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[MetalSlimeHunt]

What is TDR-TB? Oh, only a little thing called Totally Drug Resistant Tuberculosis. As the name might suggest, it is not vulnerable to any known antibiotics, and so far has never been cured by anything.

TDR-TB is the next step up from XDR-TB (Extremely Drug Resistant Tuberculosis) and MDR-TB (Moderately Drug Resistant Tuberculosis), both of which are already so resistant as to greatly thwart medical science.

This is a perfect example of why antibiotic distribution needs to change, because things like this happen in response to taking antibiotics for every little disease or trying to ration them instead of using them correctly (and thus allowing the disease time to mutate an immunity to it).

Here's hoping none of you have been coughing recently, because these super-diseases are only going to become more common until people learn to use antibiotics responsibly or have their access to them restricted.

[Levi]

That is a little terrifying. 

My solution is to come up with more types of antibiotics.  Multiple classes of drugs worked wonders against HIV.

[MetalSlimeHunt]

The antibiotics aren't the problem, it's the people using them. A new antibiotic will just get snatched up and used in the same irresponsible way.

[Levi]

Sure, but its hard for a disease to adapt itself to multiple pressures like that.  In adapting to the second drug it might become less virulent, or lose some protection to the first drug.

People are pretty much doomed to irresponsible, and it doesn't seem like that is going to get better.  Might as plan for our bad behavior ahead of time.   

[MetalSlimeHunt]

TDR-TB isn't adapted to one drug. It's adapted to every single first-line and second-line antibiotic that works against tuberculosis.

[scriver]

or trying to ration them instead of using them correctly

Explain the difference?

[MonkeyHead]

Drug companies also have to take some responsibility. There have been few, if any, advances in antibiotic drugs in about 40 years or so, simply as they arent as profitable as anti-depressants, viagra, and mild analgesics. Of course, any new antibiotic will probably be just as overused as the rest of them, creating the same problems as we currently face...

[RedKing]

Levi: Only if it's having to adapt to multiple pressures at the same time. It's extremely rare for a drug-resistant pathogen to mutate in a way that causes it to lose some of that acquired resistance.

Russian hospitals are another potential ground zero for breeding drug-resistant pathogens. If this sort of thing scares you, never EVER read Laurie Garrett, particularly The Coming Plague or Betrayal of Trust. It's all nonfiction and it will all make you not want to set foot in any hospital ever again.

[Levi]

or trying to ration them instead of using them correctly

Explain the difference?

Drugs have an intended dosage for a reason.  If the virus isn't getting the full force of the drugs at all times, it is a lot easier for the virus to become resistant.

Its usually better to take all the drugs as prescribed, or none at all.  Its the in-between that is often the worst thing to do.

[Sheb]

Well, that or the taking of antibiotics for stuff that don't need them (It's a fuckin' cold, just wait it out!). And of course the massive use of "preventive" antibiotics in cattle and other industrially-produced meat.

[Aqizzar]

Okay... So if using antibiotics to cure a life-threatening disease is a bad thing, then what is the correct way to cure it?  I do understand the logic behind the concept, don't get me wrong, but until you have a replacement for taking medicine besides Don't Get Sick, what exactly do you expect people to do when they get tuberculosis?

Or I suppose the real question is, until better antibiotic practices are understood worldwide, what should people who get serious diseases like tuberculosis do?  Besides die that is, as is nature's answer.

[RedKing]

While that's true, I think what MSH meant was, "Stop giving out antibiotics to every person with a sinus cold and reserve them for serious dangerous infections".

Also, stop giving them to livestock. If you're a bacterium, and you're spawning in an environment which is utterly awash in antibiotics, eventually Nature is going to make some of your progeny resistant. And since they won't be competing for resources with all the other millions of far-less-harmful bacteria that would be present in a normal environment, they'll go absolutely apeshit once they achieve that resistance.

This is why things you get things like MRSA outbreaks in hospitals. The modern hospital is so awash in antibacterial soaps, fabrics, and drug-soaked patients that it doesn't even have most natural harmless bacteria that you'd find anywhere else. So when a MRSA bacteria gets into the environment, it's like letting a kid into a candy store without any other kids to compete with.

@Aqizzar: I think public health officials would agree that TB patients getting antibiotics isn't the problem, it's all the OTHER people getting antibiotics for conditions that, while non-trivial, don't necessarily warrant antibiotics. Sinus colds, ear infections, that sort of thing.

The problem is (at least in the United States), healthcare is a free market commodity. If the patient wants antibiotics, and you refuse to prescribe them, they're just gonna go find another doctor who will give them. And people have generally been led to believe that antibiotics are a good thing. Hell, look at how many products there are out there which are antibacterial (Kleenex, wipes, hand soaps, etc.) While those aren't using antibiotics, they still have two negatives:

1. It reinforces this idea that all bacteria are BAD and need to be wiped out. Sterile = Good, and bacteria (which we've been living with in our environment since before we came down out of the trees) = bad. The whole "probiotics" thing is starting to help counteract that a little bit but there's still plenty of fear-mongering in advertising for these kind of products.
2. Antibacterial products kill off naturally occuring harmless bacteria in the environment, which reduces competition pressure on serious pathogens (see above).

And if you've got a kid who's screaming in agony because they have an ear infection...it's hard to tell their parents that they've gotta suck it up so that we don't eventually create drug-resistant superflu or something. They just want you to give the kid some goddamn Cipro so he gets better.

I'll admit, I'm as guilty as the next person. I get bad sinus colds a couple of times a year, and the doc usually just gives me a 7-day batch of amoxicillin or Cipro and calls it a day. The last couple of times, I've managed to just tough it out, but it sucks.

[MetalSlimeHunt]

Okay... So if using antibiotics to cure a life-threatening disease is a bad thing, then what is the correct way to cure it?  I do understand the logic behind the concept, don't get me wrong, but until you have a replacement for taking medicine besides Don't Get Sick, what exactly do you expect people to do when they get tuberculosis?

Because they aren't using it right, especially in poorer areas. Antibiotics are a more expensive thing, and people who don't understand how they work have a tendency to treat them like they'd treat Aspirin and use as little as possible to try and insure that they get cured by it.

With antibiotics, this strategy is what we in the medical field refer to as WRONG.

Instead of "helping you wait it out" using less of the antibiotics than your required dosage kills off the instances of the disease that are weakest to it...but leaves the stronger (yet still vulnerable) strains. These strains then reproduce, and as evolution is want to do, they then adapt to their environment....which is now filled with this antibiotic. Then the disease inevitably mutates in such a way that it can shrug off the antibiotic entirely, and viola, you now have a MDR/XDR/TDR disease.

The solution is that you need to educate people on how the antibiotic you are giving them works and get a legal statement to use it in the correct manner....or they don't get it at all.

[Cthulhu]

This is why we need to streamline development of bacteriophage therapy.  Counteract the evolution of resistant bacteria by introducing drugs with a natural obligation to counter-evolve.

It's like using hobos to fight an eating-resistant baloney epidemic.  Bacteriophages only "eat" bacteria so you can be damn sure they'll figure something out no matter what the bacteria tries.

[scriver]

we in the medical field

...We? Aren't you like 16 years or so?

Anyway, I get what you were saying know - I misunderstood the use of "ration" and thought you meant we shouldn't be using them less than we do know in general.

This is why we need to streamline development of bacteriophage therapy.  Counteract the evolution of resistant bacteria by introducing drugs with a natural obligation to counter-evolve.

It's like using hobos to fight an eating-resistant baloney epidemic.  Bacteriophages only "eat" bacteria so you can be damn sure they'll figure something out no matter what the bacteria tries.

I for one welcome our new bacterial overlords.