Antibiotics resistance is a looming problem in the field of health. With the increased usage of antibiotics, the prevalence of antibiotic-resistant bacteria is increasing, resulting in a reduced efficacy in treating infections. In addition to the falling numbers of new antibiotics reaching the market (in part due to a more stringent FDA approval process), many are wondering what can be done against the wave of antibiotic-resistant bacteria.

Some believe that the novel (Soviet Russia-era) phage therapy may be the answer (which is a great idea. I love the self-replicating aspect of the treatment, but it is fraught with its own problems, such as excessive specificity, immune responses, location targeting and difficulty in approval), however, although the bacteria are evolving to combat the effects of antibiotics, I do not believe that such drastic measures are required. Rather, limiting the use of antibiotics (hah, like that's likely to happen) may allow us to continue the utilization of antibiotics, even in the face of these mutants.

The reason being that evolution is not free.

Evolution is always portrayed as a great march forward, where the next iteration is always better, faster, stronger than before, but in reality, nature has already reached a local optimum millennia before (albeit forever seeking a stable Nash equilibrium in the ever-changing payoff matrix that is nature). All new evolutions merely shift the dynamic equilibrium in one direction or another, always running, but always staying in the same place. And the same is true about antibiotic resistance.

Antibiotic resistance has always been around. The fact that we derive all of our antibiotics from bacteria themselves would suggest that somewhere, at some point in evolution, some bacteria would have evolved a way to deal with the naturally-occurring antibiotics.

The reason why all bacteria aren't already immune to all antibiotics is because evolution is not free.

Evolving antibiotics resistance is costly. Whether it be creating a new enzyme to remove or inactivate the antibiotic before it kills the cell, or by modifying the target of the antibiotic so it can no longer bind, it always comes with a cost, from the resources required to create the new enzyme to the decrease in efficiency to modifying the target so that the antibiotic no longer binds. Nature has already optimized the target to its function; to have it change its shape to evade the antibiotic is always detrimental.

Detrimental in an environment where there are no antibiotics. In an environment without antibiotics, the wildtype bacteria who do not expend excessive resources on enzymes, who are more efficient at processes with their unmodified targets, would outcompete the antibiotic-resistant strain.

And therein lies our solution. Antibiotic-resistant bacteria are selected against in the natural environment, and as long as we keep the natural environment antibiotic-free (through reducing the usage of antibiotics, especially in livestock (like capitalism will ever stand for that), proper completion of antibiotic course, or possible restricting the use of antibiotics to supervised settings. Maybe begin strong regulation over the use of antibiotics (classify as an controlled substance)), the prevalence antibiotic-resistant infections should decrease.

(Given, antibiotic-resistant strains will still evolve in a hospital setting, but it is hoped that the sterilization techniques of the hospitals is sufficient enough to kill any bacteria before the evolve and spread their antibiotic resistance.)

An alternate method of circumventing antibiotic resistance is, rather than limiting their use, always use a mixture of antibiotics, until the bacteria is unable to replicate effectively.

Current antibiotic development depends on the premise that by the time bacteria evolve resistance to one antibiotic, humans will have developed another antibiotic to take its place. However, with increased regulation and underestimating the time it take for antibiotics resistance to evolve (due to excess use), this plan has failed, and we must look towards other solutions, including (what can be considered) excessive antibiotic cocktails.

Given that antibiotic resistance can evolve by modifying the antibiotic target, the evolution of antibiotic resistance may reduce the fitness of the organism, even in the absence of antibiotics. If the organism is exposed to enough antibiotics, there comes a point where the tradeoff result in the bacteria no longer has the ability to either evade the immune system or reproduce. With enough varied antibiotics and the variety of targets, it is possible to kill the bacteria, despite being resistant to any subset of the antibiotics.

(Granted that gene duplication leading to the production of both wildtype and antibiotic-resistant targets and induced activation of resistance only in the presence of antibiotics would allow the bacteria to survive the harsh antibiotic cocktail, however, the larger the genome the more resources required to replicate it, and thus excessive gene duplication also spells doom for the bacteria. The FDA also has more stringent regulations on drug cocktails due to possible adverse effects, leading to additional difficulty.)

A solution exists to the burgeoning rise of antibiotics resistance, but the solution requires action on the government's part. Whether it be approving new treatments or regulating the usage of current treatments, something must be done in order to solve the problem of antibiotic resistance.

Or we could just wait. Innovation will find a way, and if the demand cries loud enough, we will find an answer.

(And thus says capitalism, profit and the free market. Amen).

Tagged with biology
Posted on2014-06-18 08:16
Last modified on2014-11-02 22:57

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