Thanks for the great write-up. I’ve always wondered, is resistance a “use it or lost it” kind of thing in bacteria? I see you mentioned that antibiotic immunity seemed to decrease after removing antibiotics from cattle for a few years. Would some antibiotic immunity in bacteria fade after say, 50 years without globally using penicillin (putting aside the consequences of not using the antibiotic)? I would imagine there would be a reduction in resistance in 50 years, but some forms of resistance to the same antibiotic are more stable than others, Class of 2021 Plague Doctor Mask Halloween Seniors T-Shirt and it’s likely that although resistance may have lowered, it wouldn’t go all the way to zero; there’s likely some basal level of resistance that will persist. A lot of antibiotic resistant genes can have more of a neutral effect as opposed to a deleterious effect in neutral conditions, so the bugs aren’t really bothered by their presence.
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I think a lot of poor antimicrobial stewardship is driven by the increasingly corporate, metric-based style of medicine practiced in the US. It’s very unsatisfying to patients to go to the primary care for a mild sinusitis or respiratory infection and be told that there’s not much that can be done other than symptom relief–and unsatisfactory reviews are a result. Class of 2021 Plague Doctor Mask Halloween Seniors T-Shirt Additionally, higher standards should be required for the prescription of antibiotics, to increase accountability of physicians; these standards could involve clinically verifying the presence of susceptible bacteria prior to administering a drug in situations where the disease in not life-threatening. Not always possible as negative cultures doesn’t necessarily mean absence of infection. Significant numbers of microbial species are not culturable.
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Something that is also important to mention is that antibiotic research is inherently unprofitable for pharmaceutical companies. They’re spending copious amounts of money to develop a drug that will purposefully be used as little as possible and for as short a duration as possible. Class of 2021 Plague Doctor Mask Halloween Seniors T-Shirt Compare that to the very profitable monoclonal antibody drugs for cancer and inflammatory conditions. Often extended courses of treatment (sometimes lifelong) which quickly produce return on investment. Just a warning though (not criticism!), this post is really dense and I think a lot of people are going to skip it because of the length. Everything here is great information, but I think you could reach a larger audience by cutting out the bits that aren’t 100% essential and breaking it into smaller sections that can each be summarized with a single sentence.