Thread by @Dr_TJRicks

Last time we talked about what the top 5 antibiotic resistant infections are

Today we are gonna talk about what drives antibiotic resistance and current obstacles scientists face in curbing it

We’ll use this paper for reference: pubmed.ncbi.nlm.nih.gov/25859123/

#DrTJWrites

https://twitter.com/Dr_TJRicks/status/1552712706297315328

We actually talked about antibiotics structure but y’all know what I meant 😂😂

Anyway, there are 4 crucial factors that drive antibiotic resistance:

*Human Overuse
*Inappropriate Prescribing
*Agricultural Overuse
*Lack of New Antibiotics being produced

1) Human Overuse

Alexander Fleming, founder of penicillin, warned about antibiotic overuse

“The public will demand the drug and then will begin an era of abuses”

Antibiotic overuse encourages

*Spontaneous genetic mutation
*Horizontal gene transfer (HGT)
*Unnatural Selection

Mutation is pretty standard when you’re exposed to a foreign compound, especially one trying to take you out

The interesting thing in this trio is HGT

Horizontal gene transfer is more or less bacteria swapping codes for different proteins

Here are 3 types of HGT 👇🏾

HGT can occur anywhere bacteria hang out

Including your gut. Something to remember for later.

In 2010, 22.0 standard units of antibiotics were prescribed per person in the US

Twenty. Two. 😮‍💨

Other countries suffer from no regulation so there are no use limits.

2) Inappropriate Prescribing

It wouldn’t be the US without giving people drugs they don’t need 😂😂

3 factors that contribute to this problem are

*antibiotic duration
*treatment indication
*choice of antibiotic

One of these 3 are wrong in 30-50% of cases

30-60% of antibiotics used in a hospital setting are found to be

*unnecessary
*suboptimal (not good enough)
*inappropriate (wrong)

for treatment 🤨

Suboptimal and subtherapeutic antibiotic use promotes mutations and more HGT because the bacteria survive under these conditions

3) Extensive Agricultural Use

I just did a podcast episode with @foodslain touching on this very point (which I will def link here once it’s out 🤓)

80% of the antibiotics used in the US are used on livestock to promote growth and prevent infection.

80%.

Why does this matter?

Let’s look at the chain of events that happen from farm to table.

1) Antibiotic use in animals kills/suppresses susceptible bacteria and promote resistant ones

2) Resistant bacteria are transferred to humans through meat products

3) These bacteria cause infections that are now difficult to treat

Remember we talked earlier about HGT occurring in the gut

When you ingest these animals, you ingest not only the antibiotic, you also take in the resistant bacteria.

This promotes even more HGT in your gut.

Now what you eat has to go somewhere

What animals eat has to go somewhere

Agricultural and residential runoff infiltrate the water cycle with unused and excreted antibiotics as well as the resistant bacteria

This drift spreads unchecked and unnoticed like this

https://twitter.com/dr_tjricks/status/852630155663167489

4) Availability of Few New Antibiotics

Economic and regulatory obstacles are the biggest

As far as pharma goes, antibiotics are not aggressively developed because they. Are. CURATIVE!

This means they are not lifetime medications. You take them once and your infections clears.

THIS DOES NOT MAKE PHARMA COMPANIES MONEY!!

In fact, pharma companies lose profits in the long term over treating chronic infections so antibiotic development in 13 or the top 15 leading pharma companies has been completely axed.

What else does this remind you of?

If you said c0nv1d mRNA “vaccines” you would be correct

The reason why mRNA tech is so emphasized by pharma now is because it is NOT CURATIVE!

You have to continue taking the drug, meaning a source of reoccurring profits for the pharma company.

Add to the fact that some bacteria rapidly acquire resistance and it is not economical to produce a drug that’s gonna be obsolete in less than a year

Now new antibiotics are often held as a last resort as long as other antibiotics still have some activity.

Regulatory hang ups include
-bureaucracy
-different clinical trial requirements from country to country
-changes in regulatory and licensing rules

The way clinical trials are designed in the US currently encourages large sample sizes which equals higher costs.

Add the trial cost to the real possibility of unrealized profits due to mdr acquisition and there’s even less reason to develop new antibiotics on a large scale

These factors create significant clinical and economic burden. Here are some fast facts.

- 2 million Americans/yr develop HAIs, hospital acquired infections. 99,000 deaths on average occur and the majority are caused by mdr bacteria

- costs associated with mdr = $8 billion 😳

How does something create an $8 billion cost but people claim they are unconcerned about it?

Anyway

- More toxic drugs have to be administered because the bacteria are resistant to the weaker ones

-hospital duration doubles from 6.4 to 12.7 days

-Cost per patient to treat an mdr infection ranges from ~19K-30K

-US economic burden is $20 billion/yr for health care and $35 billion/yr in lost productivity, confirming that mdr infections and antibiotic resistance are one of top 10 causes of absenteeism in the US.

As you can see, antibiotic resistance causes major problems physically in health care and economically. Finding a solution to this problem is needed as some scientists claim we are in a post-antibiotic era.

How scientists tackle this is what we will talk about next time.

In the meantime, if you enjoyed this thread or others in the series, please give this a Rt 🙏🏾

https://twitter.com/dr_tjricks/status/1554268119019016192