Beyond Resistance: The Inherent Problem with Antibiotics
You might have heard recently about the discovery of a potential new antibiotic, Teixobactin. It’s being heralded as the end of a 25 year long drought, in which no new antibiotics were discovered.
To be clear such a discovery is direly needed. Last year the World Health Organization declared that the world would soon enter a “post-antibiotic era” and a report commissioned by the UK government said that if the world did not tackle the issue of drug-resistant infections it would cost the global economy up to $100 trillion and the death rate would rise to 10 million people a year (1).
There now exist resistant strains for every antibiotic we have available to us. Even vancomycin, which has long been reserved to only being used as a last resort has multiple different strains resistant to it. So when someone says they’ve discovered an antibiotic that doesn’t easily give rise to the development of resistant strains. It’s no surprise, everyone is excited. And yet, has anything really changed? By adding another stronger antibiotic, will this have a significant effect on the coming threat?
The problem with only having a hammer, not every problem is a nail.
Skipping over the fact that this new molecule has yet to be tested in humans, will take 7–10 years and ~$100million before it ever reaches the market. It solves none of the inherent problems with using broad spectrum antibiotics.
If you present with any symptoms close to a bacterial infection, the standard of care is to dose you with a broad spectrum antibiotic. Only after this measure fails do most doctors even attempt to diagnose the species causing the disease.
As you can see in the graph to the left (the lower the number the higher the efficacy), this new antibiotic molecule has high activity against a wide range of resistant bacterial strains.
The problem with that is the line between what is and isn’t a pathogen is not so clear. A good example is methicillin-resistant staphylococcus aureus (or MRSA). Which is oft-touted as the antibiotic resistant boogeyman. Yet, what if I told you that about 40% of us have both methicillin-resistant and non-methicillin-resistant S. aureus living on the surface of our skin yet suffer no symptoms at all.
As we discover more and more about our microbiota, the collection of microbial species that exist within us, we find the old view of all bacteria being bad all the time is outdated and wrong.
In fact, we are discovering all kinds of interesting things about our microbiome and the role it might play in both preventing and causing obesity, diabetes, asthma to name a few.
Using drugs that attempt to treat a single species bacterial infection by targeting a wide range of species is equivalent to napalming an entire forest to save it from a poacher. You might fix one problem but in doing so you give rise to another.
This is because when you wipe out your gut flora with a broad spectrum antibiotic, you create room for the the most resistant, and often most toxic strains to grow.
Even before antibiotic resistance as we know it became an issue there existed opportunistic species such as Clostridium difficile or Pseudomonas (also one of the species Teixobactin has no affect on) resistant to take over when your normal flora is devastated.
This is how 1.7 million people in the US alone acquired infections from hospitals and 99,000 of whom died, all within reach of antibiotics.
We don’t just need stronger and stronger.
We need smarter, more personalized antibiotics.
