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Antibiotics, taken strategically, could actually help overcome antibiotic resistance
In the war against antibiotic-resistant bacteria, it's not just the antibiotics that reinforce the enemy, but the way they're prescribed. A new study suggests that doctors can overcome antibiotic resistance by using these same antibiotics, but in a very targeted way and in combination with other health strategies.
The wide current application of antibiotics helps resistant bacterial strains to evolve. But using data on bacterial specific resistance to more precise prescription of these same drugs can help reverse the evolution of resistant strains, according to researchers at Georgia Institute of Technology, Duke University and Harvard University.
One researcher cautioned that time is of the essence: new strategies to combat antibiotic resistance must be put in place before bacteria that are resistant to most known antibiotics become too prevalent. This would make antibiotics almost useless and it has been widely reported that this could happen by the middle of the century, making bacterial infections far more deadly.
"Once you have reached this state of resistance, it will be over," said Sam Brown, who co-directed the study and is an associate professor at Georgia Tech's School of Biological Sciences. "Unfortunately, time is running out to fight antibiotic resistance."
The new study, co-led by game theorist David McAdams, professor of administration and business management at Duke University, proposes a mathematical model to help public health and clinical researchers develop new strategies concrete prescription. And to help develop those who support health strategies focused on analyzing bacterial strains to determine which drugs they are resistant to and which ones are not.
Some medical laboratories are already analyzing human genomes for hereditary predispositions to certain medical conditions. Bacterial genomes are much simpler and much easier to analyze, and while analytical technology is not currently standard equipment in the medical offices or medical labs they work with regularly, researchers believe that this could change in many countries. a reasonable time, which would allow the approach of the study.
The researchers published their study in the journal PLOS Biology May 16, 2019. The work was funded by the Centers for Disease Control and Prevention, the National Institute of General Medical Sciences, the Simons Foundation, the Human Frontier Science Program, the Wenner-Gren Foundations and the Royal Physiographic Society of Lund. .
Q & A
Here are some questions and answers about how the counter-intuitive approach to the study could combat antibiotic resistance:
Is antibiotic prescription not the problem? How can he fight against resistance?
The real problem is the wide application of antibiotics. They treat human infections and livestock and, in so doing, destroy many non-resistant bacteria while bacteria resistant to these drugs survive. Resistant strains can then reproduce and with fewer competitors in their space, they dominate bacterial communities in host animals and in humans.
Resistant bacteria are transmitted to other hosts and become more and more widespread around the world. New prescribing strategies would go beyond this evolutionary scenario by exposing, through genomic (or other) analysis, the resistance of bacteria, but also their vulnerabilities.
"At present, there are rapid tests for the pathogen. If you have strep throat, the clinic scours the bacterium and does a quick test that says it is streptococcus, "Brown said. "But he will not tell you if he is resistant to the medication that is usually prescribed. In the future, point-of-care diagnoses could determine the strain you have and its resistance. "
Next, clinicians would choose the specific antibiotics to which the bacteria would not be resistant and kill them, thus preventing them from spreading the genes that cause their resistance to other antibiotics. The identification of the resistance of an infector thus strikes two birds with one stone.
"It's great to fight against antibiotic resistance, but also for patients, because we will always use the right antibiotic," said Brown.
[Thinking about grad school? Here’s how to apply to Georgia Tech.]
Is there enough effective antibiotics to do it?
A lot. Antibiotics always work as a rule.
In addition, the search for and destruction of resistant bacteria could help to cool the effectiveness of existing antibiotics.
"The idea is widespread that we are going to use antibiotics and then they are gone," said Brown. "It's not necessarily the case. This study introduces the concept that antibiotics could become a renewable resource if we act on time. "
As mentioned above, prescribing strategies in and of themselves will not beat the resistance, right?
Correct. The evolution of resistance presents delicate complexities.
"A lot of bacteria with the potential to make us sick like E. coli spend most of their time hiding peacefully in our bodies. These are neighborhood bacteria, and they are exposed to many antibiotics that we take for other things such as sore throats or earaches, "Brown said. "This frequent exposure is probably the main driver of the evolution of resistance."
The antibiotic prescription strategy needs these additional health measures to win the battle, but these measures are pretty simple.
What are these additional measures?
Diagnoses must also apply to nearby bacteria. E. coli in the intestine or, for example, Strep pneumoniae living peacefully in the nostrils would be subject to a resistance check, for example, during annual check-ups.
"If the patient wears a stubborn strain, you work to push it back before it can burst," Brown said. "There could be some non-antibiotic treatments that do that, like, perhaps, replacing bacteria."
Bacterial replacement therapy would introduce new bacteria into the patient's body to replace antibiotic resistant bacteria and move them. Plus, people would stay home after school and work a few days so they do not pass on bad bacteria to other people while their immune system and possibly other treatments, such as bacteriophages or non-antibiotic drugs, fought the bad bacteria.
This sounds optimistic, but are there other real circumstances to take into account?
"The mathematical models of the study are broad simplifications of real life," Brown said. "They do not take into account that pathogens spend a lot of time in other environments exposed to antibiotics, such as farms. Dealing with this will require additional research. "
The study also deliberately omits "polymicrobial infections", which are infections caused by several types of bacteria at the same time. Researchers believe that study models can still be useful to them.
"We expect that the logic of the fight against drug resistance is still valid in these more complex scenarios, but the rules of diagnosis and treatment will have to be specified specifically for them," Brown said.
Read also: Do you want to overcome antibiotic resistance? Rethink this prescription strep throat
These researchers co-authored the study: David McAdams of Duke University, Kristofer Wollein Waldetoft of Georgia Tech, Christine Tedijanto and Marc Lipsitch of Harvard University. The research was funded by the Centers for Disease Control and Prevention (OADS grant BAA 2016-N-17812), the National Institute of Sciences of General Medicine National Institutes of Health (grant U54GM088558), the Simons Foundation (grant 396001), the Human Frontier Science Program (grant RGP0011 / 2014), the Wenner-Gren Foundations and the Royal Physiographic Society of Lund.
Media / writer contact: Ben Brumfield
(404) 660-1408
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