Talk:Antimicrobial resistance/Archive 1

Archive 1

Archive 2

non NPOV language

" The pipeline of new antibiotics is drying up.[citation needed]Major pharmaceutical companies are losing interest in the antibiotics market because these drugs may not be as profitable as drugs that treat chronic (long-term) conditions and lifestyle issues.[83][citation needed]"

and a few other paragraphs in that section. — Preceding unsigned comment added by 99.162.242.12 (talk) 05:40, 26 August 2012 (UTC)

AidenG: The poor English, dramatization and lack of citation in this paragraph is indicative of conspiracy theorists. This paragraph should be rewritten. — Preceding unsigned comment added by 109.255.79.57 (talk) 14:06, 26 January 2013 (UTC)

Made some changes. Jzlcdh (talk) 18:26, 11 March 2013 (UTC)

Updates needed?

Just read an article on NPR (http://www.npr.org/blogs/health/2012/06/22/155589409/drug-resistant-germ-in-rhode-island-hospital-raises-worries) that leads me to suspect this article needs some additional material, unfortunately far beyond this author's biological/clinical "pay grade." This would include coverage of carbapenem-resistant Enterobacteriaceae (CRDs, specifically Klebsiella pneumoniae) and the concept of extensively drug resistant (XDR; i.e., almost untreatable with antibiotics) strains. If the article isn't just journalistic extremism, but it does cite a JAMA article and new CDC recommendations. Mrnatural (talk) 02:12, 23 June 2012 (UTC)

Geographic distribution

Is there any data on the geographic distribution of various resistant bacteria? Is it correlated with the frequency of antibiotic use in various parts of the world? I don't know much about this (layman), so I'm just throwing the question out there for those with more knowledge in the field.

If yes to the questions above, then that information should be included in this article, in my opinion. --Larssl (talk) 11:25, 4 December 2010 (UTC)

Epigenetic mechanism of resistance

Would it not be sensible to include in this article a description of the alternative mechanism of antibiotic-resistance, that being an alteration of gene expression?

Yep, that would be reasonable, though I don't have time now to whip out my microbiology textbooks. And the article really needs to change all the wording about "evolution" to refer to "natural selection," as resistant strains that already exist in the population are selected for and proliferate -- it's not due to a new mutation that pops up when the bacteria are exposed to antibiotics. In a generic meaning of "evolution" being that they have developed a new trait, that would work, but that's not the strict scientific meaning of the word. 68.227.38.212 (talk) 22:00, 21 July 2010 (UTC)

Natural selection is the result of evolution. Unless the thing causing the mutation is causing a mutation that leads to a stronger version of the species, there is no difference. I.e. it is incorrect, or at least misleading, to say that antibiotic resistance is "acquired" by bacteria, since "bacteria" is generally used to describe multiple bacterium. In other words, while a population may cease to have cells that are killed by antibiotics, because they all die and the others survive, the individual cells do not generally develop resistance. They existed before, but had to compete for resources with non-resistant strain. Confusing the process is like saying giraffes "developed" long necks "because" it made it easier to eat out of trees, which is false. Some giraffes randomly developed longer necks and those "survived" "because" it made it easier to eat out of trees. Even where the environment causes mutations, e.g. mutagenic antibiotic, radiation, etc., it is random luck that the particular mutation would be one that creates a stronger strain. Most are fatal or create no advantage. — Preceding unsigned comment added by 69.64.10.170 (talk) 22:49, 11 June 2013 (UTC)

Staph Penicillin Resistance =

This article used to say that: It was the first bacterium in which penicillin resistance was found—in 1947, but this is not true since fleming had found bacteria that were resistant in 1929, and the first penicillinase was isolated in 1940. However, I keep seeing this fact in various publications, does anyone know what the source for it is? Is it correct with some caveat? (eg first medically relevent, first lethal case of, etc.) —Preceding unsigned comment added by 140.247.90.36 (talk) 17:46, 17 July 2010 (UTC)

The emergence of MRSA

The phrase 'MRSA was responsible for 37% of fatal cases of blood poisoning in the UK in 1999' is not quite correct in two ways: 1) 37% refers to the percentage of fatal cases (...) out of all those attributable to Staphylococcus aureus, and NOT out of ALL cases of blood poisoning; 2) it is 33% and not 37%. If you look up the EARSS website under http://www.rivm.nl/earss/database/ you will see what I mean Pietro Coen —Preceding unsigned comment added by Pietrocoen (talk • contribs) 19:55, 25 November 2007 (UTC)

Material from multidrug resistance

Added here for use.--nixie 11:52, 16 Apr 2005 (UTC) Some antibiotics interfere with bacterial cell wall synthesis. Others inhibit the internal machinery of bacteria that is responsible for their survival or reproduction. Antibiotics act on bacteria by binding to specific sites. Take for example Streptococcus pneumoniae. Penicillin is an antibiotic in a class that contains a molecular group known as beta-lactam. The beta-lactam portion of these drugs binds to penicillin-binding proteins, and by doing so inhibit bacterial cell wall synthesis. However, if a bacterium has had a spontaneous mutation such that its penicillin-binding proteins are altered in shape, the proteins no longer bind penicillin, and the bacterium survives in the presence of penicillin. Because the bacterium survives, it reproduces, creating more and more bacteria that are resistant to penicillin.

If you take bacteria that are resistant to penicillin, and then expose them to another class of antibiotics, any that are able to mutate and survive then become resistant to two classes of antibiotics. Keep repeating the process and you begin to exhaust your options for treating infections.

Humankind has been able to stay ahead of bacterial resistance by introducing new molecules that act in novel ways. However, bacteria are gaining increased resistance to everything we've been able to throw at them so far.

Some practices we can do to decrease resistance include minimizing use of antibiotics, especially for illnesses that are known not to be of bacterial origin. Treating colds and bronchitis with antibiotics is a great way to select resistant organisms. Even worse, by killing off the resistant bacteria's competition, they have more breeding ground and nutrition and are able to reproduce more effectively. Other important practices include dosing antibiotics sufficiently high and administering antibiotics long enough to kill all of the pathologic bacteria. Remember, dead bugs don't reproduce. Some providers reserve powerful antibiotics "the big guns" for serious infections or infections that don't respond to older less potent antibiotics. Unfortunately, this plan has backfired at times, because the less potent drugs are allowing resistant bugs to survive. Again, dead bugs don't reproduce. One last practice that helps prevent bacterial resistance is for health care providers to identify what they are treating before they treat and determine which antibiotics the disease causing bacteria are sensitive to.

One encouraging fact related to drug resistance is that it is reversible. If drug misuse is discontinued, bacteria that are can be killed proliferate and decrease the percentage of resistant bugs. This has been demonstrated in subpopulations of children with ear infections caused by resistant "S. pneumonia."

One new approach to decreasing the rate of antibiotic resistance is creating a drug that binds to two distinct and independent sites within a bacterium. This means that a bacterium two spontaneous mutations in exactly the right places to become resistant, which is statistically far far less likely than a single mutation. (Remember, if the successful mutation rate is 1/10^8, then for two successful mutations the odds are (1/10^8)x(1/10^8)=1/10^16=one chance in 10,000,000,000,000,000.) One such antibiotic is telithromycin. It is a new drug, so time will tell how well the two-site approach will work.

bacteria are actually a lot smarter then we are. The way they get around the two site drugs is to develop a "mutator" phenotype; that is, the bugs start generating DNA changes at very high freguency. this is a real world problem with CF patients and P aeruginosa.

Also, the two site drug development is really hard; rightly or wrongly, we demand, at least in the US, a very high degree of safety in our pharmaceuticals; the cost to develop a two site drug is way higher then a one site. This gets into the whole economics of antibiotics which is afascinating subject. cinnamon colbert —Preceding unsigned comment added by 65.220.64.105 (talk) 15:23, 23 October 2009 (UTC)

---

Is there any plausibility to the concept of simply switching back and forth, not letting any one strain become dominant? Use one antibiotic til there's a resistance, then switch to another, then when it stops working, go back to the first (Assuming the bacteria mutated enough that they're not resistant to that one anymore) and doing it in cycles of 2 or more different antibiotics.. I heard this concept was being used on other resistence-ifying medications... and it sort of makes sense, right? --216.49.220.19 09:08, 3 June 2005 (UTC)

I'm not sure, but I suspect that repeatedly switching antibiotics would actually increase the rate at which bacteria become multiply antibiotic-resistant, because those that survived one antibiotic will then be exclusively selected from for resistance to the second, and so on. The problem is that the mutations for resistance to different toxins are not mutually exclusive. —Eldan Goldenberg (User:Eldang) 03:13, 14 February 2007 (UTC)

Garlic

Forget telithromycin! How about adding a section on recent research on the use of fresh and freeze-dried garlic as an antimicrobial? Studies in the 1980s and 1990s have shown that allicin and its daughter products, which form when garlic cloves are crushed, inhibit the growth of harmful bacteria 10 or 11 different ways, while being harmless to mammalian cells and beneficial bacteria. It's not likely that any bacterium will succeed in mutating 11 different ways simultaneously to circumvent the marvelous defenses that garlic has devised. Due to a ban on the use of human antibiotics in animal feed in the EU since January 1999, livestock now get freeze-dried garlic preparations instead. www.mercola.com/2001/mar/17/garlic_infections.htm [1]. Oh, I forgot — God has the original patent on garlic, so the pharmaceuticals can't make any money on it. How silly of me! --Quicksilver^{T @} 07:27, 8 February 2006 (UTC)

Is there any evidence (not from sources that are trying to sell me products) that garlic does not suffer from the same problems of resistance that synthetic antibiotics do? At present, the mercola link won't allow me to read anything without signing up for their newsletter (and rejects my spambucket address), and the pharmaxbiologicals one is giving me a 404 error, but in any case both appear to be advertorial-type sources. —Eldan Goldenberg (User:Eldang) 03:10, 14 February 2007 (UTC)

Mechanisms

I realize that there are dozens of classes of antibiotics, but this page desperately needs at least a few examples of resistance mechanisms, or general discussion of what forms those mechanisms take. Graft 18:17, 15 June 2006 (UTC)

---

I was looking through the causes, and found it to be quite confusing. The section opens with: "Antibiotic resistance is a consequence of evolution via natural selection or programmed evolution." But the third paragraphs states: "Antibiotic resistance is NOT a consequence of evolution." Can I get some explanation on this? And for future readers, it should probably be changed into less ambiguous wording. --67.66.48.63 23:53, 7 January 2007 (UTC)

---

This is of course a consequence of evolution, but there are ID (Intelligent Design) people misusing wikipedia as a tool to spread their fantasies about the real world. My guess is, they are siting some "Guru" of the Anti-evolutionists here, by pasting that nonsense about those mutations not being a consequence of evolution in to the article. WHY are you ID- guys destroying this wonderful tool (wikipedia)!!!??? Anyway, there shouldnt be any talk about evolution in this article, its good enough to call it mutations.

Evolution is important to the understanding of how antibiotic resistance comes about, which in turns helps to devise strategies that reduce the risks. —Eldan Goldenberg (User:Eldang) 03:17, 14 February 2007 (UTC)

Removal of Mechanism section

I have removed the "Mechanism" section. It appears to have arisen from this edit...the first paragraph of the additions was removed in the next edit and the remaining material did not really seem pertinent or make sense by itself (e.g. it references Spetner who was not introduced). If you disagree, feel free to revert and discuss.--GregRM 01:19, 24 January 2007 (UTC)

Scare tactics in Development of newer antibiotics section

The way this section is written feels extremely alarmist -- "Unfortunately, both the public and private sectors appear to have been lulled into a false sense of security based on past successes". Whether or not this is true, this seems currently like an opinion. I'm not suggesting it's true or not true, I'm not really qualified to say either way, although I would agree that MRSA is a problem. Most of the section, however, is either uncited, or from a possibly biased source (the infectious diseases society of america, which could just be representing certain interests..the citation links to a "policy focus" page, which is geared towards expressing a political opinion, and doesn't cite its sources). I would suggest this section be removed until it can be rewritten, although I admit to not being knowledgable about the Wikipedia procedures here. 24.27.41.62 14:08, 29 March 2007 (UTC)

as a scientist on the perhiphery of this field, i think it is actually not as a alarmist as it sounds; if you talk to sicentists and doctors who study infections, there is huge concern and worry about unstoppable pandemics of antibiotic resistatn organisms. signed cinnamon colbert —Preceding unsigned comment added by 65.220.64.105 (talk) 15:13, 23 October 2009 (UTC)

Race and acquisition of infection

The article stated that race was a significant factor in acquisition of infection, yet referenced an article that clearly stated:

"In our study, being nonwhite (African American and American Indian) was a significant risk factor for acquiring MRSA infection before controlling for other risk factors. However, after controlling for other risk factors, this association was no longer significant."

It would be great if people could doublecheck the references that people post without just assuming that if something is referenced that the poster is reading the research carefully.--Cank 21:39, 25 May 2007 (UTC)

Using blogs as a scientific reference

The article contained two references to [2] which contains factual inaccuracies. For example, "In 2005, biochemist Floyd Romesberg of the Scripps Research Institute, near San Diego, announced that his lab had discovered a gene called LexA that switches on the error-prone DNA, enabling the microbe to mutate rapidly." A cursory search on Google Scholar will reveal that LexA has been around far longer than that (see [3]). I realize that a blog from MIT might seem like it knows what it is talking about, but it goes to show why blogs are awful sources for information. I have removed any references to this research as it shouldn't be added unless it is properly referenced.Cank 22:01, 25 May 2007 (UTC) there was actaully something important and correct in the orig post. A published, peer reviewed scientific paper (Miller et al, www.scienceexpress.org, 12 august 2004 ) showed that antbiotics induce the SOS (lexA) stress response. cinnamon colbert —Preceding unsigned comment added by 65.220.64.105 (talk) 15:16, 23 October 2009 (UTC)

Phage therapy references

Is it really necessary to list 10+ references on one line? Cank 22:01, 25 May 2007 (UTC)

23 Citations for one paragraph?

Does the lead paragraph in the "Phage Therapy" section really need 23 of its own citations, none of which are used anywhere else in the article? I mean geez, we get it, phage therapy is real, but 23!

programmed evolution

The only google hits I get for programmed evolution indicate that it is a ID term; most discussions of it deride it as as post-hoc hand-waving attempt to discredit obvious (undirected) speciation of microorganisms.

Further, this article only mentions it in connection with SOS response, which article does not mention PE, and the PE article itself is a stub (an obscurist stub, IMO) which appears to exist only for the sake of legitimizing uses of the term (by linking to it).

I'm removing it as ID POV pushing. Restore the language only if you can cite it in an academic peer-reviewed evolutionary biology source.

Removed redundant/ unnecessary and/or otherwise biased language in "Prevention" section

Please refer to my edit and the discussion of this page on the LGBT Studies Wiki discussion board (http://wiki.riteme.site/wiki/WT:LGBT). I removed the words as "unprotected sex" is a more than adequate phrase to describe a "risk factor." —Preceding unsigned comment added by JuniorMuruin (talk • contribs) 20:19, 7 September 2007 (UTC)

• High-risk behaviour moved to 'Causes' section, which was renamed 'Causes and risk factors', because it only enumerated risk factors, and no preventive measures were suggested. Statements about hand and fruit washing were deleted as irrelevant: they decrease risk of any infection contracted through dirty hands, and their effect is not specific to drug-resistant ones. "Avoiding antibiotics" was rephrased to 'rational use of antibiotics'. Clostridium difficile infection is not caused by antibiotics as such: antibiotic treatment can cause dysbacteriosis, allowing C. difficile, which is part of natural flora, to proliferate in the absence of other organisms which would normally prevent it from multiplying beyond control. --Abanima (talk) 12:58, 19 July 2008 (UTC)

Over referencing

Isn't the amount of references on the first paragraph of the phages section a bit ridiculous? There are more of them than there are statements in the paragraph. I don't think there is a lot of point in referencing the same statement two, three or four times. Perhaps someone could go through and see which ones can be removed? Ziggaroth

Looks pretty absurd to me. Richard001 06:51, 14 September 2007 (UTC)

Antivirals

Removed paragraph about antiviral use in poultry production:

The illegal use of amantadine to medicate poultry in the South of China and other parts of southeast Asia means that although the H5N1 (avian flu) strain that appeared in Hong Kong in 1997 was amantadine sensitive, the more recent strains have all been amantadine resistant. This seriously reduces the treatment options available to doctors in the event of an influenza pandemic.

If a discussion of antivirals is to be included, it needs to be prefaced with an explanation of viruses vs. bacteria. Better yet, move the antiviral stuff to its own article and include a link in See Also. —Ryan 05:51, 31 October 2007 (UTC)

Vegetarianism

I am not sure if this has been discussed already, but it need to be rewritten. Its scope should involve solely antibiotic resistance found on farms and the practices thereof. It also needs to be resourced. I can't think of any evidence showing that ingestion of meat causes abx resistance. ————75.73.61.30 20:29, 3 November 2007 (UTC)hullcrush————

• The Economist http://www.economist.com/displaystory.cfm?story_id=10205187&fsrc=RSS">"Drug Resistant Infections: Riding Piggyback."
• Swann Report http://www.parliament.the-stationery-office.co.uk/pa/ld199798/ldselect/ldsctech/081vii/st0706.htm

History of the Use of Antibiotic as Growth Promoters in European Poultry Feeds. http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17954599&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum Antimicrobial Resistance in Scandinavia After Ban of Antimicrobial Growth Promoters http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17127526&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus http://www.fda.gov/cvm/HRESP106_157.htm 1977 FDA report http://www.nap.edu/catalog.php?record_id=21 NAP.edu 1980 study http://www.gao.gov/new.items/d04490.pdf 2004 GAO study http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1867957 "What Do We Feed to Food-Production Animals? A Review of Animal Feed Ingredients and Their Potential Impacts on Human Health" http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17600481&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus">"Antibiotic Resistance in Bacteria Associated with Food Animals: A United States Perspective of Livestock Production. http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17127530&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus">"Health Management with Reduced Antibiotic Use: The U.S. Experience." http://www.ucsusa.org/food_and_environment/antibiotics_and_food/hogging-it-estimates-of-antimicrobial-abuse-in-livestock.html

According to Madeline Drexler's 2002 "Secret Agents: The Menace of Emerging Infections" pg 143 "And each year, an estimated 300,000 pounds of antibiotic pesticides drift down of fruit trees and other crops to prevent bacterial infections suc as fire blight.... According to microbiologist Abigail Salyersm both the use of untreated or partially treated water for irrigation or for the washing of vegetables, or the use of manure as fertilizer for vegetables and fruits could contaminate food plants with antibiotic-resistant bacteria. Proving that no good deed goes unpunished, a 1993 study found higher levels of multidrug-resistant bacteria in the intestines of vegetarians than in meat eaters. Whether carnivore or vegetarian, you cannot avoid the aftermath of antibiotics applied lower in the food chain." Notice this refers to resistance of ordinary intestine flora-- the danger is that these bacteria can transfer resistance to infective foreign bacteria through bacterial conjugation, etc. Cuvtixo (talk) 22:08, 25 March 2008 (UTC)

Government Inaction

While both the US and the UK seem to be willing to talk about MR bacteria, the amount of information available through the medical profession in Australia is scant. In Febrary 2007 it was acknowledged to my sister (a registered nurse) that I had been infected with MRAB. I was told nothing. I took a guess that "central venous cathetar sepsis....caused by staph....and treated by Timentin and Vancomycin..." meant I had been infected by MRSA as well (not that there really is a difference to the victim who has to live with my neural damage). Hospitals simply encourage people to adhere to common-sense hygiene, but mention "MRSA" when looking for any treatment, and you discover the bland statement (no matter what you want to be treated): "I can't be of any help to you." 124.184.104.46 (talk) 13:21, 26 November 2007 (UTC)

Copyvio

http://www.atomicarchive.org/web-edition/columnists/laura-h-kahn/the-scourge-of-antibiotic-resistant-bacteria 66.67.47.120 (talk) 18:59, 10 May 2008 (UTC)

Sexual diseases

The article should maybe explain how these superbugs are different from typical sexual diseases and whether current prevention methods are really that effective. [4]­[5] [6] ADM (talk) 20:13, 8 April 2009 (UTC)

The role of animals section

The "role of animals" section needs to be greatly trimmed down or removed. In addition to POV issues, it is way too long and rambles. I'm not even really sure if the section is needed as it spends more time complaining about the use and overuse of antibiotics and doesn't really get into resistance in animal populations. I also wonder if it is a copyright violation, give its length. Does anyone want to rewrite (or remove) this section? If not, I might deal with it in the near future. Pdcook (talk) 19:36, 15 October 2009 (UTC)

In doing some research, I've noticed that this section has been tagged for bias for a year and a half and in the time since then, it has ballooned with even more biased information. I will likely delete the section as a whole and relocate some of the information to other sections of the article. I'm happy to hear your input. Pdcook (talk) 20:08, 15 October 2009 (UTC)

BUT antibiotic over use in animals is a real public health threat; for instance, take MRSA, methicillin resistant S aureus. in the netherlands, thanks to national policys, they have very low rates of MRSA, and they have mainted these rates for many years while their neighbors (France, Germany, UK) have far higher MRSA rates. However, if you read the sicentific literature, MRSA is becoming common among pigs in the netherlands, and they are starting to see pig to human transmission as significant problem. cinnamon colbert —Preceding unsigned comment added by 65.220.64.105 (talk) 15:19, 23 October 2009 (UTC)

I agree with the poster above, since the use of antibiotics in agriculture is a major source of emerging resistant bacteria, and farm animals are important reservoirs of several clinically important antibiotic resistant pathogens (such as campylobacter and salmonella), this section is is relevant to the article. You are however right in your criticism, and it could use some work. I will try to look into it in the near future. Erigu863 (talk) 22:27, 5 November 2009 (UTC)

I do not think that the section should be deleted. It is very relevant to the subject matter and its complete removal would leave the article severely lacking. I just did a very much needed rewrite of this section. I am pretty confident that people with "connections" to the drug manufacturers as well as "health activists" had been using the section as a mini battle ground to inject major POV statements, abusing old refs from 60's and 70's to debunk 2006 studies, inserting chunks of ranting irrelevant original research etc. I have deleted most if not all of this from the section and drastically shrank it and resolved misuse of refs. I intend to keep the article on my watch list so that the section does not deteriorate like that again. I came here after this issue was raised on wiki med project (or was it wiki pharm I forget). I have now removed the tag as I feel the major issues have been resolved. If someone opposes the removal of the tag feel free to add it back up and discuss here why you are adding it back up.--Literaturegeek | T@1k? 00:24, 15 November 2009 (UTC)

Evidence

Any evidence to support this text " Several studies have demonstrated that patterns of antibiotic usage greatly affect the number of resistant organisms which develop . Overuse of broad-spectrum antibiotics, such as second- and third-generation cephalosporins, greatly hastens the development of methicillin resistance. Other factors contributing towards resistance include incorrect diagnosis, unnecessary prescriptions, improper use of antibiotics by patients, the impregnation of household items and children's toys with low levels of antibiotics, and the administration of antibiotics by mouth in livestock for growth promotion." Doc James (talk · contribs · email) 20:03, 9 November 2009 (UTC)

I have edited the section and removed cephalosporin MRSA connection. Sounded dubious to me to. The household items statement I was tempted to delete but left it for now because I have read "somewhere" about household bacterial cleaning agents being linked to antibiotic resistance.--Literaturegeek | T@1k? 00:38, 15 November 2009 (UTC)

Not saying there is not evidence just wondering what it is? Doc James (talk · contribs · email) 04:10, 15 November 2009 (UTC)

Found an interesting paper [7] Doc James (talk · contribs · email) 04:41, 15 November 2009 (UTC)

A very interesting paper Doc. I think the text that you have cited it to in this article needs changed though. From reading the discussion of the full text of that paper, they are talking about antibiotics, mainly quinolones, leading to increased colonisation of resistant bacteria, rather than causing resistance. The antibiotics are not causing the resistance but causing/promoting colonisation of superbugs; similar to how antibiotics increase risk of C difficile and yeast infections. The yeast and C difficile and MRSA is already in the environment but the antibiotics presumably are clearing the good bacteria and superbugs are taking over. MRSA as you know I am sure was created by the now banned antibiotic methycillin. I am going to add it to the quinolone article and MRSA article.--Literaturegeek | T@1k? 17:49, 16 November 2009 (UTC)

Yes i agree it is a difficult topic. However if one has a group of ten bacterial. One of which is resistant to an antibiotic and more virulent and the other nine keep it in check ( by eating the available food and taking up the available space). If one adds an antibiotic that kills the 9 none resistant ones and the remaining resistance bacterial than becomes 10 resistant of the more virulent bacteria type. Clinically you have created resistance even though evolutionarily you have just selected for a more resistance stain.

ie colonization is what is referred to clinically as the spread of resistant bacteria I think.Doc James (talk · contribs · email) 18:49, 16 November 2009 (UTC)

Ah yes, I see what you are saying, you are correct in the context you are using resistance. However, antibiotic resistance in the context of this article means an antibiotic which was previously effective against a bacteria strain becoming ineffective (due to mutations).[8] I was talking about it in a different context, i.e. the creation of resistant bacteria through mutation. The text still needs reworded though because it was talking specifically about MRSA but it is cited to bacteria in general. Found another paper which explains why quinolones are worst offenders for promoting colonisation with MRSA, it is due to as you have stated MRSA being resistant and also due to tissue pentration of quinolones (they wipe out good bacteria presumably much more than other antibiotics).--Literaturegeek | T@1k? 19:53, 16 November 2009 (UTC)

I guess we need to decide the topic this article is about, is it about bacteria becoming resistant to antibiotics, antibiotic sensitivity and its relationship to colonisation of resistant strains or both subject matters?--Literaturegeek | T@1k? 19:55, 16 November 2009 (UTC)

(undent) yes does not matter to me either way. As long as it is referenced.Doc James (talk · contribs · email) 21:50, 16 November 2009 (UTC)

Ok, fine by me, we can cover both aspects then. :)--Literaturegeek | T@1k? 21:53, 16 November 2009 (UTC)

I just did a rewrite of the section and added some more refs. I also added the full text URL to the systematic review and meta-analyis article you found. Let me know if there is anything you don't agree with. :)--Literaturegeek | T@1k? 22:32, 16 November 2009 (UTC)

WHO resource

The WHO has the following fact sheet [9] Doc James (talk · contribs · email) 22:57, 15 November 2009 (UTC)

A very good find Doc! I am going to summarise it.--Literaturegeek | T@1k? 17:52, 16 November 2009 (UTC)

Ok, I have summarised that article now and added it to the causes section. :)--Literaturegeek | T@1k? 21:22, 16 November 2009 (UTC)

Resistance and non compliance

The last ref says resistance is potential less if people stop their antibiotics early but take the full strength when they are taking them however is greater if they take a lower strength than that recommended. They divide it into type A and B non compliance.Doc James (talk · contribs · email) 09:02, 18 November 2009 (UTC)

Meaning to society

This section is very much needed, lest reading this article is just a way to pass time. Antibiotics were hailed as a miracle when they were discovered, for a reason. Now, it seems apparent we're losing this miracle because of some people's arrogance, ignorance and greed. 85.76.85.19 (talk) 12:48, 14 May 2010 (UTC)

We would need references.. --Doc James (talk · contribs · email) 20:37, 12 August 2010 (UTC)

Interesting new paper

Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study [10] Doc James (talk · contribs · email) 20:37, 12 August 2010 (UTC)

Caused by obsolete but still used transgenic technique

The paragaph:

"Antibiotic resistance can also be introduced artificially into a microorganism through laboratory protocols, sometimes used as a selectable marker to examine the mechanisms of gene transfer or to identify individuals that absorbed a piece of DNA that included the resistance gene and another gene of interest."

May be expanded in order to include its use in creation of transgenic organisms, controversially approved by the FDA, like maiz and soy beans, transgenic organisms also include animals like salmon and tilapia.

TG organisms may also be a source for horizontal transfer of antibiotic resistance to bacteria that acquires plasmids used during the insertion of transgenes. —Preceding unsigned comment added by Elias (talk • contribs) 21:32, 18 October 2010 (UTC)

Role of other animals and Factory farming

Someone suggested these would work in the "Role of other animals" section here and the Factory farming article.

• http://www.scientificamerican.com/article.cfm?id=our-big-pig-problem
  • "Since 1995 Denmark has enforced progressively tighter rules on the use of antibiotics in the raising of pigs, poultry and other livestock. In the process, it has shown that it is possible to protect human health without hurting farmers."
• http://www.latimes.com/health/la-he-antibiotics-agriculture-20110425,0,7598829.story
• http://www.businessweek.com/lifestyle/content/healthday/651982.html

I don't know what to say about it at this point, so please try to use these reports. 99.39.5.103 (talk) 14:53, 26 April 2011 (UTC)

There goes another theory out the window

It seems these genes have been around for (at least) millenia

• Cristina Luiggi (August 31, 2011). "The Age-Old Fight Against Antibiotics". The Scientist.
• Kupferschmidt K (31 August 2011). "Superbugs Predate Wonder Drugs". Science Now.
• D’Costa VM; et al. (31 August 2011). "Antibiotic Resistance is Ancient". Nature. doi:10.1038/nature10388. {{cite journal}}: Explicit use of et al. in: |author= (help)

LeadSongDog come howl! 20:05, 31 August 2011 (UTC)

Antibacterial Cannabinoids from Cannabis sativa W a: A Structure - Activity Study

link: http://www.scribd.com/doc/7718968/Antibacterial-Cannabinoids-From-Cannabis-Sativa-A-StructureActivity-Study

or search,"Antibacterial Cannabinoids from Cannabis sativa: A Structure - Activity Study"

10.1021/np8002673 CCC: 2008 American Chemical Society and American Society of Pharmacognosy Published on Web 08/06/2008

"All five major cannabinoids (cannabidiol (1b), cannabichromene (2), cannabigerol (3b), ∆ 9 -tetrahydrocannabinol (4b), and cannabinol (5)) showed potent activity against a variety of methicillin-resistant Staphylococcus aureus (MRSA) strains of current clinical relevance. Activity was remarkably tolerant to the nature of the prenyl moiety, to its relative position compared to the n-pentyl moiety (abnormal cannabinoids), and to carboxylation of the resorcinyl moiety (pre-cannabinoids). Conversely, methylation and acetylation of the phenolic hydroxyls, esterification of the carboxylic group of pre-cannabinoids, and introduction of a second prenyl moiety were all detrimental for antibacterial activity. Taken together, these observations suggest that the prenyl moiety of cannabinoids serves mainly as a modulator of lipid affinity for the olivetol core, a per se poorly active antibacterial pharmacophore, while their high potency definitely suggests a specific, but yet elusive, mechanism of activity."

One cannot refute it. Someone needs to add the pertinent information ... — Preceding unsigned comment added by 91.88.250.190 (talk) 22:14, 28 February 2012 (UTC)

US Limitations on Use in Animal Feed

The newly added section reads like a political rant. Please fix or remove. 176.3.119.128 (talk) 19:08, 13 April 2012 (UTC)

This should be removed or drastically modified. There is bad science that is downright wrong in this section. I have read through it briefly and some areas are completely wrong (eg bacterial resistance can travel horizontally and not purely to descendents. Read about [gene transfer] and bacterial conjugation) — Preceding unsigned comment added by 129.127.252.5 (talk) 01:10, 20 April 2012 (UTC)

ALso, his conclusion is fallacious. Firstly, he is saying that "proving the use is safe" is impossible to prove but the entire rant provides "evidence" that shows that "people don't die from these bacteria" etc. If the evidence for this actually exists then there is evidence to prove safe usage.

Additionally, to answer the "obvious" but apparently unanswered question of how decreased resistance to say penecillin will reduce deaths due to quinolone resistant organisms. By reducing the amount of resistance to penecillin in the population more events can be easily treated with this and thus less quinolone needs to be used. Thus the quinolones can be "saved" for the more serious infections that do arise. If we have complete penecillin resistance such that it were useless then everything would need to be treated with a quinolone which whould drastically precipitate the increase quinolone resistance.

Finally, the conclusion that there are "lots of antibiotics to conquer the antibiotic resistant bacteria" is fallacious. Firstly, there are not that many antibiotics available. Secondly, these other drugs of last resort often have many more side effects and are much more difficult to use safely/effectively. If we were unable to use beta lactams and had to use vancomycin to treat everything then people would suffer much more side effects (eg ototoxicity) from it since vancomycin is more "dangerous" to use. Additionally, it is more difficult to use as it can't be administered orally and only by IV. Therefore, anyone that needed antibiotic treatment would require a hospital admission.

Seriously, this section should be removed. — Preceding unsigned comment added by 129.127.252.5 (talk) 01:25, 20 April 2012 (UTC)

In medicine

Just edited the section under "In Medicine" because the reference given did not agree with the text. (previous version stated that an insufficient duration of antibiotics led to an increased chance of resistance, whereas most of the literature I've come across implies the opposite. In addition, I've added a reference to a study in the BMJ, as this seems more reliable than the teaching powerpoint previously there. However, the powerpoint presentation is pretty well researched, so it's worth having too.

It also seems that my edit (which included splitting a paragraph) has changed the formatting of the subsequent section. I don't know why this has happened but this is probably my inexperience. Could someone please change it to look better again? Unless it's just my browser that is...

Zchahe7 (talk) 13:55, 11 July 2012 (UTC)

I reverted your edit because it also removed several other referenced statements unrelated to the powerpoint you mention. That said, I have read the powerpoint reference as well, and don't reach the same interpretation as you seem to regarding its conclusions. Perhaps we should discuss the particular sections that lead to the opposing conclusions.

Monkeyjunky (talk) 17:54, 20 July 2012 (UTC)

edit: I seem to have fixed the formatting here just by copying and pasting it back in. Anyone care to tell me what happened here? Zchahe7 (talk)

Okay, I think I see where our disagreement has come from. In the powerpoint you referenced, there is a page which outlines the argument that shorter courses lead to resistance. This appears to be within a context of questioning the wisdom of this argument. Most examples are of webpages which tell you to finish a course, but most of the papers the author references are against this. Further quotes from the powerpoint are:

"Most data support duration, not non-compliance, α resistance"

"My conclusion

For some conditions, stopping early when you feel better is common, logical, effective and has potential benefits on resistance and side effects"

So it seems that the author is not in fact arguing for completing a course of antibiotics, except in some conditions (e.g. TB. And this is not for reasons of resistance but for clinical effect (i.e. to eradicate a disease-causing organism.)

This article is particularly in favour of short/incomplete antibiotic courses, as it reduces resistance: http://www.bmj.com/content/344/bmj.d7955

Furthermore, this paper is a meta-analysis of short vs long courses of antibiotics which implies that shorter courses (effectively an incomplete longer course) produce less resistance: http://www.ncbi.nlm.nih.gov/pubmed/17765048

Other papers which seem to imply that resistance does not arise from an incomplete course: http://www.ncbi.nlm.nih.gov/pubmed/11777803 http://www.ncbi.nlm.nih.gov/pubmed/15708101 http://infosites.mims.com/Portals/2/PDF/Low.2.Choice%20&%20Dose.pdf

The problem with the powerpoint is that it was clearly designed to be accompanied by speech, which we don't have. Are there any papers which support the argument that "An insufficiently long course of antibiotics allows the more resistant bacteria present to survive, leading to more resistant normal flora and a possible relapse with a more severe infection that is also more difficult to treat"? I can't find them, although this advice is widespread in unreferenced writing on the web. If it doesn't have a strong evidence base, and there is substantial evidence against it, then I think we should remove this part of the article.

Zchahe7 (talk) 18:30, 20 July 2012 (UTC)

Since there hasn't been any objection to the evidence I just listed, I've put the bit about shorter courses back in. Zchahe7 (talk) 11:32, 27 July 2012 (UTC)

This section looks like it has adequate references supporting many potential causes for resistance and reflects the sometimes opposing concerns of trying to find "just the right amount" of antibiotics to use. I have gone through and reworked/reflowed the section to make it read more smoothly however, as it had gotten quite disjointed, with topics being split apart in different paragraphs with other topics in between, etc. There were also some readability issues. Regards. 93.50.155.140 (talk) 13:48, 18 September 2012 (UTC)

The slideshow reference does not state with authority that relapses after insufficient antibiotic treatment are more severe. One slide appears to imply this but is not referenced, and two slides later the author contradicts this by saying "antibiotic resistant organisms are generally less fit." I've taken this bit out until we have a more reliable reference (i.e. a journal publication rather than a slide from a powerpoint presentation.) Zchahe7 (talk) 13:00, 6 November 2012 (UTC)

In case others here aren't aware, good medical content on Wikipedia is supported by sources that conform to this guideline: Identifying reliable sources/Medicine. In a nutshell: scholarly textbooks, systematic reviews in reputable peer-reviewed journals, and position statements from scholarly and professional organisations. It's more nuanced than that, though, so I recommend reading the guideline if you haven't yet. --Anthonyhcole (talk) 13:42, 6 November 2012 (UTC)

Thanks for posting this. I've added a selection of journal article references relating to the duration of the antibiotic course to make it better informed. Some of these were literature reviews. However, as some of the sources were specific to certain infections e.g. bacterial peritonitis, I've had to add a whole bunch of references to ensure that they cover a broad enough selection of examples. If anyone knows of a particularly recent and broad literature review on the topic of antibiotic course length vs. resistance then I think this would be a valuable addition, and would possibly be an improvement on needing several references to support one statement. Zchahe7 (talk) 16:51, 6 November 2012 (UTC)

I should also mention and all editors here need to be familiar with our No original research guideline; particularly the section entitled Synthesis of published material that advances a position. In a nutshell, that section says, "Do not combine material from multiple sources to reach or imply a conclusion not explicitly stated by any of the sources." If you need any advice or help at all, don't hesitate to ask at Wikiproject medicine. --Anthonyhcole (talk) 17:04, 7 November 2012 (UTC)

That powerpoint presentation seems to have reappeared as a reference. I'm going to delete the related sentence until there is a better source Zchahe7 (talk) 01:08, 26 August 2014 (UTC)

A modest proposal

A recent edit by Wuerzele (talk · contribs) included many improvements, but because of formatting and content issues was rapidly reverted. I think Wuerzele's edit highlights need to make the more article succinct and accurate, and I think many would agree that a step-wise approach to improvement would be welcome. As a start, I think the changes to the lede were uniformly positive, with one exception: MDR is not defined as resistance to "3 or more" antibiotics; as a notable example, MDR-TB is defined as resistant to two (isonazide and rifampin) or more anti-TB drugs. So, how's this for the lead paragraph(a reduction from 3 paragraphs to 1):

Antibiotic resistance is a form of drug resistance whereby some (or, less commonly, all) sub-populations of a microorganism, usually a bacterial species, are able to survive after exposure to one or more antibiotics; pathogens resistant to multiple antibiotics are considered multidrug resistant (MDR). More colloquially, MDR organisms may be called superbugs. A common misconception is that a person can become resistant to certain antibiotics. It is a strain of microorganism, not the person, that becomes resistant to antibiotics.,

-- Scray (talk) 06:19, 20 March 2013 (UTC)

I agree, Scray. The issue of people becoming resistant was previously at the bottom of the article and it belongs in the top , is a general point. BTW A lot more modest proposals are needed if you want to go through the article / my changes....thanks Wuerzele (talk) 00:32, 25 March 2013 (UTC)

And I also agree that it will take more modest proposals - but I disagree that they are mine alone to propose. I did this proposal, in part, to suggest another way you could go about improving the article (as opposed to wholesale rewrite, which rarely goes over well). Feel free to begin proposing, modestly! (of course this applies to anyone wanting to improve a WP article) -- Scray (talk) 16:45, 25 March 2013 (UTC)

Agree that improvements are needed. The new lead however is much to short and does not properly summarize the article in question. Also not happy with the ref supporting "A common misconception is that a person can become resistant to certain antibiotics." [11] I have never heard this supposedly common misconception. Was a survey done? Are there other sources that support this? I would be happy with "It is microorganisms that become resistant to an antibiotic rather than the person themselves."

Also the changes included a number of issues with WP:MEDMOS. We typically write people not patient. I do however agree that prescribers is a more accurate term than physicians because none physicians also prescribe.Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:37, 20 March 2013 (UTC)

I agree that this should simply replace the first paragraph - thanks for that. There is at least one survey (now cited) illustrating the common misconception that people, not bacteria, become antibiotic-resistant - and the CDC states the same thing (for this purpose, I think CDC is a reliable source) - so I've retained that statement. I think the CDC makes this point, as well as others I've heard personally, because if it were the person, and not the bacteria, then it would be non-transferable and less of a public health problem. Revised first paragraph follows. -- Scray (talk) 08:21, 20 March 2013 (UTC) Exactly. Wuerzele (talk) 00:36, 25 March 2013 (UTC)

Antibiotic resistance is a form of drug resistance whereby some (or, less commonly, all) sub-populations of a microorganism, usually a bacterial species, are able to survive after exposure to one or more antibiotics; pathogens resistant to multiple antibiotics are considered multidrug resistant (MDR) or, more colloquially, superbugs. A common misconception is that a person can become resistant to certain antibiotics; to the contrary, it is microorganism that becomes resistant to an antibiotic.

Okay while I agree it could be mentioned somewhere in the article I do not think it is sufficiently notable for the lead. How about

Antibiotic resistance is a form of drug resistance whereby some (or, less commonly, all) sub-populations of a microorganism, usually a bacterial species, are able to survive after exposure to one or more antibiotics; pathogens resistant to multiple antibiotics are considered multidrug resistant (MDR) or, more colloquially, superbugs. People do not develop resistance to antibiotics.

Doc James (talk · contribs · email) (if I write on your page reply on mine) 08:37, 20 March 2013 (UTC)

First paragraph replaced with that version. When I get a chance I'll come back to this, but real life beckons. -- Scray (talk) 09:46, 20 March 2013 (UTC)

Clarify individual effect

The first paragraph currently states:

"Microbes, rather than people, develop resistance to antibiotics."

I'm asking an expert to clarify: does this mean nothing individuals do affects their personal risk of antibotic resistance? Or if one person abuses antibiotics regularly, will that specific person build up a colony of resistant microbes? 72.208.148.85 (talk) 13:11, 4 December 2013 (UTC)

As I understand it, this is to counteract a common misconception that people themselves can become resistant to antibiotics. The bacterium carries the resistance factors, and there is no change that happens in the human patient. It's not straightforward to talk about an individual's risk of antibiotic resistance, because it's not necessarily a direct relationship. Talking about resistance as a health problem only really makes sense at the population level - if on average many patients abuse antibiotics, then on average you will expect a higher incidence of resistance emerge. However, you can't easily say that one individual abusing antibiotics will lead to a higher chance of resistance emerging within that patient, because that's so hard to measure and infrequent that other factors about the individual patient become more important. Scale back to 10 000 or 100 000 patients, then you can start to measure the rates of resistance emerging, but on a case-by case basis it's just not that directly linked. You need to use antibiotics appropriately not so much for yourself, but for your children, grandparents, and society at large. Scaldwell17 (talk) 00:45, 17 December 2013 (UTC)

Suggestions in Salmonella and E.coli

Under the sub-heading “Salmonella and E. coli”, it says that “some strains of E.coli have become resistant to multiple types of fluoroquinolone antibiotics.” It might be worth mentioning which strains have developed resistance and what conditions fluoroquinolone antibiotics are used to treat.

Under same sub-heading, the scope of the information on antibiotic resistance in E.coli is extremely narrow. It would be a good idea to expand the article with some general information about resistance in E.coli such as how and when this resistance evolved. Also, it would be beneficial to list a few of the more common antibiotic resistant strains.

Again under this sub-heading, it would be helpful to mention some of the environments (such as hospitals) that resistant E.coli are prevalent. Lawler.70 (talk) 21:57, 30 September 2014 (UTC)

Suggested Updates

The article mentions the importance of the bacterial protein LexA in the accumulation of mutations that may confer antibiotic resistance, but it does not describe the mechanism by which this occurs. I would like to expand on this by pointing out that the common quinolone, ciprofloxacin, induces DNA damage by interfering with the two essential type II DNA topoisomerases in bacteria, gyrase and topoisomerase IV. The DNA damage caused by this interference induces the SOS gene repressor LexA to undergo autoproteolytic activity. This includes the transcription of genes encoding Pol II, Pol IV, and Pol V, which are three nonessential DNA polymerases that are required for mutation in response to DNA damage.

The article does not explain the evolutionary origins of any antibiotic resistance genes. I would like to add information on the evolutionary origin of genes that incur resistance to aminocyclitol antibiotics. This type of antibiotic resistance is found widely among bacteria, including Staphylococcus aureus, Streptococcus, Enterobacteriacae, Pseudomonadiaceae, Bacillus circulans, and actinomycetes. Research suggests that an aminocyclitol-producing bacterium was the source of genes for aminocyclitol phosphotransferases, which allow for resistance to the antibiotic aminocyclitol. The close structural relationship among the five phosphotransferase genes found in several different bacterial species suggests that the genes are homologous but have undergone extensive divergence since their common ancestor.

The article explains the advantages of adaptive antibiotic resistance in bacteria but does not mention the disadvantages it incurs. Research suggests that chromosomal mutations for resistance to antibiotics and other chemotherapeutic agents actually confers a cost to the fitness of the microorganisms that utilize them, such as Escherichia coli and Salmonella typhimurium. The cost of fitness is evident in the growth rate and mutation rate of antibiotic resistant bacterial colonies when compared to the drug-sensitive revertants.

Pona.1 (talk) 02:29, 1 October 2014 (UTC)Pona.1

India

This piece of news seems important to me. I didn't see the topic discussed in our article: Gardiner Harris for the New York Times. 3 December 2014. ‘Superbugs’ Kill India’s Babies and Pose an Overseas Threat Jytdog (talk) 03:14, 8 December 2014 (UTC)