Comment by yarg | Hacker News Reader

Comment by yarg | Hacker News Reader

Parent Full thread

I think in general the answer is more likely to be probiotics than antibiotics.

I think we underestimate the extent to which pathogens thrive in niches carved out by the absence of symbiotic bacteria required by our microbiomes.

Fecal transplants have shown significant results in some diseases (such as Crohn's): https://academic.oup.com/ibdjournal/article/21/3/556/4602907

> Based on [Pediatric Crohn's Disease Activity Index], 7 of 9 patients were in remission at 2 weeks and 5 of 9 patients who did not receive additional medical therapy were in remission at 6 and 12 weeks.

> No or modest improvement was seen in patients who did not engraft or whose microbiome was most similar to their donor.

So I think it's either a case of pathogens that fit in with the established microbiome or that the microbiome is missing vital components.

Once your microbiome is disrupted, I believe studies indicate that it's unlikely that adding probiotics in will fix it. I could see antibiotics followed by probiotics being an effective treatment for a microbiome gone haywire.

You still should consider collateral damage - we've been throwing broad spectrum antibiotics at damned near everything for decades.

We've started an arms race with a staggeringly dynamic enemy, and our solution thus far has been to attack them with static munitions, until those munitions stop working.

You can mitigate the issue with combination antibiotic therapy (it's harder to evolve resistance on multiple fronts simultaneously), but in general (when we use them) we need to move towards targeted antibiotics.

The difficulty being that you actually need to diagnose the specific problem before treatment, not just that it's bacterial in nature.

This requires pathogen detection and recognition: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4941824/

This adds significant complexity (though I don't think that knowing what you're doing is a bad idea).

We've been using nukes for a long time now, we need to move to scalpels.

In the case of Chrons and Ulcerous colitis diet changes have big impact. There have been studies that show that high consumtion of processed food increase the likely hood of getting sick.

Reply on news.ycombinator.com