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Comment by kileywm | Hacker News Reader

Can anyone clarify the core causes of antibiotic resistance over the last several decades?

I've heard the following causes, but I cannot substantiate them:

[1] Improper patient usage. Primarily, not taking the prescribed dosage long enough to eradicate all of the target bacterium, leaving (enough) survivors to meaningfully propagate their resistance. Typical to the "Hey I think my sinus infection is gone already! Adios remaining pills."

[2] Improper targeting. A functional antibiotic used on the wrong type of bacterium, or even usage against viruses.

Are there any others? Are my [1] and [2] debunked?

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1. This is a major problem - patients start feeling better and discontinue therapy, which promotes resistance, save partially consumed prescriptions for "if this happens again", etc.

2. This is also a thing - broad spectrum antibiotics, difficulty in diagnosing, patients wanting something even if their infections are viral, etc. all lead to mistargeting of antibiotics for a number of reasons. Antimicrobial stewardship has become a major part of hospital infection control.

3. The widespread use of antibiotics in livestock. The agricultural use of antibiotics is staggering

"patients wanting something even if their infections are viral"

What the market needs is a placebo anti-biotic. One thats totally wasted by resistance so it won't hurt anything, and is reasonably cheap. Give it some nasty digestive system "effects" as a special gift to patients dumb enough to demand a pill against medical advice. Something that is, in fact, an antibiotic, so when they go home and look it up on wikipedia they don't freak out when they find out what a sucrose pill is. Maybe a homeopathic dose of it, so counter-reactions are rare and minimal.

"First, do no harm" is somewhat incompatible with dumb, demanding patients, unfortunately.

Medical ethics are also very patient focused - it's hard to deal with situations that are good for this patient but bad for hypothetical future patients.

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