Antibiotics and Resistance
HTML-код
- Опубликовано: 10 апр 2016
- A century ago, the top three causes of death were infectious diseases. More than half of all people dying in the United States died because of germs. Today, they account for a few percent of deaths at most.
We owe much of that, of course, to antibiotics. The discovery of prontosil, the first synthetic modern antibiotic, earned Gerhard Dogagk the Nobel Prize in 1939. Mass-produced penicillin earned Alexander Fleming, Ernst Boris Chain and Howard Walter Florey one in 1945.
It is hard to overstate how much less of a threat infectious diseases pose to us today. But we take antibiotics for granted. We use them inappropriately and indiscriminately. This has led many to worry that our days of receiving benefits from them are numbered.
That's the topic of this week's Healthcare Triage.
This episode was adapted from a column Aaron wrote for the Upshot. Links to further readings and references can be found there: www.nytimes.com/2016/03/08/ups...
John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen -- Graphics
/ aaronecarroll
/ crashcoursestan
/ johngreen
/ olsenvideo
And the housekeeping:
1) You can support Healthcare Triage on Patreon: vid.io/xqXr Every little bit helps make the show better!
2) Check out our Facebook page: goo.gl/LnOq5z
3) We still have merchandise available at www.hctmerch.com
![Why Are Antibiotics And Vaccines Failing Us? [4K] | The Battle Against Superbugs | Spark](/img/1.gif)
One thing that not many people know is that there is another type of treatment of bacteria in the 1910's-20's. Phage therapy which used viruses that infect bacteria were know around the time antibiotic were being developed. In short, the West went with antibiotics while the Soviets went with Phage therapy. Currently there are some trials testing the efficacy of using phages to treat certain infections while comparing to the efficacy to antibiotics. I personally think that there should be some focus on the using phages to treat certain infections while also advance the development of the new generations of antibiotics.
How about consuming less animal products and enforcing more regulation on existing farms? That should have been mentioned at the end.
This. We need better regulations and policing of global food industries.
+peachila Unfortunately, that's unlikely to work considering regulations like that are almost certain to be ineffective in developing nations and third world countries where this is most common.
+RandomGuy But I think if you use this view you can say that no regulations will work against amr can't you?
Love the content, as always!
This was very well explained. Thank you!! I finally understand it. 🙂
This is a great video to bring awareness to the public on the dangers of overuse of antibiotics causing resistance. People just love to go to the doctors and get antibiotics when they are sick instead of cold medicine or just riding out the illness to attain a natural resistance against the illness. What also assists in this increase in antibiotic use and resistance is that some people take antibiotics to prevent illnesses when traveling, so if they do contract an illness on a trip it is more aggressive. As bacteria evolve genes get deleted to to limited space in its genome, so possibly by rotating previously developed antibiotics could treat the more recent drug resistant bacterial infections. This also why there should be a policy ensuring proper use of and production of new antibiotics like the video said. One policy for ensuring proper use could be guidelines on the illnesses that doctors can prescribe antibiotics for.
Have you done any shows on Bacteriophages? I find that idea fascinating. I know its not a currently viable alternative to antibiotics, but do you think it has potential in the future?
1. Antibiotic use in the industry needs to be eliminated. 2. People need to be incentivized to stop throwing their drugs down toilets/drains. 3. When given antibiotics should be given at heavier and longer dosages with very strong incentives for patients to complete treatment. (how this is possible I don't know). 4. Proactively and aggressively push alternatives to antibiotics including to complement antibiotic usage. 5. Risk reduce/mitigate and prevent infections as well as resistant-infections. 6. Massive public funding for research, development, and implementation of new antibiotics. 7. Incentive changes for the industry relating to antibiotics. 8. Get proactive equal use health care world wide.
I really want to say what this really looks like based on the pattern but no one really cares. Great video by the way.
I agree with what he says about how the overuse of antibiotics is not helping but instead hurting our resistance to certain things. People often know that certain drugs wont actually help the discomfort they are feeling but simply the idea of taking something gives the body a placebo making them feel better even if the drug is not helping them at all. When people do this, it diminishes the body’s ability to tell what is actually the bad bacteria that the drug is aimed at getting rid of. I enjoyed how he compared this to a “kin to providing alcoholics with a stronger grade of brandy...” He is very right in saying that without these drugs we would not be where we are today but if we keep abusing them, their original uses will not be as effective as they are now.
I had a procedure this morning. For prep, I was told to wash with an antibacterial soap. In spite of all the sterilizing they do in the OR. I really need to mention this at the followup apt with the doc.
antibacterial does not necessarily mean antibiotic though
Excellent!
Nice video you guys... Any chance of releasing an official spanish subtitle option? This is a simple but straight approach to a worldwide public health problem and I would love to share it with so many patients from Chile.
Keep it up and greetings from a chilean physician
+Matias Luppi Hey Matias! If you're able to provide us with a translation, we'd be more than happy to make that an option. Let's talk further at healthcaretriage at gmail?
+Mark Olsen love to help you out guys. Should I write my mail here in the comments or is there any other way?
Awesome! It probably would be easiest to email it to us because I think the comments section has a word/character limit. Our email is healthcaretriage at gmail dot com.
+Mark Olsen awesome, we'll be in touch
Great video by the way! ;}
I love how he shows and explains that the use of antibiotics is not only growing overtime but how we the users perceive antibiotics. Yes we are given antibiotics every time we are sick and go to the doctor. Yes, our doctors normally give us the same ones almost every time we go. This causing the bacteria in our body to become susceptible to it. I love how a doctor is able to point this out even though other doctors keep giving us the same drugs every single time. "Killing off more susceptible strains of bacteria leaves the more resistant ones to fill the gap." I really love this statement. It does interest me on how these bacteria become resistable over time. Just like E Coli bacteria has become immune to almost every antibiotic. I just find this statistic to be very interesting. I think that we need to start focusing on different research to come up with different antibiotics and to focus on that. Like he states in this video, antibiotics are expensive and have a huge profit rate but we have to be willing to use that money to create them first.
I couldn't agree with more of what he said. There are so many reasons that there are antibiotic resistance bacteria which first starts off with as soon as we get sick we just want to go to the doctor and get antibiotics and we get them but how many of us actually take the prescription of antibiotics that we are given? Because if we don't take it all then we are producing antibiotic resistant bacteria. But I also think that we need to stop giving our life stock so many antibiotics because that is also causing a contribution to anti resistance bacteria. But what we need to do is focus on how to properly use antibiotics but also to create new antibiotics to reduce the higher risk of creating antibiotic resistance bacteria.
4:30 - what is the vertical axis?
+Rob Porritt The vertical axis was literally to make space for all the names. It's just a timeline as far as I can tell.
Saw this NPR article today and thought of this episode: "Taking Cues From Human Nutrition To Reduce Antibiotic Use In Livestock "
What about using something other than antibiotics? i heard about quorum sensing years ago, from a TED talk and it looked promising because rather than killing microbes it just keeps them from talking to each other.
this works because microbes will only start "attacking" the body when there is enough of them to stand against the host. they only know this if the concentration of certain molecules they produce are high enough in host.
a medicine that blocks communication avoids the issue of microbes being resistant to it by not killing them off in the first place and therefore not artificially selecting for the microbes resistant to it.
+ceneris3005 Yes! Or making drugs that hinder the microbes in some way. Like cranberries do to e coli (prevents them from "sticking"). I'm sure resistance would eventually happen, but I'm sure this is still a very fruitful area for study.
+ceneris3005 Nanomachines, son.
The problem being that there are vast differences in the molecules used for quorum sensing (as far as I know). Which would mean it wouldn't be useful against so many different kinds of bacteria. And if it was, we'd probably call it antibiotic, too
bacteriophages.
Oh, by that way, Russia and Georgia have been using bacteiophages for years to treat infections and anti-biotic resistant bacteria.
Can you do an episode on what we can do as individuals to help with the antibiotic resistance problem? You spent a lot of time talking about federal funding and legislative measures, but you didn't mention things like avoiding antibacterial hand soap or giving a sinus infection time to clear up on its own before you go to the doctor.
Antibacterial hand soaps do not contain antibiotics, so I doubt one would benefit from their use. In fact, using them is probably more beneficial anyway, since it chemically and mechanically stops the bacteria from proceeding into your system. As for the other thing, just don't take antibiotics unless your doctor tells you it's necessary. A lot of people tend to think antibiotics will get rid of their flu or their cold, so just learning about what antibiotics can actually help against would definitely help in the long run.
+Helem Morales Also: Throw away antibiotics if you got some and are done taking them. Don't take the end of your old prescription unless your doctor says so and definitely don't give your old antibiotics (or any prescription or even non prescription med for that matter) to your friends.
If you do have to take antibiotics at some point? Take all of the Dosis even if you feel better and encourage your friends to do the same.
JUICE!
Great channel, after watching your episode on milk we've been trying to have the kids drink more lemon water, tea and juice BUT as you yourself have said countless times, processed food is bad. I would love to see an episode on juice and not just fruit juice but vegetable(mixed, tomato, etc...) and how good it is(or bad) and what we should be looking for. Some 100% juice really don't look trust worthy. I've been buying the expensive mixed vegetable juice kind but am I just throwing my money out the window?
+Luc Sasaki short version: Juice takes the sugar and a few nutrients from the food and removes the good stuff like fiber. Just have the vegetables :)
+frollard While eating my veggies is all fine and dandy I still want to know what the best kind of juice has in it and what the worst kind has so that I can buy the best product possible.
Well, for one, I would avoid added sugar in all of my juices. Fruits are already sugary enough. Try to get things that still have some pulp in them, which is easier with orange juice than with other products. Vegetables are good since a lot of them are mostly just water anyway. But definitely look at the ingredients to see exactly what they put in it. A lot of them will have preservatives, which aren't inherently bad, but they do tend to mask other things like food colouring which can be bad for you, depending on the kind. However, if you have the means, try investing in one of those machines that make juices from the fruits and vegetables that you put into them. That's really the best way to know almost exactly what your getting from your juice. It's also fun to create new variations of juices and improve on them.
Kazooga 1234 The claim that organic is best is provably false depending on your definition of best. ***** Less processing is better, simple as that. Most juices on the market are apple or grape with a token amount of the named flavour added after which is borderline criminal. Fruits have a lot of vitamins and minerals. If the juice you buy shows 0% on those columns it has been processed to oblivion and is only worth the sugar in it. Preserving juice is good for society and not making people ostensibly sicker, but it does tend to have an impact on the nutrient contents. If you are going to have juice, have fresh (made that day) juice or make your own. Otherwise, you might as well have cola/soda.
+Luc Sasaki I think the argument is that juice is kind of a waste of time. The best stuff is left out during the juicing process. Buy the 100% stuff if you want it as a tasty beverage that feels healthier than cola, but for health benefits just eat the fruit/veggie itself and drink water.
Is there a time of year that is best to get flu vaccines to get ahead of "flu season"? When are the vaccines updated?
Epidemiological transition stage 5 in the works: Reemergence of infectious diseases. That's all I keep hearing when it comes to antibiotic resistance. I think it will be interesting to study, but not interesting to experience.
I have read that delivery of antibiotics can also affect resistance. It is hypothesized (or perhaps theorized) that the oral route helps gut flora to become resistant to antibiotics and help other bacteria to become resistant through horizontal gene transfer while injectable antibiotics do not affect gut flora as much and therefore reduce the incidence of resistance. I do not know, though, to what extent that this is true.
I do know that antibiotics pretty much sterilize the intestines and destroy the microflora in there. That's why they say when you take antibiotics, you should also take probiotics at the same time so whatever is flushed out, is also replenished with probiotics.
i recently found this channel and i like your videos. Just one question (to anyone who'd know it), is abstaining from antibiotics (when it's possible) helping your own organism? Or is it not? Because if it's a global phenomenon and the bacteria are getting more resistant, then your not taking antibiotics just doesn't help you when you need to take them (because they' ll be resistant anyway).
Why aren't they using copper/brass handles in public to help prevent transmission?
+Stefan Wojcik Some hospitals do. Maybe thief is an issue? I worked for a cable company, and our copper wire was always at risk of getting stolen.
That's a good point. However it would be pretty hard to unscrew and carry out a bed rail past security. I feel like it would be well worth the investment.
Yeah I agree.
This qualifies as a public service announcement good one.
+terry hollands they need to stream this to every doctor in a 10 mile radius from my pharmacy.
+Jindorek Fortunately most incompetent doctors don't make it past amoxicillin and z-pack. :3
The crazy thing being that I know so many med students who know about this in theory but still offer their friends antibiotics for viral infections. How will they not do that as doctors?
Is there any research on helping non-antibiotic resistant bacteria reproduce?
That would seem like the obvious solution.
+Rodrigo de Toni That non-resistant bacterium can just gain resistance from the resistant bacteria...
I don't think that would help. Increasing the population of non-resistant microbes would still make us use antibiotics, which in turn would kill said microbes and would leave us, once again, with resistant ones.
Mellow out that audio!
I thought this would be reassuring....aaaaaand it wasn't.
Species specific anti-bacterials would be good but diagnostics would have to improve significantly before it would be practical.
+shade_grey ID is a field that's dictated by essentially a guess in the beginning, than narrowing with information. This is mainly due to the fact that studies have shown that early (as in minutes/hours early) use of antibiotics have better outcome.
There are better diagnostics on the horizon though, with use of technology like PCR you really can speciate bacteria within hours of collecting the sample as opposed to upwards of 5 days in regular culture settings. The big issue is getting costs down for these fancy PCR machines. In addition, you still run into the problem of resistance where you can't possibly test for every single resistance gene that exists, meaning culture and sensitivities will still play a role in antibiotic use in the future.
I dunno what can make this better though, so hopefully people way smarter than me can get to it first.
make a crowdfunded atibiotic research program
+signsofevil The best way to crowd-fund this would be via taxes.
not if you think of it as a global effort which would benefit all of humanity.
I remember when you first talked about it as if it was not gonna be a big deal with the new bacteria.
How ironic is it that this issue happaned because of peoples obsession with meat.
So...well done for that burger I guess.
Antibiotic resistant bacteria can be traced to some extent to countries where you can get them over the counter without a prescription like India.
Or Spain. Or Greece.
I do think that is a very big problem I just want to point out its not only a problem of developing countries which many people tend to think.
+Sex & Co. KG I did say "to some extent"
brian whittle Sure. I'm sorry, I wasn't trying to attack you - I just wanted to raise awareness about this :)
terrifying
HOLYSHIT RRRRRUUUUUUUUUUUUUUUUUUUUNNNNNNNNNNNNNNNNNNNNNNNNNNUH
Short term money Vs. Long term health of all human beings.
Seems like an easy argument, the latter.
"New ways to incentivise" - You mean saving lives and lessening suffering isn't enough? Because this isn't horrifying enough.
This is horrific and ultimately, yes, humanity having to make their own bed and lie in it.
The fact that we can't take money out of the picture and cut the greed out is yet another downfall to do us in. -_- Way to go humans. Way to go.
i stay away from taking antibiotics and pain killers since i was a kid thanks to my dad that thought me that they weaken your immune system. when you have a headache that means something is wrong, a pain killer is like for example like an ignore button on a chat window. When you have a headache or pain dont turn to pain killers! maybe your in short of vitamins or minerals in your body that causes it! Pain is a natural warning system to let you know something is wrong! also antibiotics does weaken your system even if it helps you get better it will be a loss for you as your immune system didn't adapt or get stronger to combat future viruses and bacteria. I havent gotten sick in over 3 years and last time i got sick it was just a flue that lease got me some sick days off work.
i only smoke weed! hehe
I wouldn't say it weakens your immune system. Rather I would say taking antibiotics doesn't allow your immune system to develop better immune responses to these bacteria. The body is amazing in all the different things it can do to protect us naturally. Medicine just speeds the process for the most part. I don't believe antibiotics or pain killers are unnecessary. Depending on the severity of certain situations like surgeries, they are indeed necessary. The point of this video was to talk about the resistance to antibiotics due to growing hybrid bacteria. As mentioned by Dr. Aaron Carrol, whether we use it improperly or properly, there will always be some sort of resistance.
Every time someone reminds me that Chinese farmers gave their stock colistin I get very angry at the Chinese government (is not like I wasn't already angry with them in the 1st place) and whatever companies are gaining a profit from those farmers! Theses people were given the nuclear option of antibiotics like it was nothing! That is how stupid all those people were and are, colistin should have been super regulated to the point that it wouldn't have been cheap, but of course it wasn't and now one bacteria or many can no longer be stopped by it until we figure something that will and who knows when that'll be!
I am fed up hearing about how expensive it would cost pharmaceutical industries to do research on new antibodies and or other medicines and how they did not receive good profit measures when antibiotics can be sold at a cheaper price. These industries have made their money and than some, just ignorant on what to research and spend the money on
Yea but proper use gives us more times to make new antibiotics
exactly, he was pointing out that the problem is worsened, and not caused, by overuse.
Who else is watching this vid in the 2020?
I think it is extremely sad that the only motivator for development of life saving drugs is money. Saving people's lives even at a loss to me is well worth it. The greater good seems to always get outweighed by the greater dollar. This isn't bashing on "pharma" this is bashing generally on how we view things as a society. I understand businesses need to make money but when did it get to the point the medicine's main purpose is the profit in money and not in lives.
Is there vaccine resistance?
Lol. Viruses mutate so it is possible that the vaccine may not useful.
Interesting question.
Probably yes, but to a much lesser extent than for actual treatment, because you get misuse (taking the drug wongly, animals etc) out of the picture and because the immune system launches multipronged attacks and not just the one you get through a drug.
+Sex & Co. KG
I suppose there's also less likelihood for misuse since vaccines are generally administered only once, so there's rarely a such thing as an "incomplete course" of a vaccine.
+Nastassja Riemermann The vaccines I know are generally given three times when you have never had them?!
However, when making a vaccine the parts of the bacteria or viruses that are given to the body are parts that are well conserved- parts that don't change much because the bacteria would die without them. That's also a reason why it's so hard to make a vaccine against hiv - there are many strains and all mutate quickly.
So in my opinion vaccine resistance would be possible if the vaccine only contains a very specific part of the microbe so that there is little cross-immunity to other strains and if those other strains are already out there. It is unlikely for them to develop inside the vaccinated human body but if many people are vaccinated against one strain, another may very well gain in relative probability. This does however not mean that it will a) rise in absolute probability and b) be as dangerous as the other strain.
You didn't say anything about people not actually taking the antibiotic correctly - not finishing the course in the mistaken belief that that'll somehow reduce all these problems they keep hearing about, when in fact it exacerbates the problem. Maybe you could do that as a separate video.
However I think that that is mostly a problem in doctor patient communication. And health literacy.
plasmids? who's thinking bioshock?
+radicalbacon Bioshock got it from somewhere. ;)
Organic food isn't so pointless now is it?
+IIIhittmanIII Yeah, the restriction on antibiotics in Organic meats is definitely very good. There is non-Organic meat that's antibiotic-free, which is sometimes labelled, but not always.
Sadly, the organic label means covers a bunch of things, a few of which are important and valuable, but many of which aren't. Ideally, we'd have a good evidence-backed labelling initiative instead of the sometimes-we'll-listen-to-science-but-sometimes-we're-in-direct-opposition label that "Certified Organic" currently is.
+Luca Masters All meat in the EU is supposedly free from prophylactic antibiotics, organic and non-organic.
Wellll thats were your wrong organic food can be infected while fake food (mcdonalds chiken nuggets) are less likely to be infected since virus are made for infecting organic stuff
Also I am not saying we should eat nothing but mcdonalds
soooo... what do we do? we can't play cat and mouse with resistant bacteria forever. are we fucked?
Why don't researchers just work on ways to improve or boost the human immune system itself and keep people healthier? i.e. instead of using drugs to kill the bacteria, do research on what helps our bodies kill bacteria more effectively, since it seems every drug is met with a resistance. I'm not an expert and am totally talking out of my ass here, but my gut reaction is to think that new antibiotics won't help.
+xfrancescanicolex Some antibiotics don't kill bacteria but block their replication so our immune system can fight them.
Some of the "worst super-bug" are commensal bacteria (is a fancy term that means if you are healthy they live inside you without any problem). Clebsiella and Pseudomonas are two of them.
Pathogen bacteria can cause infection eventhough you are perfectly healthy they can cause problem (for example Salmonella, some E.Coli, Staphilococcus A). These are dangerous because they can produce toxins that interact in a different numeber of way. Some of these toxin can cause the immune system to over react and this could lead to a setic shock (and we aren't good at treating that).
gentamicin or gentomycin?
folks can get more sick at times from antibiotics, so sad and shameful.
Quarantine
***** injections only work if they get in the blood stream, just like quarantines only work when they are actually quarantines. If a bunch of doctors were just spraying injections on the skin of patients would you really cont that in how well injections work?
Anticipating anther possible response, quarantine also doesn't mean you let the infected suffer or die, you just keep them from spreading the infection by using gloves, masks, isolated ventilation, etc.
You clearly don't understand what a quarantine is, which is all the more reason Healthcare Triage should do an episode on them (unless you count the first bit of the "Antibiotics are Overused" as good enough)
***** but breaking it is not using it, I refer you back to my injection comparison.
Anyone here from M.J. Ryerson Health Class?
too many power point like slides :(
Literally 1 view
+Ique literally 17,304 views
is that Apple Watch?
too bad nobody wants tax increase to increase funding for antibiotic research. you can literally pry my money from my cold dead hands.
We'll be waiting
Protect humans and animals, come to veganism..
+Dylan T yaassss
+Dylan T A lot of fruits and veggies have it worse than humans. Crops are held to a very high conformity standard and so just one fungus can wipe out billions of dollars worth of crops. A particular example being bananas, where the old type of banana is basically not sold anymore since a fungus had completely destroyed the industry. In addition, at this point it wouldn't really be protecting animals since if the meat industry was lowered significantly then it would probably cause farm animal deaths on a massive scale since there's no way they'd survive without being taken care of by humans.
I agree with the "protect humans" part of that since it'd lower the chances of another MRSA bacterium emerging, though I'm unlikely to stop eating meat just because of that. I am hopeful about that bacon seaweed thing they're making as a reasonable alternative though.
As for the impact on the environment, I've seen a few studies that indicate (at least in Australia as far as I recall) that crops would actually cause more damage to the environment due to water and energy usage.
RandomGuy666100 Eating less meat would not all-of-a-sudden cause extra cows to be let out into the wild. It would just make meat producers bread fewer animals. Each animal you don't eat is another animal not born into bondage, abuse and an early death.
Most of the land used to grow grain is destined to be livestock feed. Humans go hungry so you can go to in-n-out.
Dylan T you must mean "breed" and there's always deer hunting, and that kind of thing
Fuck no that would cause the market to crash and animal breeders would go out of business so I am not gonna be vegan
pumping antibiotics unnecessarily into animals for animal agriculture is a major factor in this area.. go vegan for yourself, for the people, for the environment and for the animals
+Katie Thompson Pretty much. Something like 80% of all abx use is in agriculture. Even our last line drug (colistin) is in widespread use in developing countries such as India, and they are cheap by the pound...
save the planet, go vegan.
Veigar's Twitchy Hand fuck no
And people make fun of vegans..
Correction: Assholes make fun of vegans. Preachy vegans are just as bad as the people making fun of them however. Judging anybody for anything hasn't ever gotten anyone anywhere.
Because most vegans are dick heads who think there above everyone
too bad nobody wants tax increase to increase funding for antibiotic research. you can literally pry my money from my cold dead hands.
If antibiotic resistance gets common enough, that might just happen
We'll be waiting