antibiotic resistance
Discussion
my GP said something the other day that made me think.... bulls
t.
He said microbiologists now recommend only short courses of antibiotics as longer courses have no evidence of better success, and can contribute to greater antibiotic resistance.
Surely if you give a short course (which i think we as patients all feel never quite do the trick) all it does is think out the weakest microbes, leaving the strongest and already most resistant to that antibiotic as breeding survivors. Then you go back, they give you another short course and the stronger ones survive yet again.
Am I talking st or what... have the NHS started actively lying to people about this stuff?
t. He said microbiologists now recommend only short courses of antibiotics as longer courses have no evidence of better success, and can contribute to greater antibiotic resistance.
Surely if you give a short course (which i think we as patients all feel never quite do the trick) all it does is think out the weakest microbes, leaving the strongest and already most resistant to that antibiotic as breeding survivors. Then you go back, they give you another short course and the stronger ones survive yet again.
Am I talking s
t or what... have the NHS started actively lying to people about this stuff?To be fair, we're all bksed in that area anyway.
Picked up a prescription yesterday, the dad in front was given 2 bottles of antibiotics, with an explanation that it's only a 5 day course, so after 5 days put the rest down the drain.
That's a healthcare professional advocating to do the worst thing you can do with antibiotics.
ksed in that area anyway.Picked up a prescription yesterday, the dad in front was given 2 bottles of antibiotics, with an explanation that it's only a 5 day course, so after 5 days put the rest down the drain.
That's a healthcare professional advocating to do the worst thing you can do with antibiotics.
oddman said:
It's not case of weak or strong bugs.
The longer a pathogen is exposed to an antibiotic, the longer the selective pressure works in favour of an emergent sub population of resistant bugs thus increasing the liklihood of emergence of a resistant strain.
How do you think that works then... being exposed to antibiotics doesn't change their DNA does it....The longer a pathogen is exposed to an antibiotic, the longer the selective pressure works in favour of an emergent sub population of resistant bugs thus increasing the liklihood of emergence of a resistant strain.
The words 'weaker' and 'stronger' are just shorthand so ultimately we are talking about the same thing. The antibiotic simply kills the bacteria more susceptible, and leaves only those that are less, thus increasing the proportion of bacteria that are less susceptible in the population/infection.
Blown2CV said:
oddman said:
It's not case of weak or strong bugs.
The longer a pathogen is exposed to an antibiotic, the longer the selective pressure works in favour of an emergent sub population of resistant bugs thus increasing the liklihood of emergence of a resistant strain.
How do you think that works then... being exposed to antibiotics doesn't change their DNA does it....The longer a pathogen is exposed to an antibiotic, the longer the selective pressure works in favour of an emergent sub population of resistant bugs thus increasing the liklihood of emergence of a resistant strain.
The words 'weaker' and 'stronger' are just shorthand so ultimately we are talking about the same thing. The antibiotic simply kills the bacteria more susceptible, and leaves only those that are less, thus increasing the proportion of bacteria that are less susceptible in the population/infection.
Bacteria multiply very rapidly so have a high likelihood of spontaneous mutation so in a sense they do change their DNA. Some of these mutations may confer resistance to antibiotics. Only if exposed to antibiotics will this mutation be advantageous. Thus minimising exposure (not using for viral infections; using for too long) minimises the emergence of resistant strains.
The microbiologist is concerned about the effect of antibiotic exposure at a population level.
GP is humble enough to listen to expert advice, learn and pass this on.
I still don't think we're saying different things...
genetic mutations generate the differences between more and less susceptible bacteria - i am not debating that. Genetic mutations create all sorts of things, but the traits and attributes don't become more or less common in the population unless there is positive or negative survival value in them.
A longer course of antibiotics might kill an entire infection population, leaving none to reproduce, regardless of their attributes. However if for whatever reason we accept that a course of antibiotics shouldn't be long enough to do that, then the antibiotics kill off the most susceptible bacteria, leaving a greater percentage of antibiotic resistant bacteria behind to reproduce, and to leave the host and enter the 'general population' of bacteria.
I am not trying to say the bacteria are fighting a conscious battle or actively 'trying' to become more antibiotic resistant, but thanks for giving me the unwarranted tag of someone who doesn't understand this stuff. I do think it's funny that you said this in one breath but then used the phraseology "bacteria change their DNA' in another.
genetic mutations generate the differences between more and less susceptible bacteria - i am not debating that. Genetic mutations create all sorts of things, but the traits and attributes don't become more or less common in the population unless there is positive or negative survival value in them.
A longer course of antibiotics might kill an entire infection population, leaving none to reproduce, regardless of their attributes. However if for whatever reason we accept that a course of antibiotics shouldn't be long enough to do that, then the antibiotics kill off the most susceptible bacteria, leaving a greater percentage of antibiotic resistant bacteria behind to reproduce, and to leave the host and enter the 'general population' of bacteria.
I am not trying to say the bacteria are fighting a conscious battle or actively 'trying' to become more antibiotic resistant, but thanks for giving me the unwarranted tag of someone who doesn't understand this stuff. I do think it's funny that you said this in one breath but then used the phraseology "bacteria change their DNA' in another.
Some Gump said:
To be fair, we're all bksed in that area anyway.
Picked up a prescription yesterday, the dad in front was given 2 bottles of antibiotics, with an explanation that it's only a 5 day course, so after 5 days put the rest down the drain.
That's a healthcare professional advocating to do the worst thing you can do with antibiotics.
Probably liquid for a child. Should have advised to return any unused for disposal.ksed in that area anyway.Picked up a prescription yesterday, the dad in front was given 2 bottles of antibiotics, with an explanation that it's only a 5 day course, so after 5 days put the rest down the drain.
That's a healthcare professional advocating to do the worst thing you can do with antibiotics.
Some Gump said:
To be fair, we're all bksed in that area anyway.
Picked up a prescription yesterday, the dad in front was given 2 bottles of antibiotics, with an explanation that it's only a 5 day course, so after 5 days put the rest down the drain.
That's a healthcare professional advocating to do the worst thing you can do with antibiotics.
I will stick my neck on the line and say it is the counter assistant and they have no professional qualifications. Unused should be returned and chucked in clinical waste or whatever they use in community pharmaciesksed in that area anyway.Picked up a prescription yesterday, the dad in front was given 2 bottles of antibiotics, with an explanation that it's only a 5 day course, so after 5 days put the rest down the drain.
That's a healthcare professional advocating to do the worst thing you can do with antibiotics.
Riley Blue said:
Probably liquid for a child. Should have advised to return any unused for disposal.
Yep! Amoxcillin, the apparent "give it to every child for everything" pink wonder liquid. We've had it loads, always ended up with a part bottle, always taken the semi-empties to pharmacist for disposal. I might be being too para, but with family in NSH / customers that work in antimicrobial resistance research, I've had it drummed into me that AMR could be the downfall of man some day!
There is a strong scientific argument for taking antibiotics until you feel better, then just stopping. Not the 7 days or 10 days written on the box. Particularly for urinary tract infections and cellulitis and similar where we don't see much resistance.
It isn't current practice, but I've read the articles and it is strongly supported.
You have to remember, the body's immunity can kill bacteria, it just sometimes needs a leg up.
And to answer the question, yes shortened courses are now routinely suggested. It's called Antibiotic Stewardship, and the people (my friends) who come up with it are significantly more intelligent than me.
We're talking PhD level research.
It isn't current practice, but I've read the articles and it is strongly supported.
You have to remember, the body's immunity can kill bacteria, it just sometimes needs a leg up.
And to answer the question, yes shortened courses are now routinely suggested. It's called Antibiotic Stewardship, and the people (my friends) who come up with it are significantly more intelligent than me.
We're talking PhD level research.
OK well that was kind of the point of my post. I'd originally assumed shorter courses would make antibiotic resistance worse, unless it was sufficient to eradicate all infection, so wanted to ask the question as to why longer courses result in more resistance.
I'd absolutely expect anyone doing research which then becomes public policy to have a PhD. It's kind of a research hygiene factor anyway isn't it?
I'd absolutely expect anyone doing research which then becomes public policy to have a PhD. It's kind of a research hygiene factor anyway isn't it?
Shorter courses may make antimicrobial resistance worse in certain situations when longer courses are required.
However your GP will be under advice made up from a large pool of studies that have looked into specific infections and how long it will take to reduce the bacterial load for a cure.
There are different types of bacteria that different antibiotics treat. Some antibiotics treat a wide (broad) spectrum of bacteria therefore will affect bacteria throughout the body, not just the infection you are treating. Therefore the longer you give them, the more time the rest of your bodies bacteria (gut, nose, mouth etc) will be affected which is obviously bad and why the courses arguably should be shorter.
However your GP will be under advice made up from a large pool of studies that have looked into specific infections and how long it will take to reduce the bacterial load for a cure.
There are different types of bacteria that different antibiotics treat. Some antibiotics treat a wide (broad) spectrum of bacteria therefore will affect bacteria throughout the body, not just the infection you are treating. Therefore the longer you give them, the more time the rest of your bodies bacteria (gut, nose, mouth etc) will be affected which is obviously bad and why the courses arguably should be shorter.
OK well, GPs now prescribe short courses as default regardless. Recently a GP told me they now only prescribe short courses full stop. So, there must be plenty of cases where a longer course would have been more appropriate; hence GP prescribing policy must be worsening antibiotic resistance.
Blown2CV said:
OK well, GPs now prescribe short courses as default regardless. Recently a GP told me they now only prescribe short courses full stop. So, there must be plenty of cases where a longer course would have been more appropriate; hence GP prescribing policy must be worsening antibiotic resistance.
"So, there must be plenty of cases where a longer course would have been more appropriate;"- No. Why? The scientific trials show a shorter course works just as well in all these cases. Why do you think they go shorter? If you go back to your GP because you are not cured, they will usually pick a 2nd line drug (according to their guidance) on the assumption that the first drug didn't work because of resistance. There are local and national protocols for what is 1st and 2nd line, and they are reviewed and updated.
True and gold standard antibiotic use is after sampling, microscopy, culture and sensitivity analysis. So the antibiotic chosen is proven to kill the the actual bug. But this takes 4+ days and often isn't feasible. So empiric or best informed guesses are used. Informed being the key word.
"hence GP prescribing policy must be worsening antibiotic resistance"
No. Resistance is linked to over use of antibiotics, not underuse. The shorter courses reduce resistance, side effects and cost.
That's why the NHS does it.
NICE is about doing it right and spending the money wisely.
The_Doc said:
Blown2CV said:
OK well, GPs now prescribe short courses as default regardless. Recently a GP told me they now only prescribe short courses full stop. So, there must be plenty of cases where a longer course would have been more appropriate; hence GP prescribing policy must be worsening antibiotic resistance.
"So, there must be plenty of cases where a longer course would have been more appropriate;"- No. Why? The scientific trials show a shorter course works just as well in all these cases. Why do you think they go shorter? If you go back to your GP because you are not cured, they will usually pick a 2nd line drug (according to their guidance) on the assumption that the first drug didn't work because of resistance. There are local and national protocols for what is 1st and 2nd line, and they are reviewed and updated.
True and gold standard antibiotic use is after sampling, microscopy, culture and sensitivity analysis. So the antibiotic chosen is proven to kill the the actual bug. But this takes 4+ days and often isn't feasible. So empiric or best informed guesses are used. Informed being the key word.
"hence GP prescribing policy must be worsening antibiotic resistance"
No. Resistance is linked to over use of antibiotics, not underuse. The shorter courses reduce resistance, side effects and cost.
That's why the NHS does it.
NICE is about doing it right and spending the money wisely.
The exception is the failed first course, because the research into sensitivities and previous successful treatments informs the baseline treatment.
Empiric treatments are best informed guesses and these change, but they will work for most people without problems.
I'm sorry you have trouble, but what you are looking at is a carefully balanced system applied to 60million people, and playing the odds of success in the majority. I have no doubt you have experienced personal failures. The vast majority of the NHS is successful treatments (albeit delivered late these days)
Have a read of this on Empiric Therapy https://en.m.wikipedia.org/wiki/Empiric_therapy#:~...
I do disagree that all empiric antibiotics are broad spectrum though. They aren't. They are increasingly well targeted. But nobody really edits scientific content too strictly on Wikip
Empiric treatments are best informed guesses and these change, but they will work for most people without problems.
I'm sorry you have trouble, but what you are looking at is a carefully balanced system applied to 60million people, and playing the odds of success in the majority. I have no doubt you have experienced personal failures. The vast majority of the NHS is successful treatments (albeit delivered late these days)
Have a read of this on Empiric Therapy https://en.m.wikipedia.org/wiki/Empiric_therapy#:~...
I do disagree that all empiric antibiotics are broad spectrum though. They aren't. They are increasingly well targeted. But nobody really edits scientific content too strictly on Wikip
Edited by The_Doc on Friday 9th February 09:58
Most Microbiology tests take 48 hours to get sensitivities back, 24 hours to grow the organism, then another 24 hours to then perform sensitivity testing on that organism. That's a best case assuming no delays (sensitivities failing etc.)
If GPs waited then it would potentially put patients at risk from the infection getting worse in the meantime.
Also, for certain infections, antibiotic prescription is based on what common organisms cause infection. For example, the majority of bacterial sore throats are caused by Beta-haemolytic Streptococci (A/C/G) which are sensitive to Penicillin/Amoxicillin.
On the wider point, obviously for serious infections no clinician would risk a shorter course than necessary and indeed there is set guidance for certain conditions (sepsis, meningitis, endocarditis etc.)
However, for less severe conditions, the evidence may point to shorter courses being used to help prevent resistance occuring.
As someone mentioned previously, it is no just the current pathogen that is taken into account but also the possibility of resistance occuring in other bacteria within your body. This could then cause problems in the future.
Just to add, not all antibiotics actually kill the bacteria. Some do and are called bacteriocidal antibiotics, others interfere with the bacteria's ability to reproduce, these are bacteriostatic antibiotics.
So the idea is not necessarily to kill off 100% of the pathogen but more to reduce pathogen numbers so that it is more easily managed/destroyed by the immune system.
If GPs waited then it would potentially put patients at risk from the infection getting worse in the meantime.
Also, for certain infections, antibiotic prescription is based on what common organisms cause infection. For example, the majority of bacterial sore throats are caused by Beta-haemolytic Streptococci (A/C/G) which are sensitive to Penicillin/Amoxicillin.
On the wider point, obviously for serious infections no clinician would risk a shorter course than necessary and indeed there is set guidance for certain conditions (sepsis, meningitis, endocarditis etc.)
However, for less severe conditions, the evidence may point to shorter courses being used to help prevent resistance occuring.
As someone mentioned previously, it is no just the current pathogen that is taken into account but also the possibility of resistance occuring in other bacteria within your body. This could then cause problems in the future.
Just to add, not all antibiotics actually kill the bacteria. Some do and are called bacteriocidal antibiotics, others interfere with the bacteria's ability to reproduce, these are bacteriostatic antibiotics.
So the idea is not necessarily to kill off 100% of the pathogen but more to reduce pathogen numbers so that it is more easily managed/destroyed by the immune system.
Edited by jayymannon on Friday 9th February 11:04
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