Talk:Antibiotic resistance

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[edit] The emergence of MRSA

The phrase 'MRSA was responsible for 37% of fatal cases of blood poisoning in the UK in 1999' is not quite correct in two ways: 1) 37% refers to the percentage of fatal cases (...) out of all those attributable to Staphylococcus aureus, and NOT out of ALL cases of blood poisoning; 2) it is 33% and not 37%. If you look up the EARSS website under http://www.rivm.nl/earss/database/ you will see what I mean Pietro Coen —Preceding unsigned comment added by Pietrocoen (talk • contribs) 19:55, 25 November 2007 (UTC)

[edit] Material from multidrug resistance

Added here for use.--nixie 11:52, 16 Apr 2005 (UTC) Some antibiotics interfere with bacterial cell wall synthesis. Others inhibit the internal machinery of bacteria that is responsible for their survival or reproduction. Antibiotics act on bacteria by binding to specific sites. Take for example Streptococcus pneumoniae. Penicillin is an antibiotic in a class that contains a molecular group known as beta-lactam. The beta-lactam portion of these drugs binds to penicillin-binding proteins, and by doing so inhibit bacterial cell wall synthesis. However, if a bacterium has had a spontaneous mutation such that its penicillin-binding proteins are altered in shape, the proteins no longer bind penicillin, and the bacterium survives in the presence of penicillin. Because the bacterium survives, it reproduces, creating more and more bacteria that are resistant to penicillin.

If you take bacteria that are resistant to penicillin, and then expose them to another class of antibiotics, any that are able to mutate and survive then become resistant to two classes of antibiotics. Keep repeating the process and you begin to exhaust your options for treating infections.

Humankind has been able to stay ahead of bacterial resistance by introducing new molecules that act in novel ways. However, bacteria are gaining increased resistance to everything we've been able to throw at them so far.

Some practices we can do to decrease resistance include minimizing use of antibiotics, especially for illnesses that are known not to be of bacterial origin. Treating colds and bronchitis with antibiotics is a great way to select resistant organisms. Even worse, by killing off the resistant bacteria's competition, they have more breeding ground and nutrition and are able to reproduce more effectively. Other important practices include dosing antibiotics sufficiently high and administering antibiotics long enough to kill all of the pathologic bacteria. Remember, dead bugs don't reproduce. Some providers reserve powerful antibiotics "the big guns" for serious infections or infections that don't respond to older less potent antibiotics. Unfortunately, this plan has backfired at times, because the less potent drugs are allowing resistant bugs to survive. Again, dead bugs don't reproduce. One last practice that helps prevent bacterial resistance is for health care providers to identify what they are treating before they treat and determine which antibiotics the disease causing bacteria are sensitive to.

One encouraging fact related to drug resistance is that it is reversible. If drug misuse is discontinued, bacteria that are can be killed proliferate and decrease the percentage of resistant bugs. This has been demonstrated in subpopulations of children with ear infections caused by resistant "S. pneumonia."

One new approach to decreasing the rate of antibiotic resistance is creating a drug that binds to two distinct and independent sites within a bacterium. This means that a bacterium two spontaneous mutations in exactly the right places to become resistant, which is statistically far far less likely than a single mutation. (Remember, if the successful mutation rate is 1/10^8, then for two successful mutations the odds are (1/10^8)x(1/10^8)=1/10^16=one chance in 10,000,000,000,000,000.) One such antibiotic is telithromycin. It is a new drug, so time will tell how well the two-site approach will work.

Is there any plausibility to the concept of simply switching back and forth, not letting any one strain become dominant? Use one antibiotic til there's a resistance, then switch to another, then when it stops working, go back to the first (Assuming the bacteria mutated enough that they're not resistant to that one anymore) and doing it in cycles of 2 or more different antibiotics.. I heard this concept was being used on other resistence-ifying medications... and it sort of makes sense, right? --216.49.220.19 09:08, 3 June 2005 (UTC)

I'm not sure, but I suspect that repeatedly switching antibiotics would actually increase the rate at which bacteria become multiply antibiotic-resistant, because those that survived one antibiotic will then be exclusively selected from for resistance to the second, and so on. The problem is that the mutations for resistance to different toxins are not mutually exclusive. —Eldan Goldenberg (User:Eldang) 03:13, 14 February 2007 (UTC)

[edit] Garlic

Forget telithromycin! How about adding a section on recent research on the use of fresh and freeze-dried garlic as an antimicrobial? Studies in the 1980s and 1990s have shown that allicin and its daughter products, which form when garlic cloves are crushed, inhibit the growth of harmful bacteria 10 or 11 different ways, while being harmless to mammalian cells and beneficial bacteria. It's not likely that any bacterium will succeed in mutating 11 different ways simultaneously to circumvent the marvelous defenses that garlic has devised. Due to a ban on the use of human antibiotics in animal feed in the EU since January 1999, livestock now get freeze-dried garlic preparations instead. [1] [2]. Oh, I forgot — God has the original patent on garlic, so the pharmaceuticals can't make any money on it. How silly of me! --QuicksilverT @ 07:27, 8 February 2006 (UTC)

Is there any evidence (not from sources that are trying to sell me products) that garlic does not suffer from the same problems of resistance that synthetic antibiotics do? At present, the mercola link won't allow me to read anything without signing up for their newsletter (and rejects my spambucket address), and the pharmaxbiologicals one is giving me a 404 error, but in any case both appear to be advertorial-type sources. —Eldan Goldenberg (User:Eldang) 03:10, 14 February 2007 (UTC)

[edit] Mechanisms

I realize that there are dozens of classes of antibiotics, but this page desperately needs at least a few examples of resistance mechanisms, or general discussion of what forms those mechanisms take. Graft 18:17, 15 June 2006 (UTC)

I was looking through the causes, and found it to be quite confusing. The section opens with: "Antibiotic resistance is a consequence of evolution via natural selection or programmed evolution." But the third paragraphs states: "Antibiotic resistance is NOT a consequence of evolution." Can I get some explanation on this? And for future readers, it should probably be changed into less ambiguous wording. --67.66.48.63 23:53, 7 January 2007 (UTC)

This is of course a consequence of evolution, but there are ID (Intelligent Design) people misusing wikipedia as a tool to spread their fantasies about the real world. My guess is, they are siting some "Guru" of the Anti-evolutionists here, by pasting that nonsense about those mutations not being a consequence of evolution in to the article. WHY are you ID- guys destroying this wonderful tool (wikipedia)!!!??? Anyway, there shouldnt be any talk about evolution in this article, its good enough to call it mutations.

Evolution is important to the understanding of how antibiotic resistance comes about, which in turns helps to devise strategies that reduce the risks. —Eldan Goldenberg (User:Eldang) 03:17, 14 February 2007 (UTC)

[edit] Removal of Mechanism section

I have removed the "Mechanism" section. It appears to have arisen from this edit...the first paragraph of the additions was removed in the next edit and the remaining material did not really seem pertinent or make sense by itself (e.g. it references Spetner who was not introduced). If you disagree, feel free to revert and discuss.--GregRM 01:19, 24 January 2007 (UTC)

[edit] Scare tactics in Development of newer antibiotics section

The way this section is written feels extremely alarmist -- "Unfortunately, both the public and private sectors appear to have been lulled into a false sense of security based on past successes". Whether or not this is true, this seems currently like an opinion. I'm not suggesting it's true or not true, I'm not really qualified to say either way, although I would agree that MRSA is a problem. Most of the section, however, is either uncited, or from a possibly biased source (the infectious diseases society of america, which could just be representing certain interests..the citation links to a "policy focus" page, which is geared towards expressing a political opinion, and doesn't cite its sources). I would suggest this section be removed until it can be rewritten, although I admit to not being knowledgable about the Wikipedia procedures here. 24.27.41.62 14:08, 29 March 2007 (UTC)

[edit] Race and acquisition of infection

The article stated that race was a significant factor in acquisition of infection, yet referenced an article that clearly stated:

"In our study, being nonwhite (African American and American Indian) was a significant risk factor for acquiring MRSA infection before controlling for other risk factors. However, after controlling for other risk factors, this association was no longer significant."

It would be great if people could doublecheck the references that people post without just assuming that if something is referenced that the poster is reading the research carefully.--Cank 21:39, 25 May 2007 (UTC)

[edit] Using blogs as a scientific reference

The article contained two references to [3] which contains factual inaccuracies. For example, "In 2005, biochemist Floyd Romesberg of the Scripps Research Institute, near San Diego, announced that his lab had discovered a gene called LexA that switches on the error-prone DNA, enabling the microbe to mutate rapidly." A cursory search on Google Scholar will reveal that LexA has been around far longer than that (see [4]). I realize that a blog from MIT might seem like it knows what it is talking about, but it goes to show why blogs are awful sources for information. I have removed any references to this research as it shouldn't be added unless it is properly referenced.Cank 22:01, 25 May 2007 (UTC)

[edit] Phage therapy references

Is it really necessary to list 10+ references on one line? Cank 22:01, 25 May 2007 (UTC)

[edit] 23 Citations for one paragraph?

Does the lead paragraph in the "Phage Therapy" section really need 23 of its own citations, none of which are used anywhere else in the article? I mean geez, we get it, phage therapy is real, but 23!

[edit] programmed evolution

The only google hits I get for programmed evolution indicate that it is a ID term; most discussions of it deride it as as post-hoc hand-waving attempt to discredit obvious (undirected) speciation of microorganisms.

Further, this article only mentions it in connection with SOS response, which article does not mention PE, and the PE article itself is a stub (an obscurist stub, IMO) which appears to exist only for the sake of legitimizing uses of the term (by linking to it).

I'm removing it as ID POV pushing. Restore the language only if you can cite it in an academic peer-reviewed evolutionary biology source.

[edit] Removed redundant/ unnecessary and/or otherwise biased language in "Prevention" section

Please refer to my edit and the discussion of this page on the LGBT Studies Wiki discussion board (http://en.wikipedia.org/wiki/WT:LGBT). I removed the words as "unprotected sex" is a more than adequate phrase to describe a "risk factor." —Preceding unsigned comment added by JuniorMuruin (talk • contribs) 20:19, 7 September 2007 (UTC)

[edit] Over referencing

Isn't the amount of references on the first paragraph of the phages section a bit ridiculous? There are more of them than there are statements in the paragraph. I don't think there is a lot of point in referencing the same statement two, three or four times. Perhaps someone could go through and see which ones can be removed? Ziggaroth

Looks pretty absurd to me. Richard001 06:51, 14 September 2007 (UTC)

[edit] Antivirals

Removed paragraph about antiviral use in poultry production:

The illegal use of amantadine to medicate poultry in the South of China and other parts of southeast Asia means that although the H5N1 (avian flu) strain that appeared in Hong Kong in 1997 was amantadine sensitive, the more recent strains have all been amantadine resistant. This seriously reduces the treatment options available to doctors in the event of an influenza pandemic.

If a discussion of antivirals is to be included, it needs to be prefaced with an explanation of viruses vs. bacteria. Better yet, move the antiviral stuff to its own article and include a link in See Also. —Ryan 05:51, 31 October 2007 (UTC)

[edit] Vegetarianism

I am not sure if this has been discussed already, but it need to be rewritten. Its scope should involve solely antibiotic resistance found on farms and the practices thereof. It also needs to be resourced. I can't think of any evidence showing that ingestion of meat causes abx resistance. ————75.73.61.30 20:29, 3 November 2007 (UTC)hullcrush————

History of the Use of Antibiotic as Growth Promoters in European Poultry Feeds. http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17954599&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum Antimicrobial Resistance in Scandinavia After Ban of Antimicrobial Growth Promoters http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17127526&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus http://www.fda.gov/cvm/HRESP106_157.htm 1977 FDA report http://www.nap.edu/catalog.php?record_id=21 NAP.edu 1980 study http://www.gao.gov/new.items/d04490.pdf 2004 GAO study http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1867957 "What Do We Feed to Food-Production Animals? A Review of Animal Feed Ingredients and Their Potential Impacts on Human Health" http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17600481&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus">"Antibiotic Resistance in Bacteria Associated with Food Animals: A United States Perspective of Livestock Production. http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17127530&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus">"Health Management with Reduced Antibiotic Use: The U.S. Experience." http://www.ucsusa.org/food_and_environment/antibiotics_and_food/hogging-it-estimates-of-antimicrobial-abuse-in-livestock.html

According to Madeline Drexler's 2002 "Secret Agents: The Menace of Emerging Infections" pg 143 "And each year, an estimated 300,000 pounds of antibiotic pesticides drift down of fruit trees and other crops to prevent bacterial infections suc as fire blight.... According to microbiologist Abigail Salyersm both the use of untreated or partially treated water for irrigation or for the washing of vegetables, or the use of manure as fertilizer for vegetables and fruits could contaminate food plants with antibiotic-resistant bacteria. Proving that no good deed goes unpunished, a 1993 study found higher levels of multidrug-resistant bacteria in the intestines of vegetarians than in meat eaters. Whether carnivore or vegetarian, you cannot avoid the aftermath of antibiotics applied lower in the food chain." Notice this refers to resistance of ordinary intestine flora-- the danger is that these bacteria can transfer resistance to infective foreign bacteria through bacterial conjugation, etc. Cuvtixo (talk) 22:08, 25 March 2008 (UTC)

[edit] Government Inaction

While both the US and the UK seem to be willing to talk about MR bacteria, the amount of information available through the medical profession in Australia is scant. In Febrary 2007 it was acknowledged to my sister (a registered nurse) that I had been infected with MRAB. I was told nothing. I took a guess that "central venous cathetar sepsis....caused by staph....and treated by Timentin and Vancomycin..." meant I had been infected by MRSA as well (not that there really is a difference to the victim who has to live with my neural damage). Hospitals simply encourage people to adhere to common-sense hygiene, but mention "MRSA" when looking for any treatment, and you discover the bland statement (no matter what you want to be treated): "I can't be of any help to you." 124.184.104.46 (talk) 13:21, 26 November 2007 (UTC)

[edit] Copyvio

http://www.atomicarchive.org/web-edition/columnists/laura-h-kahn/the-scourge-of-antibiotic-resistant-bacteria 66.67.47.120 (talk) 18:59, 10 May 2008 (UTC)