On Tuesday, August 15, 2023 at 7:33:41 AM UTC-4, Martin Harran wrote:
Apologies for the OT post from a non-regular here but Talk Origins is
down and I'd like to get an answer to this before I see my doctor
tomorrow.
I have a recurring health issue, nothing major but it ends up in me
getting antibiotics about every 6 months. I am conscious of the
growing issue of antimicrobial resistance evolving due to the
widespread use of antibiotics. If I understand properly, however, this
is a *population* issue rather than an *individual* one, and the risk
of me personally developing such resistance is probably quite low.
Have I got that right?
I do understand that my using antibiotics does contribute to the
widespread use but I regard all these things as about balance.
Unfortunately, you have it wrong, maybe, somewhat.
There are myriad things which affect the situation. So details matter.
Discuss them with your physician, although be prepared that not all
physicians are educated equal.
Some background. Not all antibiotic resistance comes about the same
way. It can evolve spontaneously, but that's pretty rare. The best way(worst?) for this to happen is under a low dosage regimen where the drug concentration of some populations of bacteria are exposed to are only partially inhibited in growth and reproduction. In such populations, minor changes in pathways
that reduce the impact of the antibiotic can produce significant competitive advantages. You can play out the classical natural selection schemes where multiple small advantages accumulate. Moreover, the population of bacteria
that now have a higher tolerance for the antibiotic can colonize parts of the organism that had slightly higher concentrations of active antibiotic giving another population boost. All of this argues against half measures with lower concentrations of antibiotics and prolonged use.
That said, the problem of greater significance is that there's a far more common
route of acquiring antibiotic resistance. And that's sloppy bacterial sex. Okay,
most don't consider it actual sex but bacteria can share DNA with each other
as small little independent circles of DNA called plasmids. Plasmids have discovered
that carrying genes for antibiotic resistance is a very effective survival strategy.
I'm indulging in some poetic license.
The take home point is that our modern world has evolved through enough of
a history of antibiotic use that the slow method of inventing antibiotic resistance
has left a legacy in the populations of plasmids that are out there. It's sadly common to find plasmids that contain multiple genes that afford resistance
to multiple disparate antibiotics. There's more to the story as the use of antibiotics
in agriculture is way over done, maintaining populations of bacteria that carry multi-antibiotic resistance plasmids. Feed lots are especially notorious.
For your particular case, again, consult your physician. But if you undergo a two week or 10 day course of antibiotics twice a year, then you will be renewing
your personal population of antibiotic resistant plasmids. By theory, when you finish your course of antibiotics, the bacteria supporting the added plasmids will have a slight competitive disadvantage to those that don't, so they ought to be outbreed. But the advantage is slight. And not to attack you personally, you have many reservoirs of bacteria, so after 6 months it's likely you still have
some enhanced levels of resistance conferring plasmids.
Some will suggest that you can help yourself with probiotics. If you're taking an
oral antibiotic, it will likely have a significant effect on your gut microbiome.
Some probiotic yoghurts are often a good choice. And as a numbers game,
giving yourself some good bacteria (most are good) can help dilute away those with the nasty plasmids.
Your physician might hedge, as our broader environment is mostly out of your control. If you volunteer at a hospital, or have young relatives in daycare, you
will be exposed to places where antibiotic resistant bacteria are endemic. Or if you're exposed to the 'fragrances of nature" near a feed lots, or a neighbor
likes to spread fresh manure on their flower beds, or some further hundreds of aspects of modern life, the specter remains.
But as a final note, you probably don't need to worry much about it.
Most of the anti-bacterials you would be prescribed are fundamentally bacterio- static, as opposed to bactericidal. They mostly stop the bacteria from growing rather than outright killing it. Your immune system will finish the job for bad
infections, or your body will come back into a balance where the little critters
aren't taking over. Whatever particular reason you are being prescribed antibiotics,
in this semi-regular basis, the level of resistance in you is unlikely to confound
the therapeutic needs. And the chance that you will be the critical incubator that spawned a scourge predicted by a certain expert on the subjective/objective
divide is next to zero.
PS. If you want to mess with your MD, tell him you read something on WebMD
and want to talk to him about it.
--- SoupGate-Win32 v1.05
* Origin: fsxNet Usenet Gateway (21:1/5)