[gringochileno]

This is one of those problems that has multiple causes and will require multiple solutions. Just off the top of my head I can think of several:

• Antibiotic use in livestock needs to be stopped completely or heavily restricted. I bet some of you didn't know that 70% of antibiotics are used in livestock, almost all of which are given to healthy animals because it promotes their growth, not because they're sick. The research suggests that this may be the single most important factor driving the development of resistance. It may make meat a little bit more expensive but the alternative is unimaginably large loss of life. Europe has already done this to a large extent and they haven't imploded from it.
• Drug companies have little incentive to put money into R&D for new antibiotics. Antibiotics don't tend to be very good money-makers because you prescribe them once, finish the course, and then you're done with them. The big bucks are in medications for chronic diseases which have to be taken for years or even a lifetime, and as you can guess a disproportionate amount of funding goes into researching new medications of this kind at the expense of drugs that are sorely needed but not as profitable. The result is that there are very few new antibiotics coming online while resistance continues to march forward. I think we need an aggressive program of subsidies to counteract this similar to the orphan drug program that provides funding for treating very rare diseases.
• Patients are really bad at taking antibiotics. Most prescribed courses of antibiotics aren't completed properly, which means you only kill the most susceptible bacteria and select for resistant organisms. Often patients will get standard antibiotics for a common infection, stop taking them when they feel better, and then end up in the hospital with a resistant strain that we need to pull out second- or third-line agents to defeat. Do this enough times and eventually you'll get bugs that not even our biggest guns can kill. Developing once-daily extended release dosings of drugs that are easier to adhere to, as well as improved education on the importance of finishing every course of antibiotics once it's started, may help mitigate this.
• Doctors prescribe a lot of inappropriate antibiotics. The classic example of this is someone who comes in with a cough for a week or so. This is 90% likely to be a viral infection that antibiotics can't treat, but patients often have their heart set on walking out of there with some pills, and too often doctors will take the easy way out and just write a prescription rather than take the time to explain why antibiotics aren't needed, which is likely to just piss off the patient anyway.
• We do a very poor job of protecting our second-line and "last resort" antibiotics, especially in hospital settings. Resistance to powerful drugs like fluoroquinolones and vancomycin is developing rapidly because we're too quick to deploy them empirically in hospitalized patients, when a less powerful agent would do the job most of the time. If we don't save these drugs for when they're really needed they'll lose their effectiveness.
• We use the same antibiotics over and over again. There's some evidence that doing coordinated "crop rotation," where drugs are periodically taken out of use and replaced with equivalent agents to allow susceptibility to go down, can slow the development of resistance. Obviously this is hard to coordinate when you don't have an advanced healthcare infrastructure.
  

(02-09-2012 12:55 PM)Charlie Foxtrot Wrote:  

And in my opinion the worst is even if you don't ever take any antibiotics you can get a super strain of one of these bacteria. I feel is is not fair, at all, and needs to be fixed now. How about everyone stops taking antibiotics, for good?

That would kind of defeat the purpose, wouldn't it? The whole point of combating antibiotic resistance is to make it so we can still use these drugs and not go back to the pre-antibiotic era when common infections (the kind you would never worry about today) were one of the leading causes of death. You seriously would not want to do that--antibiotics are one of the single greatest discoveries in human history in terms of the number of lives saved and the improvement to quality of life (the only things I can think of that beat them out are vaccines and sanitation).

(02-09-2012 01:17 PM)Tuthmosis Wrote:  

You have hand sanitizer ("Purell"), anti-bacterial soaps, and all that shit to thank--I'm convinced of it.

Those actually haven't been shown to increase resistance. The concern with anti-bacterial soaps is that they can kill the "good" bacteria that are naturally present and leave room for opportunistic infections to set in.

The fact that this is a multifaceted problem, many of whose causes are very widespread and hard to deal with, is what makes the issue of antibiotic resistance so challenging. At the same time, it's absolutely critical that we take steps to slow the development of resistance because the emergence of bacteria that resist all of our drugs is one of the greatest public health threats we face. It doesn't get nearly enough attention and the fact that anyone opposes obvious actions like stopping routine antibiotic use in livestock is completely absurd.