The myth of antibiotic resistance and taking your full course of antibiotics or antimicrobials-bad medicine

Weird logic and false conclusions abound in medicine, as has been an important part of this blog. We are not doing blood-letting anymore; but doctors make mistakes sometimes because a) of very smart drug company salesmen disguised as scientists and researchers, and b) because they don't have the time to fully understand Darwin's theory of evolution, and another researcher or biologist gives them a wrong interpretation of the theory. Here's an example of what I believe most people take for granted-but isn't true.

No need to finish the full dose of antibiotics

Doctors recommend that you take your full course of antibiotics (and more generally, antimicrobials-which includes viruses, fungi and parasites in addition to bacteria) even if your infection goes away and you become better. They say that you should take the full course because the residual bacteria which might remain (you have taken care of most of the bacteria with the antibiotic, but not all)  is LIKELY TO BECOME RESISTANT to the drug if the drug is not taken anymore.

That is false logic.

Let's say 1% of the bacteria is left, the antibiotic having taken care of 99% of it. If you give up the drug now-and start your medication when this residual bacteria multiplies in a few years let's say and you fall sick again, or get infected with more bacteria-you are back to square one. The bacteria resistance may develop; but taking the full course now, or spread out over 5 years, wont change the resistance pattern of the bacteria. It is saying in effect that you have to kill all of them to eliminate them developing resistance; which is perverse logic, because if you are able to kill them, then by definition they are not developing resistance to it!

Of course there are many different kinds of bacteria and antibiotics, and antibiotics have side-effects etc. which much be considered, but the rule of finishing your whole course is recommended for antibiotics, and that's what I am questioning. It may even have been some eager drug company salesmen, who are paid by volume of drugs sold, who might have presented this twisted logic in some medical conference, and the poor doctors fell for it.

What on earth is a full course anyway? Someone says three weeks, someone 1 week. It would obviously depend on the person's size and age. There are too many variables; you can't say what a full course is. That's why, it is completely fine to stop taking the drug when the infection or the symptoms go away-you are cured for now. In a few years you will get infected again and we will start all over, nothing has changed; but you haven't overmedicated yourself senselessly.

Antibiotic resistance does not develop from use or overuse of antibiotics

A very closely related issue which you hear in the medical profession is that you should not take antibiotics unnecessarily, otherwise bacteria become resistant to it, and that bacteria and microbes are developing newer and newer varieties and that's why we need newer and newer antibiotics to kill them. This is also bad logic by the medical community. Why?

While it may be true that drug-resistant mutants of a bacteria may develop, which will make a particular antibiotic drug ineffective, but that does not mean that taking the drug is the cause of the development of drug resistant bacteria! The mutant bacteria are not being created by the antibiotic drug (a misplaced causality). To give you a simpler example, imagine if you have terrorists who are killed by gunfire. Some terrorists will survive and you can think of them as the ones who beat gunfire and are "resistant to gunfire". Would it not be absurd to say that let's not use gunfire on these terrorists, because using gunfire on them resulted in these gunfire resistant survivor terrorists? Well it is the same strange logic with antibiotics causing the birth of resistant bacteria. It is unfortunate that antibiotics will stop working on bacteria and you will have surviving mutants, and it is unfortunate that you will have terrorists who will survive all your gunfire, but that doesn't mean that stopping antibiotic or gun use will stop these mutant bacteria or surviving terrorists to develop. The resistant mutants were already present in the population-and it is just that after you administer antibiotics, you have a larger fraction of them, because the other ones who couldn't resist the drug are dead!  According to Darwin's theory of Evolution, mutations are random, internal to the organism, and are not generated by the environment; the mutant bacteria resistant to antibiotics are growing and multiplying spontaneously anyway, without anything to do with you giving the antibiotic to the person. Giving antibiotics does not affect the mutations of the bacteria or the growth of the resistant strains. It only kills the non-resistant strains, that's all.  Similarly, terrorists might already have gun-resistant abilities without you firing on them with your gun.

There is no evidence of antibiotic resistance in real life, human situations. What these biologists do in the name of science is grow bacteria in a petri dish, and "induce" resistance. They feel they are doing something great and novel-in reality they are just doing artificial selection, which has been done by man on plants and animals since centuries. Darwin's massive work "The Variation of Animals and Plants under Domestication" goes over dozens of examples of this-where pigeons, cats, dogs, etc. are selected by animal breeders depending on all kinds of characteristics. What he mentions clearly, and what these biologists doing experiments in petri dishes seem to ignore, is that controlled environment experiments have nothing to do with real life in the wild. The bacteria which are resistant to antibiotics in a petri dish will multiply (if you feed them) and it will seem that the antibiotic is doing this to the bacterial colony. However, this result is a controlled experiment, and in wild nature (or a human body), where there are thousands of species of bacteria, chemicals and antibodies, etc and other living organisms who compete with each other, it is impossible to have these "antibiotic resistance" bacteria survive, in all probability. The petri dish experiments have not much to do with the chaos of the real world. If you select for white pigeons (a favorite Darwin experiment) in a controlled setting, let's say by killing the others by an anti-pigeon drug, that breeding in a far has nothing to do with white pigeon selection in nature! Those are entirely different environments. The biologists who are marveling at antibiotic resistant strains produced in a lab would do well to read Darwin's "The variation of Animals and Plants.." and save themselves a lot of trouble (and wasted research dollars). Scientists seem to continue doing this not just for bacteria but for larger animals (developing butterflies of colors etc.) and believe that it is something amazing and novel; stuff which farmers and animal breeders have been doing for centuries.

It would bee impossible to  "induce" resistance in a real life situation (e.g. a human body) by administering antibiotics. There are a large number of factors involved (other bacteria and microorganisms, body's natural defenses which will change over time, availability of food, bacteria coming from other humans into the body of the host, etc, etc), and you could not assure anything. After you kill off the non-antibiotic resistant bacteria in the human body (as is done when you get Cholera or Pneumonia), you don't know what happens to the bacteria who didn't die from the drug-you can't predict how their population will evolve, etc. etc. It is a chaotic world out there, and all you can say is that by giving the antbacterial to kill off Streptococcus pneumoniae, you improved the patient, but after that, what happens to the small remaining bacteria (some resistant to the drug you used, some surviving just by chance, hiding in a place where the drug didn't reach, etc) you can't predict how their colonies will evolve. The human body is not a controlled petri-dish.

Another example, you can't predict the change in the pigeon population distribution in a jungle once you kill all the black pigeons. The real jungle is chaotic, dynamic, full of other animals, etc; and the proportion of black pigeons today (or other such statistics) has nothing to do with what it will be in a few years. Killing off a small part of the population of a species in a mighty jungle will not give you any predictability of what happens to others in that species. It is the same with killing off some bacteria in the jungle of a human or animal body. There is no such thing as an "equilibrium population" or "equilibrium population distribution" of species-bacteria in the human body, or black pigeons in a jungle full of pigeons of all colors, and thousands of other species. Researchers in biology tend to use the word "equilibrium population" a lot-it is a Physics terms and is best left there. Darwin never used this term in the context of population of species. The equilibrium are in small, controlled petri-dish type settings, and have little relevance to the real world. Killing all the black pigeons in a jungle, which has hundreds of other pigeon species, and thousands of other animal species, does not give you any idea about how the remaining pigeon species grow. You are killing off 0.001% of the species and are trying to predict the development of the rest of the animals, which is foolish, as you can obviously see.

Here's another example to explain that the oft repeated "overuse of antibiotics is leading to the development of antibiotic resistant superbugs. We must cut down on the use of antibiotics, otherwise we will develop these superbugs which we won't be able to kill anymore" is wrong.  Imagine an aquarium with 10 species of fish, S1, S2, S3...S10. Imagine now that the species S1 has fish with three colors, A, B and C. So S1 has three varieties of fish, S1A, S1B and S1C. Let's say we develop a drug which selectively kills S1A, but does not harm S1B or S1C. The drug also doesn't harm any other species of the aquarium. If we administer a dose of our S1A killer drug, and kill all the S1A or many of the S1A fish, can we predict what happens to the population of S1B and S1C and their progeny in the acquarium???  Clearly we cannot..the loss of S1A will not mean that we will suddenly have more of S1B or S1C in the aquarium. On removing S1A, we just can say that we have taken away that variety; but we have no control nor can we predict what happens to S1B, S1C, or their offspring. A few weeks down the road, the distribution is not predictable. The same example can be translated for bacteria (S1A being the bacteria which is killed by our antibiotic, while S1B and S1C are antibiotic resistant bacteria) and hopefully you can see that killing off one variety of bacteria doesn't give us any confidence is saying how the non-resistant bacteria will develop, they are independent things-much more so when thousands of other animals and species are present.

I guess the scientists who proposed these antibiotic resistance ideas just grew two bacteria, e.g. S1A and S1B, in a petri dish. Then they fed them well; and if you were to kill of the S1A bacteria with a selective drug, you would be left with all S1B in the petridish, and because there are no other competitors for even food in the petridish (just S1A and S1B) you will falsely conclude that giving the drug "caused" you to preferentially select S1B. The petri dish has nothing to do with what goes on in real life-where thousands of bacterial species, chemical agents etc. are determining the chances of survival of an individual (bacteria). The scientists coming up with these theories do no realize that the lab experiments may not be a good replication of real life.

In certain countries like India and Argentina, where medicine hasn't bought this strange logic of antibiotic use causing resistance, you can buy antibiotics easily, over the counter. Developed countries in Europe, and both the Americas, have fallen for all this bad logic and the result is that you to get these wonderful life-saving drugs only with the prescription of a doctor. There seems to be some artificial regulation issues here-the medical community (probably because of  clever marketing by drug companies) is controlling the exact amount of antibiotics they can dispense, and when.

You can take all the antibiotics you want, that will not "cause" bacteria to become resistant. You may have other side effects which you may not like, and that's a good reason not to overdose yourself. But taking the antibiotics will not cause the resistant bacteria to develop. In addition, you can stop your antiobiotic use whenever you feel the symptoms are gone, there is no fear of left over bacteria multiplying etc. because of you stopping antibiotic use.

Antibiotics, if there are no severe side effects, should be used without problems. The older antibiotics, which we are quite sure do not have many severe side effects, should be brought back as over the counter drugs. Their overuse is not harmful, and if you stop using them just after symptoms go away, it won't hurt you either (except that the same illness can be born again, or of side effects).

Plenty of experienced medical professionals know this already.

Antibiotics act on the bacteria, not on the human body

The confusion of "resistance to antibiotics-therefore let's take less of them" is also because these doctors are missing the point that antibiotics are acting on the bacteria, and NOT on the human body. Obviously everyone knows that you need more and more alcohol to get drunk, more and more pain killers to relieve pain, etc. as you get "used to them". But that's entirely different from bacteria surviving after antibiotics. The resistance can be developed only by the ones who survive!  You need more alcohol to get drunk than you did 10 years ago, but this is not the same as you will need more antibiotic to fight off bacteria as well.

Horizontal gene transfer is a rare phenomenon

There is a theory of horizontal gene transfer with plasmids which is also use to explain development of antibiotic resistance. Horizontal gene transfer, spontaneously, is probably a very rare phenomenon-and exotic explanations like that do not prove or disprove that antibiotic resistance is developed at the first place (it explains the how, but doesn't answer why).

Uses of antibiotics

If you accept that overuse of antibiotics will not lead to developing of "resistance", you can use them for treatment of some very common infections and diseases.

Infections on fingers from nail biting, or rough use of hands-construction workers, car mechanics, etc: This is another area where I have used antibiotics to cure myself and people around me very effectively. If you are "fortified" with antibiotics in your diet,  you won't even get these infections (the white pus kinda stuff is a symptom) but if you don't, you can quickly cure them by applying antibiotics locally. Tonic water has traces of quinine, which works well. Eugenol (Clove oil) is also excellent-apply it locally to an infection and it goes away in 24 hours or less. I don't claim to know how (the mechanism) and why antibiotics work in these infections.

I wouldn't go as far as taking antibiotics as vitamins, but I believe in these two very common infections-of teeth and of fingers, we can take care of them by taking antibiotics orally or applying them locally.

See also this post on stress induced illnesses. 
this post on uselessness of low fat foods.

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