{"600252":{"#nid":"600252","#data":{"type":"news","title":"Want to Beat Antibiotic-Resistant Superbugs? Rethink Strep Throat Remedies","body":[{"value":"\u003Cp\u003EGot a sore throat? The doctor may write a quick prescription for penicillin or amoxicillin, and with the stroke of a pen, help diminish public health and your own future health by encouraging bacteria to evolve resistance to antibiotics.\u003C\/p\u003E\r\n\r\n\u003Cp\u003EIt\u0026rsquo;s time to develop alternatives to antibiotics for small infections, according to a\u0026nbsp;\u003Ca href=\u0022https:\/\/doi.org\/10.1371\/journal.pbio.2003533.g001\u0022 rel=\u0022noopener noreferrer\u0022 target=\u0022_blank\u0022\u003Enew thought paper by scientists at the Georgia Institute of Technology\u003C\/a\u003E, and to do so quickly.\u003C\/p\u003E\r\n\r\n\u003Cp\u003EIt has been\u0026nbsp;\u003Ca href=\u0022http:\/\/www.latimes.com\/science\/sciencenow\/la-sci-antibiotic-resistance-20160711-snap-story.html\u0022 rel=\u0022noopener noreferrer\u0022 target=\u0022_blank\u0022\u003Ewidely reported that bacteria will evolve to render antibiotics mostly ineffective\u003C\/a\u003E\u0026nbsp;against them by mid-century, and current strategies to make up for the projected shortfalls haven\u0026rsquo;t worked.\u003C\/p\u003E\r\n\r\n\u003Cp\u003EOne possible problem is that 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.\u003C\/p\u003E\r\n\r\n\u003Cp\u003EBut the evolutionary process that brings forth antibiotic resistance doesn\u0026rsquo;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, the Georgia Tech researchers said.\u003C\/p\u003E\r\n\r\n\u003Cp\u003E\u0026ldquo;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,\u0026rdquo; said\u0026nbsp;\u003Ca href=\u0022http:\/\/biosci.gatech.edu\/people\/sam-brown\u0022 rel=\u0022noopener noreferrer\u0022 target=\u0022_blank\u0022\u003ESam Brown, an associate professor in Georgia Tech\u0026rsquo;s School of Biological Sciences\u003C\/a\u003E. 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.\u003C\/p\u003E\r\n\r\n\u003Cp\u003E\u0026ldquo;It might make more sense to give antibiotics less often and preserve their effectiveness for when they\u0026rsquo;re really needed. And develop alternate treatments for the small infections,\u0026rdquo; Brown said.\u003C\/p\u003E\r\n\r\n\u003Cp\u003EBrown, who specializes in the evolution of microbes and in\u0026nbsp;\u003Ca href=\u0022https:\/\/en.wikipedia.org\/wiki\/Virulence#Virulent_bacteria\u0022 rel=\u0022noopener noreferrer\u0022 target=\u0022_blank\u0022\u003Ebacterial virulence\u003C\/a\u003E, and first author Kristofer Wollein Waldetoft, a medical doctor and postdoctoral research assistant in Brown\u0026rsquo;s lab, published an\u0026nbsp;\u003Ca href=\u0022https:\/\/doi.org\/10.1371\/journal.pbio.2003533\u0022 rel=\u0022noopener noreferrer\u0022 target=\u0022_blank\u0022\u003Eessay detailing their suggestion for refocusing the development of bacteria-fighting drugs on December 28, 2017, in the journal\u0026nbsp;\u003Cem\u003EPLOS Biology\u003C\/em\u003E\u003C\/a\u003E.\u003C\/p\u003E\r\n\r\n\u003Ch4\u003E\u003Cstrong\u003EDuplicitous antibiotics\u003C\/strong\u003E\u003C\/h4\u003E\r\n\r\n\u003Cp\u003EThe evolution of antibiotic resistance can be downright two-faced.\u003C\/p\u003E\r\n\r\n\u003Cp\u003E\u0026ldquo;If you or your kid go to the doctor with an upper respiratory infection, you often get amoxicillin, which is a relatively broad-spectrum antibiotic,\u0026rdquo; Brown said. \u0026ldquo;So, it kills not only strep but also a lot of other bacteria, including in places like the digestive tract, and that has quite broad impacts.\u0026rdquo;\u003C\/p\u003E\r\n\r\n\u003Cp\u003E\u003Cem\u003EE. coli\u003C\/em\u003E\u0026nbsp;is widespread in the human gut, and some strains secrete enzymes that thwart antibiotics, while other strains don\u0026rsquo;t. A broad-spectrum antibiotic can kill off more of the vulnerable, less dangerous bacteria, leaving the more dangerous and robust bacteria to propagate.\u003C\/p\u003E\r\n\r\n\u003Cp\u003E\u0026ldquo;You take an antibiotic to go after that thing in your throat, and you end up with gut bacteria that are super-resistant,\u0026rdquo; Brown said. \u0026ldquo;Then later, if you have to have surgery, you have a problem. Or you give that resistant\u0026nbsp;\u003Cem\u003EE. coli\u003C\/em\u003E\u0026nbsp;to an elderly relative.\u0026rdquo;\u003C\/p\u003E\r\n\r\n\u003Cp\u003EMuch too often, superbugs have made their way into hospitals in someone\u0026rsquo;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.\u003C\/p\u003E\r\n\r\n\u003Cp\u003EFurious infections have ensued, essentially invulnerable to antibiotics, followed by sepsis and death.\u003C\/p\u003E\r\n\r\n\u003Ch4\u003E\u003Cstrong\u003EAlternatives get an \u0026ldquo;F\u0026rdquo;\u003C\/strong\u003E\u003C\/h4\u003E\r\n\r\n\u003Cp\u003EDrug developers facing dwindling antibiotic effectiveness against evolved bacteria have looked for multiple alternate treatments. The focus has often been to find some new class of drug that works as well as or better than antibiotics, but so far, nothing has, Brown said.\u003C\/p\u003E\r\n\r\n\u003Cp\u003EWollein Waldetoft came across a\u0026nbsp;\u003Ca href=\u0022https:\/\/doi.org\/10.1016\/S1473-3099(15)00466-1\u0022 rel=\u0022noopener noreferrer\u0022 target=\u0022_blank\u0022\u003Eresearch paper in the medical journal\u0026nbsp;\u003Cem\u003ELancet Infectious Diseases\u0026nbsp;\u003C\/em\u003E\u003C\/a\u003Ethat examined study after study on such alternate treatments against big, deadly infections.\u003C\/p\u003E\r\n\r\n\u003Cp\u003E\u0026ldquo;It was a kind of scorecard, and it was almost uniformly negative,\u0026rdquo; Brown said. \u0026ldquo;These alternate therapies, such as\u0026nbsp;\u003Ca href=\u0022https:\/\/en.wikipedia.org\/wiki\/Phage_therapy\u0022 rel=\u0022noopener noreferrer\u0022 target=\u0022_blank\u0022\u003Ephage\u003C\/a\u003E\u0026nbsp;or\u0026nbsp;\u003Ca href=\u0022https:\/\/www.nature.com\/articles\/nrd.2017.23\u0022 rel=\u0022noopener noreferrer\u0022 target=\u0022_blank\u0022\u003Eanti-virulence drugs\u003C\/a\u003E\u0026nbsp;or,\u0026nbsp;\u003Ca href=\u0022https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9168627\u0022 rel=\u0022noopener noreferrer\u0022 target=\u0022_blank\u0022\u003Ebacteriocins\u003C\/a\u003E\u0026nbsp;-- you name it -- just didn\u0026rsquo;t rise to the same bar of efficacy that existing antibiotics did.\u0026rdquo;\u003C\/p\u003E\r\n\r\n\u003Cp\u003E\u0026ldquo;It was a type of doom and gloom paper that said once the antibiotics are gone, we\u0026rsquo;re in trouble,\u0026rdquo; Brown said. \u0026ldquo;Drug companies still are investing in alternate drug research, because it has gotten very, very hard to develop new effective antibiotics. We don\u0026rsquo;t have a lot of other options.\u0026rdquo;\u003C\/p\u003E\r\n\r\n\u003Cp\u003EBut the focus on new treatments for extreme infections has bothered the researchers\u0026nbsp;because the main arena where the vast portion of resistance evolution occurs is in small infections. \u0026ldquo;We felt like there was a disconnect going on here,\u0026rdquo; Brown said.\u003C\/p\u003E\r\n\r\n\u003Ch4\u003E\u003Cstrong\u003EDon\u0026rsquo;t kill strep, beat it\u003C\/strong\u003E\u003C\/h4\u003E\r\n\r\n\u003Cp\u003EThe researchers proposed a different approach: \u0026ldquo;Take the easier tasks, like sore throats, off of antibiotics and reserve antibiotics for these really serious conditions.\u0026rdquo;\u003C\/p\u003E\r\n\r\n\u003Cp\u003EDeveloping non-antibiotic therapies for strep throat, bladder infections, and bronchitis could prove easier, thus encouraging pharmaceutical investment and research.\u003C\/p\u003E\r\n\r\n\u003Cp\u003EFor example, one particular kind of strep bacteria, group A\u003Cem\u003E\u0026nbsp;streptococci\u003C\/em\u003E, is responsible for the vast majority of bacterial upper respiratory infections. People often carry it without it breaking out.\u003C\/p\u003E\r\n\r\n\u003Cp\u003EStrep 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.\u003C\/p\u003E\r\n\r\n\u003Cp\u003EBrown cautioned that strep infection can lead to rheumatic heart disease, a deadly condition that is very rare in the industrialized world, but it still takes a toll in other parts of the world. \u0026ldquo;A less powerful drug can be good enough if you don\u0026rsquo;t have serious strep throat issues in your medical history,\u0026rdquo; he said.\u003C\/p\u003E\r\n\r\n\u003Cp\u003ESometimes, all it takes is some push-back against\u0026nbsp;\u003Ca href=\u0022https:\/\/en.wikipedia.org\/wiki\/Virulence#Virulent_bacteria\u0022 rel=\u0022noopener noreferrer\u0022 target=\u0022_blank\u0022\u003Evirulent bacteria\u003C\/a\u003E\u0026nbsp;until the body\u0026rsquo;s immune system can take care of it. Developing a spray-on treatment with bacteriophages, viruses that attack bacteria, might possibly do the trick.\u003C\/p\u003E\r\n\r\n\u003Cp\u003EIf doctors had enough alternatives to antibiotics for the multitude of small infections they treat, they could help preserve antibiotic effectiveness longer for the far less common but much more deadly infections, for which they\u0026rsquo;re most needed.\u003C\/p\u003E\r\n\r\n\u003Cblockquote\u003E\r\n\u003Cp\u003E\u003Cstrong\u003EWant to Learn More?\u0026nbsp;Read: \u003Ca href=\u0022https:\/\/www.news.gatech.edu\/2019\/02\/06\/fda-taps-georgia-tech-help-reduce-cost-making-antibiotics\u0022\u003EFDA Taps Georgia Tech to Help Reduce Cost of Making Antibiotics\u003C\/a\u003E\u003C\/strong\u003E\u003C\/p\u003E\r\n\u003C\/blockquote\u003E\r\n\r\n\u003Cp\u003E\u003Cem\u003EResearch was funded by the Simons Foundation (grant 396001), the Centers for Disease Control and Prevention (grant OADS-2016-N-17812), the Wenner-Gren Foundation, and the Physiographic Society of Lund. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the sponsors.\u003C\/em\u003E\u003C\/p\u003E\r\n","summary":null,"format":"limited_html"}],"field_subtitle":"","field_summary":[{"value":"\u003Cp\u003EAntibiotics could become nearly useless by mid-century against intense infections due to bacteria evolving antibiotic resistance. And alternative treatments haven\u0026#39;t been able to replace antibiotics in those big infections. It\u0026#39;s time for a rethink: Try reducing antibiotic use for small infections and find alternate remedies for them instead to slow the evolution of resistance. That should preserve antibiotic effectiveness for the big infections.\u003C\/p\u003E\r\n","format":"limited_html"}],"field_summary_sentence":[{"value":"It\u0027s time to develop alternate drugs against small infections as a strategy to slow the antibiotic resistance crisis, Georgia Tech evolutionary bacteriologists say."}],"uid":"31759","created_gmt":"2017-12-28 20:37:34","changed_gmt":"2019-03-07 20:56:56","author":"Ben Brumfield","boilerplate_text":"","field_publication":"","field_article_url":"","dateline":{"date":"2017-12-28T00:00:00-05:00","iso_date":"2017-12-28T00:00:00-05:00","tz":"America\/New_York"},"extras":[],"hg_media":{"600247":{"id":"600247","type":"image","title":"Group A Streptococci NIAID","body":null,"created":"1514489748","gmt_created":"2017-12-28 19:35:48","changed":"1556728853","gmt_changed":"2019-05-01 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