at the point treatment has begun as a result of spontaneous mutagenesis in normal cell cycle reproduction. With antibiotic, those more resistant aberrants are selected for and have an advantage in reproducing.
        • by rthille (8526) <web-slashdot.rangat@org> on Wednesday July 11, 2007 @10:06AM (#19824847) Homepage Journal
          I'm not a doctor either, but I'm smart enough to take all the antibiotics I'm prescribed. Trouble is, that may not be enough. I'm on my 3rd different perscription for a sinus infection right now. First was amoxicillin, then cipro, and now Avelox. I got 7 days into the 10 of amoxicillin and felt worse. Called the doctor and got a perscription for the cipro. After the full 10 days of cipro, I felt way better, but I still had a bit of 'color' in my snot, so I went back to see the doctor. That time they gave me a bunch more stuff for my allergies to help dry up my sinuses and open the passages so the new Avelox antibiotic would work better. I wonder if the bacteria was forming 'bacterial matts' like was talked about in a previous article.
          I guess my point is that even if you follow your doctor's instructions, if you aren't "on top of it" or don't use "common sense" you can still end up generating some resistant bacteria.
    • by msauve (701917) on Tuesday July 10, 2007 @06:32PM (#19819257)
      just put them in an autoclave.
    • by Citizen of Earth (569446) on Tuesday July 10, 2007 @09:07PM (#19820553)

      what happens when the bugs become resistant to these two drugs as well?

      But that would imply that these organisms evolve. That's impossible! [ucomics.com]

    • by camperslo (704715) on Wednesday July 11, 2007 @12:48AM (#19821907)
      We'll get bone-eating bacteria?
  • by Slicebo (221580) on Tuesday July 10, 2007 @06:03PM (#19818883)
    It's always good to see existing drugs being used in new ways, because it shortens the amount of time it takes to get the treatment to market.
  • by filesiteguy (695431) <kai@perfectreign.com> on Tuesday July 10, 2007 @06:05PM (#19818911) Homepage

    discovered that two drugs used to treat bone loss in old folks can both kill and short-circuit the 'sex life' of antibiotic-resistant bacteria

    Um, doesn't marriage do the same thing?

    Just asking, because it would certainly save a lot of money if we just get these bacteria to marry.

  • by wizardforce (1005805) on Tuesday July 10, 2007 @06:09PM (#19818971) Journal
    so the drugs prevent genetic transer through the sex pilli so that the bacteria can not share genes and recombine them into new genes/phenotypes. that isnt a cure, it will slow thigns down but really I doubt all the drug resistant bacteria are suceptable to it and even if they were it will eventually be overcome and as a defense, become meaningless. now if we found a way to make bacteriophages induce this effect in bacteria THEN we might have a chance. viruses mutate and evolve along with their hosts and might actually put a damper on the epidemic. there are however, other ways of transferring DNA, the most important of which in this case is DNA transferred by way of bacteriophage. the phages don't do it "intentionally" it is just a consequence of their reproduction. in this case, if the drugs do work, they will fail in preventing DNA transfer through other mechanisms [there are a lot of ways this can happen]
    • by wytcld (179112) on Tuesday July 10, 2007 @06:18PM (#19819085) Homepage
      You didn't read the whole article. The drugs were initially tested for the property of blocking the transfer of genes for multiple drug resistance. But they were surprised to find that it specifically killed those bacteria which had already received the upgrade package. Multiple drug resistance is evidently a specific trick - not multiple resistances to multiple drugs, but a single resistance mechanism that blocks nearly all drugs, and that can be passed from one species of bacteria to others. These newly-tested but available drugs kill any bacteria which have adopted that mechanism.
      • by revengebomber (1080189) on Wednesday July 11, 2007 @12:39AM (#19821869)

        You didn't read the whole article. The drugs were initially tested for the property of blocking the transfer of genes for multiple drug resistance. But they were surprised to find that it specifically killed those bacteria which had already received the upgrade package.
        That's not the DARPA chief!
      • by smellsofbikes (890263) on Wednesday July 11, 2007 @11:13AM (#19825507) Journal
        I haven't read the article because for some reason our corporate firewall doesn't like it (but it's cool with slashdot: ??!?)

        Anyway, I know there are multiple paths for drug resistance.
        Generally speaking, antibiotics target a specific enzyme or pathway. Take penicillin: it inhibits an enzyme used in linking sugars used in building the cell wall. To evade this, some bacteria make beta-lactamases, enzymes that specifically attack and break down penicillin, while other bacteria just massively overproduce the enzyme that the penicillin targets, so that even under high penicillin dosages, there is enough enzyme activity left that the bacterium can build strong cell walls. Those are completely different forms of resistance, and one drug is unlikely to manage to stop both (unless it just kills the cell, which will of course stop both mechanisms, but that's not what we're talking about.)
        If you're interested, here's an interesting article [postgradmed.com] that discussses a bunch of issues related to developing antibiotic-resistance, including quick takes on how it's not really related to massive widespread antibiotic use, to length of time using the antibiotic, and some other widely-held misunderstandings.
  • by tinrobot (314936) on Tuesday July 10, 2007 @06:12PM (#19819017)
    So, the few bugs that escape this new form of microbial torture will simply become stronger and even more resistant. Great. I am not a biologist, but are there any other ways of getting around this war of escalation?

    Maybe scientists could find some other critter that the bugs like better, like cockroaches or the small dogs that live in women's purses.
    • by wizardforce (1005805) on Tuesday July 10, 2007 @06:25PM (#19819187) Journal
      yes. bacteria can be killed by bacteriophages which the Russians had used a lot due to antibiotics being less available and the viruses constantly evolve along side the bacteria. when the bacteria evolve to fight the virus, the viruses evolve back- a constant tug of war beween them that has managed to work for the last well, several billion years. as for making better targets that the bacteria like better than us, that is a very good idea. in fact, those sort of experiments may be taking place here in a few years or so to test if that idea actually works. in this case, instead of cockroaches and small dogs we'll probably be trying other bacteria or single cell life forms as better targets. modify the cell membrane receptors/cell biochemistry and voila! the bacteria ignore us and go after our little baited bacteria traps. [these traps would naturally have some enzyme or something capable of killing the bacteria]
    • by element-o.p. (939033) on Tuesday July 10, 2007 @08:37PM (#19820297) Homepage
      I'd donate my step-daughter's little shi^H^H^Hdog for testing.
  • by TheMohel (143568) on Tuesday July 10, 2007 @06:13PM (#19819031) Homepage
    I'm a skeptic about a lot of things in medicine (I live in that world), especially "wonder drugs", and the writer of TFA demonstrates his limited skills in microbiology enough to make me cringe. But the science here is going to be fun to see.

    Don't get me wrong - we need to know the doses, the regimen, the side effects at antimicrobial dosing, and all the rest of the nuts-and-bolts pharmacology. On the other hand, the putative mechanism, which is to interfere with sharing of genes between bacteria, is in itself ground-breaking. Used properly (that is, not overused and used with care), this could prevent rapid resistance emergence in bacteria where the treatment itself takes weeks to months (osteomyelitis, for example, or infection with certain stubborn bugs). These drugs (etidronate and pamidronate) have their own not-insignificant side effect profile, of course, and there are no guarantees at this stage.

    I'll be interested in the actual research, because TFA is filtered through a layer of ignorance and sensationalism, but it sounds interesting.
  • by loteck (533317) on Tuesday July 10, 2007 @06:18PM (#19819087) Homepage
    ...also a proven way to virtually extinguish one's sex life.
  • by Doc Ruby (173196) on Tuesday July 10, 2007 @06:31PM (#19819239) Homepage Journal
    Hopefully the doctors who prescribe this new cure won't just pump the environment full of it at any sign of anything wrong, the way generations of their fellow doctors have antibiotics to create today's resistant "superbugs". Every time around this treadmill it's harder to kill the new superbugs, and the more people get sick and die from them.
    • by TheMohel (143568) on Tuesday July 10, 2007 @06:51PM (#19819457) Homepage
      Always a concern, but the trend in medicine over the past decade or so has been to reduce the number of times we prescribe, even as we increase both the dose and duration of care when we do pull the trigger. Antibiotic resistance has been strongly linked to inadequate dosing (killing only the susceptible bugs, while letting the borderline-resistant clones reinforce themselves), as well as to courses too short or patient noncompliance.

      Patients are part of the problem too, since there is a tendency (cultural in some cases, personal in others) to demand that a doctor "do something" to fix the problem. Antibiotics were perceived for a long time as something harmless to give in those circumstances, but that perception is fading fast. If anything, the trend now is to err on the side of letting things play out a little more to see if antibiotic therapy is really needed.

      This has also caused physicians to have to explain the situation better. I know for myself that when I am explaining to a suspicious parent the reason that I'm not going to give their child an antibiotic for their viral infection, I don't waste a lot of time explaining resistance. If they already understand resistance, they're not asking for antibiotics. If they don't, it just sounds like I'm making things up. I focus instead on side effects and cost, and my typical (true) statement is "about all I can do with antibiotics would be to give your child diarrhea to go with her cold." This is surprisingly effective, especially in the parents of non-potty-trained toddlers.

      None of which stops me from pulling out the stops when I'm faced with a septic kid or a real infection that needs to be nuked. In those cases, though, I'm very careful to make sure that the regimen I use is appropriate, considering the resistance patterns and the risk of making them worse.

      Now if we could only get the idiots who lace animal feed with antibiotics to do the same. Ever wonder where resistant strains start? Hint: it ain't just in the hospitals.
      • by Chris Burke (6130) on Tuesday July 10, 2007 @07:18PM (#19819679) Homepage
        Antibiotic resistance has been strongly linked to inadequate dosing (killing only the susceptible bugs, while letting the borderline-resistant clones reinforce themselves), as well as to courses too short or patient noncompliance.

        I didn't used to understand this well, thinking that basically you're still going to leave some bacteria alive, and they're going to be the most-uber-resistant bacteria of them all. But someone pointed out what may be obvious, which is that after the full regiment there are going to be few enough of these bacteria left that the human immune system can finish the job of wiping them out completely, leaving no antibiotic-resistant bacteria at all. Is this accurate?

        Now if we could only get the idiots who lace animal feed with antibiotics to do the same. Ever wonder where resistant strains start? Hint: it ain't just in the hospitals.

        Hormones and antibiotics in livestock has got to be the one of the worst abuses of public health I can think of at this time.
        • by TheMohel (143568) on Tuesday July 10, 2007 @10:34PM (#19821101) Homepage

          But someone pointed out what may be obvious, which is that after the full regiment there are going to be few enough of these bacteria left that the human immune system can finish the job of wiping them out completely, leaving no antibiotic-resistant bacteria at all. Is this accurate?
          In essence, yes. In fact, people who have immune deficiencies are particularly likely to develop resistant bugs, and we suspect that at least part of the problem is that the immune system can't quite finish the job.

        • by SatanicPuppy (611928) * <Satanicpuppy@g m a i l .com> on Wednesday July 11, 2007 @09:17AM (#19824329) Journal
          This is true, but the thing to remember is, while those germs are alive, it is still possible to pass them to a new host.

          Sure, your body is kicking bacterial ass, but that last cough or sneeze that they manage to wring out of you could spew a few lucky winners into a coworkers face, and the cycle starts again, but with a slightly more resistant strain.
      • by Some_Llama (763766) on Tuesday July 10, 2007 @08:02PM (#19820063) Homepage Journal
        "Ever wonder where resistant strains start? Hint: it ain't just in the hospitals."

        Mexico? My mother in law works at a farm that produces fruit with a lot of immagrant worker.. they routinely go back to Mexico to see family and pick her up Antibiotics because she likes to pop a few when she has a cold (yes a few, yes a cold).

        I had her get me some because i regularly get bronchitis (I smoke) and when it gets infected it's hard to get doctors to prescribe antibiotics. she brought me a bottle of 500 tablets. No script needed, no doctor warnings etc...
        • by TheMohel (143568) on Tuesday July 10, 2007 @08:22PM (#19820189) Homepage
          Yep. I've got patients who do the same (I live in an area where we have a lot of Hispanic immigrants, legal and otherwise). Nothing I can do about it except to talk with them, which I do. I try to encourage them to be reasonable and to take an entire course when they start one (nothing's worse than an occasional antibiotic pill). I have mixed success, but I don't expect perfection and I think my attitude helps the situation. I do get a lot of "do you suggest I start this" kinds of calls and questions and I treat those calls as victories.

          This gets me into the whole doctor-as-gatekeeper-for-pills thing that drives me nuts. I challenge colleagues once in a while: in an environment where all medications were available at retail, could they still justify their fees? Could they market themselves well enough to avoid starvation? I think I could, because of the kind of medicine I practice (and because I can sometimes go a dozen patients between giving a prescription), but it's definitely something honest physicians should be asking themselves.

          In the no-Rx-required environment, though, there's no question that resistance emerges rapidly. Fortunately, the antibiotics available in Mexico are a small subset of the ones we use here, and most of the ones that patients can buy OTC have broad therapeutic indices (overdose doesn't hurt you much) and are from antibiotic classes (penicillins, macrolides) where we have later-generation alternatives that avoid the common resistances. It's a fluid situation, though, and one that has infectious disease specialists always a little on edge.
      • by Peale (9155) on Tuesday July 10, 2007 @08:57PM (#19820495) Homepage Journal
        As a doctor, I urge you to read these sites:

        http://www.fluoroquinolones.org/ [fluoroquinolones.org]
        http://www.antibiotics.org/ [antibiotics.org]

        And pass this knowledge along. I, along with many many other people, have to live in pain now because of this.
    • by Attila Dimedici (1036002) on Tuesday July 10, 2007 @06:53PM (#19819471)
      I hate to have to tell you this, but fewer people get sick and die from the "superbugs" than died from their predecessors. Despite what you were taught or at least led to believe, as a general rule, antibiotic resistant bacteria are not "stronger" than the non-antibiotic resistant versions. That is why you very rarely hear of someone getting infected with antibiotic resistant bacteria outside of a hospital. Antibiotic resistant bacteria are at a significant competitive disadvantage when no antibiotics are present. Many people are not aware disease causing bacteria spend most of their existence not causing illness (for various reasons), in these settings the non antibiotic resistant bacteria generally completely overrun the antibiotic resistant bacteria.
      • by Doc Ruby (173196) on Tuesday July 10, 2007 @07:01PM (#19819541) Homepage Journal
        I didn't say the superbugs were more lethal than antibiotic-sensitive strains, or anything else except that they are antibiotic resistant.

        I don't know where you get your stats from, but antibiotic-resistant pathogens [wikipedia.org] are a serious health threat. Unless there is specific evidence that resistance mechanisms offer significant disadvantages to competing with sensitive strains, then it's pretty clear that the resistance to a lethal environmental element is an advantage, and that the resistant strain will eventually succeed in replacing the sensitive strain in the environment to which it is better fit to survive to reproduce.
        • by Attila Dimedici (1036002) on Tuesday July 10, 2007 @07:26PM (#19819761)
          Most (if not all) antibiotic resistant strains of bacteria accomplish this resistance by disabling the protein which the antibiotic attacks. The reason they had said protein in the first place was because it offered a significant competitive advantage. To be precise, the protein in question in most cases has to do with carrying chemicals across the cell membrane. The bacteria are significantly less efficient at transferring chemicals across the cell membrane without the protein that they have deactivated to be resistant to antibiotics. It is sort of like if you avoid being exposed to poison by not opening your mouth, the poison wouldn't get in, but it would be harder to eat.
          • by reverseengineer (580922) on Tuesday July 10, 2007 @11:14PM (#19821367)
            That's not necessarily true- there are quite a few ways bacteria have become resistant to drugs- because there are quite a few different drug targets scientists have tried.

            Before even penicillin, there were the miraculous sulfa drugs, which block a bacteria's ability to make folic acid: bacteria learned to uptake folate just as we do.

            Beta-lactams like penicillin prevent bacteria from making peptidoglycan, the material of their cell walls: bacteria came up with beta-lactamase to break it down.

            Better beta-lactams like oxacillin and methicillin were developed to be more effective at killing bacteria before lactamase neutralized them: mutant forms of proteins involved in making peptidoglycan (and were resistant to binding lactam drugs) began to proliferate, and now we of course have Methicillin Resistant Staphylococcus Aureus to deal with. (And studies have shown that MRSA bacteremia is just as deadly as regular SA, even correcting for the fact that MRSA tends to hit hospital patients. The rise in community-associated MRSA suggests it can fend for itself in the wild as well.)

            Quinolones attack bacterial topoisomerases, the enzymes they use to wind and unwind DNA: mutant topoisomerases beat these.

            Macrolides (most of the -mycin family) and oxazolidones bind to bacterial ribosomes to stop protein translation: modified ribosomal subunits beat these.

            Vancomycin prevents peptidoglycan formation in by preventing incorporation of the monomers that make it up: modified monomers, and now we see VRSA.

            We keep finding new targets for antibiotics, but as the Red Queen said, "It takes all the running you can do, to keep in the same place."

    • by reverseengineer (580922) on Tuesday July 10, 2007 @10:05PM (#19820947)
      Actually, it would be unwise to prescribe these drugs recklessly for another reason- the bisphosphonates, the class of compounds which these two drugs belong to, can have a rather serious side effect when taken in high doses for long periods. Bisphosphonates taken in high doses for long periods can cause osteonecrosis of the jaw, though it should be noted that etidronate and clodronate are older drugs with far less potency than newer drugs in the class like alendronate and zoledronic acid.
  • by JazzXP (770338) on Tuesday July 10, 2007 @06:53PM (#19819475) Homepage
    both kill and short-circuit the 'sex life' Do they extract the drug from slashdot readers? :-P
  • by CrankyOldBastard (945508) on Tuesday July 10, 2007 @07:10PM (#19819621)
    It's easy to be a sceptic and ask about 'and what about when the bugs become resistant to this'. As a person who had his life ruined by MRSA, I know too well the impact these types of infection have on individuals and families. Anything that can extend the reach of antibiotics (particularly the less toxic ones - I was only 2 or 3 days off being killed by the antibiotic that beat my infection) and decrease the chance of resistance is a good thing.

    Hopefully this won't be used promiscuously, and I hope they'll work out the interactions with other treatments, as quite often treatment is multi-modal.

    I wouldn't wish what I go through due to MRSA on anyone (except my stepfather, but that's another story altogether.
  • by SolusSD (680489) on Tuesday July 10, 2007 @07:16PM (#19819665) Homepage
    in simple life forms, such as bacteria, the mutations neccesary to change the organism in a useful way can happen in far fewer generations. combined with the speed at which these ateria reproduce it is only a matter of time before they adapt to this new treatment. the trick is staying ahead of them-- which is difficult.
  • 100K deaths (Score:2, Insightful)

    by Anomalyst (742352) on Tuesday July 10, 2007 @07:46PM (#19819921)
    100K deaths per year, thats more than an order of magnitude than the number of deaths attributed to terrorism in the last decade. Why are they telling us terrorists are dangerous? Imagine the lives saved if we poured half a trillion dollars to combat this, plus no armed forces casualties and no need to tap our phones or sniff our internet traffic.
  • by DrBuzzo (913503) on Tuesday July 10, 2007 @08:19PM (#19820181) Homepage
    I'm glad to hear that there is a new avenue, but as stated, there's no certainty that resistance couldn't be acquired to these drugs. Right now, bacterial infections that are resistant to multiple kinds of antibiotics are still a small portion of infections in general, and new antibiotics help too.

    But ultimately the best way to prevent this is for people NOT to insist on being given antibiotics for infections that are probably viral, for people to not stop taking their antibiotics when the symptoms are gone, even if their prescription calls for more and to NEVER take antibiotics you happen to have without confirming with a doctor that you need them.

    This is how this happens.. the infection is not wiped out entirely and thus some bacteria survive, even survive the body's immune system. Antibiotics are truely one of the the closest things to miraculous which medicine has. An infection that would kill you will go away with a few pills. DON'T GO AND RUIN THAT! Or you will end up dying anyway, because I will come and kill you! Seriously... stop that BS and we'll at least severely slow down the evolution of drug resistant bacteria
  • by djupedal (584558) on Tuesday July 10, 2007 @08:43PM (#19820351)
    ...but until you've had an opportunity to get up close and personal with CA-MRSA, you DO NOT know how much fun you are missing.

    Starts out like an ingrown hair or pimple. Might even be a spider bite. Then it gets angry. Take a large marble...light it on fire and have it surgically planted underneath, say, two layers of skin. Day three and the redness is now inches in diameter and the bump is still growing and...damn! It hurts! Burns like hell! Pimple my ass! Get that thing out of there! You can't sleep from the pain and you find yourself wondering which would be the better method to dig it out: kitchen cutlery or claw-hammer. In any case, if you don't have a doctor lance it, you're going to have to do it yourself.

    Day four and it is open, draining and talk about cheese!! The stuff draining from the now open wound is so toxic, it blisters the surrounding skin. Makes it a bit difficult to remember to trash your clothes, bedsheets, etc., but at least the burning has lessened...a bit.

    Ten or twelve days later, after finally getting on an anti-biotic (tetracycline?) that can put up a fight, the fluid draining out is almost stopped, the redness is almost gone and a bit of scar tissue is starting to form. Good news is, now that you know the routine, you can put up a slightly better fight next time - and there will be a next time...unless you died from this incident, of course. You did wash your hands before you helped your kids get dressed this morning, right...?
  • http://www.scoop.co.nz/stories/HL9910/S00096.htm [scoop.co.nz]
    "Phage Therapy: where communism succeeded and capitalism failed. Western capitalism has another kind of correctness that can be at least as disabling; a correctness based on profit, and an unwillingness to check the growth of an industry that is too lucrative to too many people. The story of antibiotics is becoming one of those stories. An elementary application of Evolution 101 tells us that bacteria evolve. In an antibiotic-rich environment, selective pressure favours those bacteria strains that are resistant to antibiotics. It's virtually a tautology. The wonder is that we have got away with abusing antibiotic therapy for so long. The antibiotic-resistant superbugs have now arrived. The use of antibiotics as a cure-all is more stupid than anything that happened in the name of Lysenko. Antibiotic therapy used as anything other than a backup medicine defies the basic laws of evolution. As a general means of treating bacterial infections (and as food additives), the use of antibiotics only makes sense in terms of creationist biology. In creation science, all species are fixed. Antibiotic A will cure disease A for all of the time that God grants us. ... It is embarrassing when western science is out-trumped, especially by the "communists". Usually, when out-trumped, we don't tell anyone. That's what happened here. Not only did we not have the nous to start a western programme in bacteriophage research; we looked the other way when the files of phials threatened to be destroyed following the breakup of the Soviet Union, and during the little reported civil war that engulfed Georgia a few years ago. So much for the knowledge economies of the west. How can such valuable knowledge be so cheap?"

    http://en.wikipedia.org/wiki/Phage_therapy [wikipedia.org]

    "Phage therapy is the therapeutic use of lytic bacteriophages to treat pathogenic bacterial infections. Bacteriophages, or "phages" are viruses that invade only bacterial cells and, in the case of lytic phages, cause the bacterium to burst and die, thus releasing more phages. Phage therapy is one of the viable alternatives to antibiotics, being developed for clinical use in the 21st century by many research groups in Europe and the US. After having been extensively used and developed mainly in former Soviet Union countries for about 90 years, phage therapy is now becoming more available in other countries such as USA for a variety of bacterial and poly-microbial biofilm infections.[1] Phage therapy has many applications in human medicine as well as dentistry, veterinary science and agriculture."
  • by dna_(c)(tm)(r) (618003) on Wednesday July 11, 2007 @01:42AM (#19822157)

    ...nearly 100,000 hospital deaths across the country each year.

    Hurry! Get this medicine to Andorra [wikipedia.org] before it's too late!

  • by Nom du Keyboard (633989) on Wednesday July 11, 2007 @11:37AM (#19825861)
    And they figured this out how? The obvious thought is that the old people with bone loss weren't dying nearly as fast as the other, otherwise, healthy patients.
  • by crasg156 (1127405) on Thursday July 12, 2007 @07:20PM (#19844063)
    I myself spent six months in a hospital after being diagnosed w/ MRSA. Actually, I should clarify that and state that at first they treated it as a NON-methycillin resistant Staph A. infection using heavy doses of a pretty tough antibiotic....only after weeks of therapy when they found it continued to spread (I had endocarditis...and it had also spread to two vertebrae in my neck causing temporary paralysis, my knees, my lungs, etc....it was everywhere) they finally realized they had to switch to a new drug. That took 3 months to recover from and I had multiple surgeries in between. Then, as they sent me home, they gave me an additional script for levofloxin "just in case" and was advised to take it until I ran out. Well, they fucked up and filled the script w/ three times the amount required. I didnt realize this (shame on me) until I was 2/3 of the way through. By then I had suffered from serious side effects from that antibiotic (although not as badly as many people have suffered from levofloxin). I am fairly sure I didnt need that last prescription at all. And levofloxin is no lightweight antibiotic (one of the main drugs used to treat anthrax among other things) but the doctors I saw always seemed like they felt they 'had' to do 'something' and that meant writing a script. Hell, when I left the hospital after 6 months I had lost all my good lean weight and looked like shit. (Im sure the hospital food didnt help there....wasnt much protein in what I was getting) I was weak as hell and it took me 6 more months to recover at home to the point where I could actually leave the house and/or stand and move around for more than 15 mins or so. The docs surmised that I probably picked up the infection while in the hospital getting my back stitched up after it had been sliced up pretty bad. I remember thinking that they didnt seem to clean the wound as thoroughly as I would have thought....and docs went from patient to patient in the ER sometimes forgetting to change latex gloves, etc. I had to ask one doc to change his gloves before touching the wound and I remember he was not at all happy to hear that, but he complied. That infection almost killed me 3 times during that six months. But the antibiotics they used at first did nothing but compound the problem...my kidneys almost failed at one point, strain on other organs, etc not attributed to the Staph A. It sucked. I've recovered from it with just the scars on my back, legs, chest, etc where they performed surgery, but Im told my heart is as healthy or even healthier now than it ever was (Im a gym rat who seriously took to cardio after my recovery to lose the pot belly I started to get while lying in a bed 24hrs a day for 6 months) so Im pretty lucky in that sense as many people I have met or corresponded with have suffered a lot more lasting effects. Many from the overprescribing of levofloxin or other floroquinones. So any new treatment that doesnt include traditional antibiotics is a huge plus in my opinion. I also remember reading in the Boston Globe last year about a company that was producing a drug called Cubicin (sp?) that essentially worked by passing through the Staph cell wall and rendering it unable to reproduce. I havent heard anything else about that drug since, but hopefully something has come from it. -Crash

The meat is rotten, but the booze is holding out. Computer translation of "The spirit is willing, but the flesh is weak."

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