Keep in mind that modern antibiotics were created partly because at the time plants with antibiotic properties were being used so heavily that they were already becoming endangered. E.g.: https://en.wikipedia.org/wiki/Goldenseal
> One of the bright spots is that it seems hard for bacteria to evolve more than one resistance
Not sure where you got that impression. There are bacteria out there that are basically resistant to every antibiotic we have. The article even gave an example of a case where someone died because of this.
> There are modern techniques to avoid resistance issues.
Yes, true, and it is right that we should implement these techniques. However, until the whole world plays along there are going to be problems. If sub-clinical or too frequent doses of antibiotics are given somewhere in the world, then antibiotic resistant strains of bacteria will develop, and can be transmitted across borders.
> I've heard the opinion that most antibiotic resistance genes don't seem to originate in agricultural use.
Maybe true but I don't see the post you're replying to saying that. If you are saying that, a reference to some research showing that would be welcome.
> but it's way more complicated
surely true, but it doesn't mean antibiotic overuse isn't a damn good starting point for resistance to develop.
I’m not saying modern medicine didn’t put a ton of evolutionary pressure on antibiotic resistance. However, there’s some evidence of AR genes being present in the microbiomes of previously isolated tribes [1]. So we didn’t promote the “invention” of AR by bacteria, but likely just accelerated the selection of AR strains.
> It's easy to take these miraculous little pills for granted even though we've had them for fewer than 100 years.
We've had effective antibiotics for thousands of years. When penicillin was first isolated in 1928, there was so little demand for it that it took over a decade before anyone even bothered working on a way to commercialize it. It wasn't particularly difficult to commercialize, but no one actually cared.
Modern antibiotics are mostly only necessary if you get shot or you're a burn victim or something, which is why no one cared until WWII. Also, some of the berberine plants that were used before that were starting to become less common around that time.
If we didn't have effective antibiotics before penicillin then human life expectancy would have gone way up after the discovery of penicillin. But looking at the data, it's pretty obvious that that didn't actually happen. Pretty much every scientific paper agrees with this, e.g.:
> Its going to be the antibiotic winter, antibiotic resistant bacteria.... Bacteria will cause extinction.
They didn't cause humanity to go extinct before antibiotics were invented. If they all lost effectiveness, we'd just return to the status quo ante (not extinct, with more sickness).
> Much more importantly, our use of medicines (antibiotics, antivirals, antifungals, etc.) have put extreme selective pressure on pathogens to evolve to become resistant to them.
I don't think that makes sense when comparing against the threat level of pre-antimicrobial times. It didn't matter that they weren't resistant before we had antimicrobial drugs. Lack of resistence was useless in cave man times.
> 1) Resistance is inevitable. It doesn't matter if everyone finishes their prescribed treatment or not, bacteria will develop resistance to antibiotics one way or another.
Not wrong, but it paints a pretty black and white picture of something that has a lot of shades of gray. The way we use antibiotics strongly influences how quick antibiotic-resistant bacteria evolve.
With very good usage discipline you could even try to kill all resistant bacteria by use of different antibiotics before the bacteria become multi-resistant.
> Eventually bacteria will evolve, and they’ll adapt ways around that to overcome that obstacle.
I am more optimistic than that.
Sure: as long as antibiotic resistance is crucial for bacterial survival, bacteria have a natural need to evolve it. And, they will.
But, this will come with a genetic cost to the bacteria.
The reason that antibiotics work is because they are attacking some function that has deliberately evolved, through natural selection, to be like that. Antibiotic resistance must literally cost bacteria some efficiency in some of their other functions.
This cost was originally such that the bacteria would die. Fantastic. But note: we wouldn't actually benefit from all bacteria dying at the mention of the word antibiotic, and some bacterial resistance is good for us.
Under normal circumstances, bacteria that don't need to carry around antibiotic resistance with them will most likely have a lower genetic cost and thrive better. This may be why we have seen MRSA predominantly in hospitals and rarely in the 'wild'. (If MRSA was necessary or not costly, all SA would be MR all the time).
This gives me some hope - that antibiotic resistance is balanced, genetically forcing bacteria to be less effective in other ways and less competitive in other circumstances.
> Antibiotic resistant genes don't just disappear when we stop using antibiotics. They will remain in the gene pool effectively forever at low levels.
They very likely already were in the gene pool before we went on the antibiotics binge. Remember that our antibiotics were discovered in nature. They're used by other species to fight bacteria. Penicillin was used by moulds for unknown millions of years before we coopted it.
Since bacteria multiply within days or even hours, evolution works very fast in them. This is why they develop resistance within a few decades. How fast they would lose the resistance if we stopped is AFAIK not something we can know until we do it and see what happens.
> Microorganisms have been using antibiotics against each other since life begun on Earth and have evolved ways to evolve around them and develop resistance.
The same is true with regards to viruses, is it not?
> given there's no known evolutionary pressure towards it.
There will be, once the antibiotic is put into use. And that's assuming something working roughly the same way isn't, unbeknownst to us, already present in nature, leading to countermeasures also already being present in the environment.
> Could you elaborate on how you think such a thing might appear in nature?
The same way everything else does - natural selection. By random chance, some bacteria will survive the antibiotic treatment. Those bacteria will get to reproduce where their neighbors won't. Now, while it's possible many of the survivors will be left unharmed because their mutations made them completely broken and not worth the antibiotic's metaphorical effort, eventually there will be a survivor that's mutated just right to resist while being able to reproduce and thrive. Its lineage may still die off, but then maybe next one's won't, and now you have a resistant strain in the wild, possibly further spreading resistance-conveying plasmids.
> IIRC, general antibiotics have never lasted more than 18 months before we found a bacteria that became resistant to them.
This does not seem to be correct. With the most recently introduced antibiotics—Levoflaxacin, Linezolid and Ceftaroline—resistance has developed very rapidly. But that didn't used to be the case; old antibiotics lasted much longer before resistance developed. [1]
I am not sure why this is---are these newer antibiotics more fragile (i.e., easier to resist), or are they being misused more broadly? If it is the latter reason, then perhaps we should stop developing new antibiotics until better usage practices are enforced. It is stupid to spend a lot of money developing antibiotics, only to throw it away by misusing them.
Fungus could tell another history, about how they design, make and use exactly the same compounds since thousands, maybe millions of years for the same purposes.
Keep in mind that modern antibiotics were created partly because at the time plants with antibiotic properties were being used so heavily that they were already becoming endangered. E.g.: https://en.wikipedia.org/wiki/Goldenseal
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