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Drug development strategies have focused on replacing antibiotics in extreme infections, such as sepsis, where every minute without an effective drug increases the risk of death. But the evolutionary process that brings forth antibiotic resistance doesn’t happen nearly as often in those big infections as it does in the multitude of small ones like sinusitis, tonsillitis, bronchitis, and bladder infections.
Antibiotic prescriptions against those smaller ailments account for about 90 percent of antibiotic use, and so are likely to be the major driver of resistance evolution. Bacteria that survive these many small battles against antibiotics grow in strength and numbers to become formidable armies in big infections, like those that strike after surgery. It is advisable to give antibiotics less often and preserve their effectiveness for when they’re really needed.
E. coli is widespread in the human gut, and some strains secrete enzymes that thwart antibiotics, while other strains don’t.
A broad-spectrum antibiotic can kill off more of the vulnerable, less dangerous bacteria, leaving the more dangerous and robust bacteria to propagate. Much too often, superbugs have made their way into hospitals in someone’s intestines, where they had evolved high resistance through years of occasional treatment with antibiotics for small infections. Then those bacteria have infected patients with weak immune systems.
Drug developers facing dwindling antibiotic effectiveness against evolved bacteria have looked for multiple alternate treatments. Developing non-antibiotic therapies for strep throat, bladder infections, and bronchitis could prove easier, thus encouraging pharmaceutical investment and research.
For example, one particular kind of strep bacteria , group A streptococci, is responsible for the vast majority of bacterial upper respiratory infections. People often carry it without it breaking out. Strep bacteria secrete compounds that promote inflammation and bacterial spread. If an anti-virulence drug could fight the secretions, the drug could knock back the strep into being present but not sickening.
Strep infection can lead to rheumatic heart disease, a deadly condition that is very rare in the industrialized world. Some push-back against virulent bacteria until the body’s immune system can take care of it. Developing a spray-on treatment with bacteriophages, viruses that attack bacteria can prevent the resistance.
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