Basically use dirty water, finely filter it, such that only things as big as phages remain. Put that liquid in a solution of bacteria you want to treat. Filter it again, repeat... In the end you should end up with some phage solution which specifically attacks the bacteria. If these phages don't work anymore, find new ones.
George Eliava Institute in Tbilisi is where you could get such a treatment. In the West you might be able to source it from food production related suppliers: https://phageguard.com. I guess an open wound where treatment with antibiotics fails and loosing your foot etc. is on the table, this might be an option of last resort.
> the western process of developing and releasing new medicine is ill-suited for phage treatment
…as evidenced by the booming phage industry somewhere in the east?
(The weird thing is this railing against western medicine or whatnot is usually a dead ringer for pseudoscience. Yet phages are a scientifically valid thereaupeutic route [1].)
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.
“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.
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.
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.
> 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.
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?
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.
> 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.
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.
- Overuse in meat agriculture evolving new DRB as a side-effect of profiteering from animal cruelty by force-feeding animals soy and corn.
- Overuse for emotional customer satisfaction reasons rather than evidence-based scientific treatment of viruses with totally-inappropriate antibiotics. This isn't a problem limited to the Global South that this article wags its finger at with imperial arrogance. This happens all the time with American primary care doctors dispensing antibiotics without proof of bacterial infection.
I once went to the doc with symptoms of strep. He prescribed antibiotics. I asked, why didn't you do a strep test first, as I didn't want to take the antibiotics if it wasn't strep? He looked annoyed and did the strep test. The results came back in a few minutes that I had strep.
The whole article talks about tracking and tracking better is helpful I get that but that won't stop it reverse the trend? Even in areas where we have clean data we see the trends.
Don't worry governments worldwide (except perhaps China, who knows) are defunding medical research. And they're defunding nothing faster than research into new antibiotics.
This last bit is partially indirect, since it has the problem that while new antibiotics might very well exist, governments will not approve them unless they have no other choice. Yes, nationalized health insurance providers are the majority of the worldwide market. Second a number of markets (notably India, but certainly not just them) will rip off the medication and not pay a dime for it. This all combines to make it really hard to get people to invest in widely applicable antibiotics. Unfortunately that does include direct subsidies as well (governments do ask big pharma what to subsidize).
So the money is in medicines that fix one particular fatal illness, medications for which no alternatives exist, that are very difficult to produce. This makes getting approval very easy, and allows for high prices.
At least that was the situation ~2016. Since then governments have been "tightening the belt" or whatever they call it and the situation has gotten worse to the point that a number of (especially European) labs now don't exist anymore. Which means even if the defunding is undone they will take a decade to get back up to speed. This is affecting a lot of other things as well. Like the ever-worsening doctor shortage predicted to worsen to the point that even just actual life-saving operations (now ~40% of the total, which is already way too much) won't be able to happen anymore ... by 2035, in the UK. This is not when you get ill, and need a treatment in 6 months, this is about someone closing up internal bleeding when you get hit by a car. Needless to say, the government is defunding education of new surgeons further, worsening the situation. I mean, everything is getting worse, on purpose, in the UK. From roads, public transport, and indeed the NHS. "Doing less with less" seems to be the government motto.
Another source of antibiotic resistance (which the article forgets to mention) is their routine use in livestock, preventatively and to accelerate growth. I would wager that is the far more significant contributor, since there's simply much more of it - compare the total number of cattle in places where such use is allowed (meaning cattle are exposed to antibiotics for most of their lives), versus the number of people being treated with antibiotics (i.e. a very limited population, for a very limited period):
Something else unmentioned is that 70-80% of hospital acquired infections are related to medical devices that are susceptible to the formation of biofilms where the bacteria create a protective layer that antibiotics can't penetrate.
For example antibiotic resistant urinary tract infections caused by the use of catheters. Effective antibiotics simply don't work when they can't reach the infection.
Nothing can be _completely_ sterile all the time. Urinary catheters also tend to move a bit when inserted, so they tend to slowly transport bacteria from the outside into the inside.
Industrial meat agriculture is killing us and the Earth ecosystem in manifold preventable ways if we'd just stop being so selfish and doing the same thing and expecting a different result:
You couldn't be more wrong. The overwhelming majority of people are against animal cruelty and creating more antibiotic resistance through cattle farming, even if it means slightly-to-modestly more expensive meat. The reason it continues is a failure to inform (seen the insides of many factory farms on the news lately?), organize, and act to that end. It is not because of selfishness that it continues (except the selfishness of those profiting from it, but there will always be someone selfish, no matter how selfless the average person gets), but because the virtuous have not gathered enough power to stop it (at home and especially abroad [1]).
It's used to keep cows alive that would otherwise die from being force-fed corn purely for economic reasons. It's the ranchers' choice to make more money at the expense of suffering of all of us and of the animals they torture. I've listened to former KAFO ranch hands bemoan that it's a truly shameful and disgusting practice that needs to be outlawed globally.
humans are now, and have been for some time, the largest biological niche to exist.
biological law: all niches will be filled.
all life shares the same chemistry
humans are activly digging up and playing with every tiny little other nitche on the planet and moving stuff around, AND useing various genetic edditing technolgys to modify numerous life forms, which are "washed" down the drain after the experiment is over.
https://en.wikipedia.org/wiki/Phage_therapy
Basically use dirty water, finely filter it, such that only things as big as phages remain. Put that liquid in a solution of bacteria you want to treat. Filter it again, repeat... In the end you should end up with some phage solution which specifically attacks the bacteria. If these phages don't work anymore, find new ones.
George Eliava Institute in Tbilisi is where you could get such a treatment. In the West you might be able to source it from food production related suppliers: https://phageguard.com. I guess an open wound where treatment with antibiotics fails and loosing your foot etc. is on the table, this might be an option of last resort.
> In the end you should end up with some phage solution which specifically attacks the bacteria
This reminds of the universal cure to disease being a bullet [1].
Phages are promising. That doesn’t mean they can’t hurt you [2].
[1] https://xkcd.com/1217/
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC8310247/
"we found some adverse events associated with phage therapy, but serious events were extremely rare."
The biggest hindrance is that the western process of developing and releasing new medicine is ill-suited for phage treatment.
> the western process of developing and releasing new medicine is ill-suited for phage treatment
…as evidenced by the booming phage industry somewhere in the east?
(The weird thing is this railing against western medicine or whatnot is usually a dead ringer for pseudoscience. Yet phages are a scientifically valid thereaupeutic route [1].)
[1] https://www.nature.com/subjects/bacteriophages
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/
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.
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.
> 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.
The majority of antibiotics are not consumed by humans though, but by the animals raised to be eaten.
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?
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.
> 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.
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.
You just executed a kill mission on the HQ and general staff in this war, the CDC. Totally gonna change the trajectory
The war is being lost for 3 main reasons:
- Overuse in meat agriculture evolving new DRB as a side-effect of profiteering from animal cruelty by force-feeding animals soy and corn.
- Overuse for emotional customer satisfaction reasons rather than evidence-based scientific treatment of viruses with totally-inappropriate antibiotics. This isn't a problem limited to the Global South that this article wags its finger at with imperial arrogance. This happens all the time with American primary care doctors dispensing antibiotics without proof of bacterial infection.
- Lack of R&D into new drug classes.
I once went to the doc with symptoms of strep. He prescribed antibiotics. I asked, why didn't you do a strep test first, as I didn't want to take the antibiotics if it wasn't strep? He looked annoyed and did the strep test. The results came back in a few minutes that I had strep.
I wonder whether the test cost more than the antibiotics. I'm impressed at the speed, though.
The whole article talks about tracking and tracking better is helpful I get that but that won't stop it reverse the trend? Even in areas where we have clean data we see the trends.
So what's next?
Don't worry governments worldwide (except perhaps China, who knows) are defunding medical research. And they're defunding nothing faster than research into new antibiotics.
This last bit is partially indirect, since it has the problem that while new antibiotics might very well exist, governments will not approve them unless they have no other choice. Yes, nationalized health insurance providers are the majority of the worldwide market. Second a number of markets (notably India, but certainly not just them) will rip off the medication and not pay a dime for it. This all combines to make it really hard to get people to invest in widely applicable antibiotics. Unfortunately that does include direct subsidies as well (governments do ask big pharma what to subsidize).
So the money is in medicines that fix one particular fatal illness, medications for which no alternatives exist, that are very difficult to produce. This makes getting approval very easy, and allows for high prices.
At least that was the situation ~2016. Since then governments have been "tightening the belt" or whatever they call it and the situation has gotten worse to the point that a number of (especially European) labs now don't exist anymore. Which means even if the defunding is undone they will take a decade to get back up to speed. This is affecting a lot of other things as well. Like the ever-worsening doctor shortage predicted to worsen to the point that even just actual life-saving operations (now ~40% of the total, which is already way too much) won't be able to happen anymore ... by 2035, in the UK. This is not when you get ill, and need a treatment in 6 months, this is about someone closing up internal bleeding when you get hit by a car. Needless to say, the government is defunding education of new surgeons further, worsening the situation. I mean, everything is getting worse, on purpose, in the UK. From roads, public transport, and indeed the NHS. "Doing less with less" seems to be the government motto.
Another source of antibiotic resistance (which the article forgets to mention) is their routine use in livestock, preventatively and to accelerate growth. I would wager that is the far more significant contributor, since there's simply much more of it - compare the total number of cattle in places where such use is allowed (meaning cattle are exposed to antibiotics for most of their lives), versus the number of people being treated with antibiotics (i.e. a very limited population, for a very limited period):
https://pmc.ncbi.nlm.nih.gov/articles/PMC12029767/
https://pmc.ncbi.nlm.nih.gov/articles/PMC6017557/
Something else unmentioned is that 70-80% of hospital acquired infections are related to medical devices that are susceptible to the formation of biofilms where the bacteria create a protective layer that antibiotics can't penetrate.
For example antibiotic resistant urinary tract infections caused by the use of catheters. Effective antibiotics simply don't work when they can't reach the infection.
Oh, that's messed up. Aren't catheters supposed to be air-tight, sterile and single-use? Or do they reuse them?! >__>
Sure. But the lubricant they use usually contains antibiotics. Go figure.
Nothing can be _completely_ sterile all the time. Urinary catheters also tend to move a bit when inserted, so they tend to slowly transport bacteria from the outside into the inside.
Interesting - do you have the source handy?
It’s not a coincidence that many of the antibiotic resistant bacteria tend to pop up in areas where the livestock industry is located.
Industrial meat agriculture is killing us and the Earth ecosystem in manifold preventable ways if we'd just stop being so selfish and doing the same thing and expecting a different result:
- Antibiotic-resistant bacteria evolution
- Animal cruelty
- Pandemic virus evolution
- Climate change
- Air, water, and soil pollution
> if we'd just stop being so selfish
You couldn't be more wrong. The overwhelming majority of people are against animal cruelty and creating more antibiotic resistance through cattle farming, even if it means slightly-to-modestly more expensive meat. The reason it continues is a failure to inform (seen the insides of many factory farms on the news lately?), organize, and act to that end. It is not because of selfishness that it continues (except the selfishness of those profiting from it, but there will always be someone selfish, no matter how selfless the average person gets), but because the virtuous have not gathered enough power to stop it (at home and especially abroad [1]).
Self-flagellation will accomplish nothing.
[1] https://ourworldindata.org/grapher/antibiotic-use-livestock-...
> even if it means slightly-to-modestly more expensive meat.
This is a hard one to prove without trying. A lot of people would say that and then buy the cheaper version when the time comes.
It's used to keep cows alive that would otherwise die from being force-fed corn purely for economic reasons. It's the ranchers' choice to make more money at the expense of suffering of all of us and of the animals they torture. I've listened to former KAFO ranch hands bemoan that it's a truly shameful and disgusting practice that needs to be outlawed globally.
here are simple facts
humans are now, and have been for some time, the largest biological niche to exist.
biological law: all niches will be filled.
all life shares the same chemistry
humans are activly digging up and playing with every tiny little other nitche on the planet and moving stuff around, AND useing various genetic edditing technolgys to modify numerous life forms, which are "washed" down the drain after the experiment is over.
it goes on.
we are so fucked.