More people died of superbacteria in 2019 than HIV or malaria, study suggests
edition.cnn.comThe study is here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
My hope is that phage therapy can solve the issue of drug-resistant bacteria. Also we really need to get our things together and work against misuse of antibiotics.
I did a pharmacy degree circa 1983-87 in the UK.
Antibiotic resistance was already a pressing problem. Penicillin-V was little more use than a placebo as of 1984; Amoxicillin was in danger, MRSA was already out there. The big short-term hope was Augmentin (Amoxicillin/clavulanic acid) -- clavulanic acid was a beta-lactamase inhibitor, beta-lactamase being the primary pathway for penicillin resistance in bacteria, so it was somewhat effective against penicillin-resistant infections. But resistance was already showing up for almost every antibiotic on the market except vancomycin (which is pretty nasty stuff, toxicity-wise). Today, resistance to vancomycin and other antibiotics of last resort is a thing. So there are infections out there that will kill you gruesomely, just as there were in the 19th century and earlier, because we collectively dropped the ball.
As with anthropogenic climate change, the writing has been on the wall for decades -- and has been systematically ignored by policy-makers. Adding antibiotics to animal feed improves weight gain in farm animals so farmers still shovel the stuff by the bucketload. But it also applies a selection pressure for antibiotic resistance to the bacteria infesting those animals, and when they go to the slaughterhouse the resistant strains migrate into the human reservoir.
And this says nothing about the structural incentives to discount antibiotic R&D in the commercial pharmaceutical industry. (Bluntly: they're not profitable enough to bother with, because bacterial infections are acute disease -- you cure it in a few days or weeks, your customer goes away satisfied. Unlike antidepressants or anti-hypertensives or diabetes meds, which the patient is typically on for years to life.)
We should have restricted access to antibiotics the way we (try) to restrict opiates. Failing that we should have government funded R&D via non-profits. Only now it's too late and corrective action won't take effect for years.
> Also we really need to get our things together and work against misuse of antibiotics.
Too late for that, we already have the superbugs. Not to say that reducing antibiotic usage in farms is not worth the effort (because it is), but we need to ramp up investment in basic R&D for antibiotics again - there is almost none of that any more since it is extremely cost-intensive and the medications are low-revenue [1].
ETA: Additionally, we could curb human antibiotic usage by making rapid tests for common viral infections more available. Routinely checking for strep throat and the various flu viruses both at-home and in clinical situations could save people a lot of completely unnecessary antibiotics courses - as well as teaching basic life education like "if it's not a bacterial infection behind your sore throat, an antibiotics course won't help at all, it will go away on itself after three to four days".
Lateral flow rapid tests are incredibly cheap to manufacture and (as the last two years have shown) capable of being self-administered - making them account for multiple sorts of antibodies is already done for COVID tests.
Why a phage therapy is not widespread?
1. "Not invented here" (western medical practice largely ignored the USSR, where phage treatments were a big thing: journals didn't get translated, treatments didn't get picked up).
2. Not profitable. They were developed in the Soviet bloc hence not patented but it would have invalidated any patent in the west, so there was no lucrative monopoly to pursue.
After the collapse of the USSR western antibiotics flooded in; the home-grown technique (which was somewhat time-consuming and expensive: matching a phage to an infection requires lab work and specialist facilities) was undermined and fell into disuse.
But fortunately the know-how is still there (https://en.wikipedia.org/wiki/George_Eliava_Institute), and lately there is renewed interest, so let's hope something comes out of it...
It could potentially work under Pharmacopeia / Value-based healthcare model, and as a service it's less like a drug and more like a "process"; more like surgery, less like a pill. "Surgery wouldn't work under the pharmaceutical industry either"
We're working with the Australian government to make this happen: https://www.westmeadinstitute.org.au/news-and-events/2021/we...
The difference we have now vs. 80 years ago Soviet Russia, is that we have tools that speed up lab work and the pipeline of "finding/getting/checking/manufacturing/using" the right phage for the right infection.
It's still going to be mighty difficult, though. And not sure if the economics really would make sense, but still — do the economics of surgery make sense? (I actually don't know the answer to that)
How can a technique that requires lab work not be profitable?
Your assumption is that the medical industry is profitable. This is not universally shared.
I am in the UK; we have socialized healthcare here. Lab work is an overhead, not a profit centre.
(Antibiotics can be prescribed instantly on demand by any doctor. Whereas phage treatment requires a sample of the infective agent to be obtained, cultured, then tested against a library of phages. All of which is time-consuming so renders phage treatments only really useful for severe infections causing hospitalization. At least, that was historically the case: rapid DNA sequencers could in principle turn it into something that can be rolled out to GP practices. But this tech didn't exist even a decade ago.)
It's pretty easy to buy phages in Russia. It is sold in almost any pharmacy, doctors sometimes recommend it, you can check if bacteria sample is sensitive to phage in almost any medical lab.
I even had an experience of treating infection with phages myself, as antibiotics had interactions with my other drugs. It went pretty well.
But in my case, course of treatment with phages is around 100$, while course of treatment with antibiotics is 5-10$.
complex. it is made per bacteria type as far as I know and it does not scale like a chemical compound.
which is good, then you can't "preventively" use it on cattle, pigs, chicken etc. like they do with antibiotics, causing resistant strains to develop. I imagine phage therapy would only be an additional "line of defense" against resistant bacteria, similar to the "reserve antibiotics" (which are however more and more widely used, including for animals, despite their "reserve" status).
We should start with cattle and livestock in deveolping nations like India. Farmers abuse antibiotics the most.
By "superbacteria" I mean "drug-resistant bacteria".
I linked the original study, but I saw it Spanish national media, and then here: https://edition.cnn.com/2022/01/19/health/bacterial-antimicr...
The HN guidelines ask submissions not to edit the title except for certain narrow exceptions.
Also, here's a BBC article on the topic: https://www.bbc.co.uk/news/health-60058120
The title was from the cnn.com article. I've changed to that now from https://www.thelancet.com/journals/lancet/article/PIIS0140-6... - usually the best choice for studies like this is to link to the best third-party article and link to the paper in the thread.
Got it, thanks.
All the health agencies in the world know this is a problem, but are there any actual changes being made to prevent the worst-case scenario?
I worry this is the same situation as Covid, where health agencies knew for years hospital capacity was stretched thin, and lo-and-behold, thousands of people die unnecessarily when a new virus arrives because hospital capacity was overwhelmed.
Afaik, one problem is that the health agencies can only do so much. Most antibiotics and antibiotics misuse happens in agriculture where a totally different agency is responsible. Yes, they should foster more research into new drugs, but the main challenge remains prophylactic animal treatment.
It seems like a situation where hospitals could be designed in such a way to reduce the likelihood of creating 'superbacteria.' Certainly some must be better than others?
They could also address society generally having poor health - If the CDC pounded the table about unhealthy foods/the obesity epidemic I'm sure it could move the needle in some way. Addressing the obesity epidemic would be killing 100+ birds with one stone.
Well now pretty much half of the country refuses anything the CDC says.
It's like insurance, they think they won't need it and they don't have any incentive to do the right thing (spend more, much more, for a catastrophic but low chance scenario).
Well. There are two old St.Aureus vaccines which, in combination, allowed me to eradicate MRSA which I got during a hospital stay. One these vaccines was created long time ago in USSR for veterinary workers, another one - to treat skin infections in babies. Both are still produced and available though most of the doctors are not aware of them. Both, of course, were never tested in proper trials.
Not like anyone cares.
https://www.rlsnet.ru/tn_index_id_5850.htm
https://www.vidal.ru/drugs/therapeutic_staphylococcal_vaccin...
Interesting. I wonder on the issues, efficacy, etc.
TB vaccine is troublesome and not that effective, to the point that some debate it should not be used, tetanus seems wildly successful.
(These are the only other bacteria vaccines I know of)
They are many bacterial vaccine out there against pneumococcal, meningococcal, typhoid fever, cholera, haemophilus influenzae type B etc.
> Our approach can be divided into five broad components: number of deaths where infection played a role, proportion of infectious deaths attributable to a given infectious syndrome, proportion of infectious syndrome deaths attributable to a given pathogen, the percentage of a given pathogen resistant to an antibiotic of interest, and the excess risk of death or duration of an infection associated with this resistance
The headline that you wrote phrases this as "died of superbacteria", does this relate to the number where an infection played a role or the number attributable to a given pathogen?
There's some hope maybe with
>Microorganisms found in dirt have yielded antibiotics that can kill pathogens resistant to multiple drugs. https://www.nature.com/articles/d41586-018-01931-4
and similar stuff? We could do with some government action to develop some and ban using them in farming.