Talk:Antimicrobial resistance

Over prescription of Antibiotics

It could be beneficial to discuss the over prescribing of antibiotics to patients and how it has led to an increase in antibiotic resistant infections.

Updates needed? Yes, near end of 2014

This is a big issue and will probably continue to be in the future for some time, so the page needs to be better, some consolidation, rewriting and updating. I've taken an interest in this and want to make some changes that I'll propose here before making. A better title might be "Antimicrobial resistance." By one definition, by the WHO, "antimicrobial" is a broader term covering all microbial organisms (viruses, fungi, parasites as well as bacteria), while antibiotic resistance refers to "resistance to antibiotics that occurs in common bacteria that cause infections." (see WHO fact sheet 194) The CDC waffles, using both.

I've written a new introductory paragraph as follows:

Antimicrobial resistance occurs when pathogenic microbes continue to grow after exposure to one or more antimicrobial agents due to genetic modifications that impart resistance. Microbes that exhibit resistance can include viruses, fungi and parasites, but antimicrobial resistance (also called antibiotic or drug resistance) is mostly a problem in the treatment of infections caused by bacterial pathogens. In a recent report, the World Health Organization states that antibiotic resistance is "a growing public health threat of broad concern... [that] threatens the achievements of modern medicine." Bacteria that are resistant to multiple antibiotics are considered multidrug resistant (MDR) or, more colloquially, superbugs. In September 2014, US president Obama issued an executive order forming a task force to tackle the threat and calling the issue one of national security.

COMMENTS?

The existing intro paragraph doesn't much stress the importance of the issue I don't think.

Other issues:

- veterinary medicine is probably not the best subheading for this section. To me that would indicate that drug resistance is a problem in the treatment of animals with infections, which is not the issue here or course. It should be something like: Inappropriate use of antibiotics in animal husbandry IMHO

- maybe create a new subheading under Prevention, called Action. Include more about the executive order, the CDC threat report of 2013, this (http://www.whitehouse.gov/sites/default/files/microsites/ostp/PCAST/pcast_carb_report_sept2014.pdf) and then keep this updated (action plan to be submitted by 15 February 2015).

I'm making my way through, wordsmithing and looking for other possible changes/additions — Preceding unsigned comment added by Jtamad (talk • contribs) 04:13, 8 December 2014‎ UTC}

please focus on improving the body of the article. per WP:LEAD, the lead paragraph should summarize what is in the body of the article. when you do that well, you don't need any sources in the lead, as everything in the lead is already in the body, and of course well sourced there per WP:VERIFY. Jytdog (talk) 05:17, 8 December 2014 (UTC)

Article title change?

There's an article title antimicrobial resistance that is pretty minimal. How about changing the title of this article to "antimicrobial resistance" (better I think) and combine the articles? juanTamad 10:58, 17 January 2015 (UTC) — Preceding unsigned comment added by Jtamad (talk • contribs)

I agree. The current title is misleading; antibiotics are not used to combat viral infections. We could rename the article as suggested and leave a redirect from Antibiotic resistance. Graham Beards (talk) 12:41, 17 January 2015 (UTC)

• Support Doc James (talk · contribs · email) 23:58, 17 January 2015 (UTC)
• Disagree strongly I totally disagree with the move, albeit 9 days late. the antibiotic article has had long existing problems that are not solved by a move. I worked on the antimicrobial resistance article a year ago, for reasons that can be discussed. It is a meta heading so to speak and needs to stay a separate article IMHO. Graham Beards's point has nothing to do with widening the title to antimicrobial resistance

Jtamad, Antibiotic resistance is what lay people know about, want to know about and and need to know about. Antifungal and antiviral, anti-protozoal resistance is for the expert. Doc James although head huncho at WP: Medicine, is clearly not a content expert on this as an ER doc. CAVEAT: This is no personal attack, but merely the facts, like the bold font sticking out. (BTW: if you guys want to rename something partout, why not rename antibiotic sensitivity to antibiotic susceptibility which is the proper term. Skin is sensitive, neither bacteria not antibiotics.) --Wuerzele (talk) 05:18, 27 January 2015 (UTC)

Antimicrobial resistance is a broader term. One does not need to be an expert to figure this out.

This is an editorial discussion rather than a content one. Do we want more articles that are narrower in scope or fewer articles that are broader in scope. I am in the later camp.

Doc James (talk · contribs · email) 15:33, 27 January 2015 (UTC)

• Re: "Antimicrobial resistance is a broader term. One does not need to be an expert to figure this out" A broader term, exactly , but it appears you didnt follow that this means more content. why would you want to pack in more content into this page? Does one need to be a content expert to figure this out?
• So, one more time, in more words: Antimicrobial resistance is a meta heading and NOT in common use by the lay audience. But antibiotic resistance is, and is WAY enough to write about in one article, as it was. You cannot cram all of antimicrobial resistance in one article on an encyclopedic level. I suggest a separate article, which was the status quo.
• Re "This is an editorial discussion rather than a content one." First, I dont see you discuss anything and why are you differentiating editorial from content?? Merging teh 2 articles (editorial decision) enormously influences the content.
• Re: "Do we want more articles that are narrower in scope or fewer articles that are broader in scope." ?? Counterquestion: Why distract from the issue on the table by generalizing the issue ad ultimo? Rhethoric? This is a talk page on one not very easy, but damn important topic, antibiotic resistance. why are you even posing this loaded question? for me to getsecond thoughts? I clearly answered your question for this, antibiotic resistance, and said Do NOT throw in antiviral and antifungal etc. so there was no need to ask. First, there is no wild abundance of WP articles in the area of clinical microbiology and infectious diseases anyway, -correct me if I am wrong, with stats- to justify a merger of this kind. Second by comparison, consider all the kinds of overlapping pages, eg for Meningococcus and its diseases 3 or even 4, and you make a fuss about this one mega topic of antimicrobial resistance, that permeates all fields of medicine incl. veterinary medicine, soil biology and what not.
• You merely allow antibiotic resistance to be a redirect, but not to have its own page? You don't need to be a content expert to realize that that is undue.
• Procedural comment: It is unheard of on WP, that only two editors establish a consensus, when numerous other editors work on a page. after waiting only like, what? one day, and on a decision of such a huge topic. Have a good one. --Wuerzele (talk) 08:04, 29 January 2015 (UTC)

Moved Jan 26th [1] after more than one week. Doc James (talk · contribs · email) 13:53, 29 January 2015 (UTC)

Doc James striking out the minor error I made, after having written IN THE BEGINNING if you look up: 9 days. It appears you use that error as a distraction and excuse to not engage in a discussion. And again, if its not too much for you , please have the courtesy to ping me if you communicate. --Wuerzele (talk) 08:13, 31 January 2015 (UTC)

It is totally obvious that you dodge discussions, but that is no remedy.--Wuerzele (talk) 05:27, 7 March 2015 (UTC)

image and caption

as of this version, image and caption were as in the top image.

Antibiotic resistance tests: The bacteria in the culture on the left are susceptible to the antibiotics contained in the white paper discs. The bacteria in the culture on the right are resistant to most of the antibiotics.

Was changed, per the bottom version.

Antibiotic resistance tests: The bacteria in the culture on the left are susceptible (dark, clear rings) to the antibiotics contained in the white paper discs. Those on the right are fully susceptible to only three of the seven antibiotics tested.

There is no source for this caption. Both versions of the captions are wrong. The dark rings are growth which means resistance. No ring = no growth = susceptible. Both of those are relative, not absolute. See the caption here. I would be happy to see the image restored with a correct and sourced caption. To explain, the dish is covered with the antibiotic. The white disks have different strains of bacteria on them. If the bacteria are resistant to the drug, they live and divide and expand, creating the dark circle. The amount of expansion is important - if the drug slows down growth, that is useful to know. If the bacteria are either killed or are prevented from dividing (in other words, the drug is a bacteriostatic agent), nothing happens, there is no growth, and no dark ring appears, and this shows that the bacteria are susceptible to the drug. OK with everybody? Jytdog (talk) 13:54, 26 January 2015 (UTC)

This is my image from cultures I made. The dark rings are not growth; they are areas where no colonies of bacteria can be seen, that is no growth. The dishes are not covered in antibiotic. The antibiotics are in the white discs. There is a different antibiotic in each one. The discs do not have strains of bacteria on them. The whole of the plates where covered with one strain of bacteria; a resistant strain and a sensitive strain. This is an example of a standard antibiotic sensitivity screen. I don't know where you have got the idea that the dark rings are growth and that each disc contains bacteria. Graham Beards (talk) 15:59, 26 January 2015 (UTC)

I restored the image with its caption and added a reference. Here is a relevant quote from the reference "The pathogenic organism is grown on Mueller-Hinton agar in the presence of various antimicrobial impregnated filter paper disks.  The presence or absence of growth around the disks is an indirect measure of the ability of that compound to inhibit that organism."--agr (talk) 16:13, 26 January 2015 (UTC)

Thanks, i was wrong! We had an edit conflict where we were each adding a source. I added content to the caption to better clarify the experiment. Sorry for my mistake. Duh and a big self-trout for me. Jytdog (talk) 16:15, 26 January 2015 (UTC)

just want to apologize again for this. amazing example for me of how one can find a source and cite it and fail to read it clearly. oy. sorry again. Jytdog (talk) 17:09, 26 January 2015 (UTC)

Thanks for the apology. But I don't think your caption edit is quite right. As i understand the procedure (Graham can correct me), the agar in the dish is streaked with a solution that contains the bacteria to be tested. At that point they are invisible. The antibiotic disks are then placed on the agar and the dish is incubated for a day or two. The bacteria grow out producing the "lawn" of bacteria you see in the image, except where antibiotic has defused from the disks in high enough concentration. It is not that the disk are added to grown bacteria and then kill them. The clear areas are where bacteria never grew.--agr (talk) 17:16, 26 January 2015 (UTC)

That's correct. This technique does not differentiate bactericidal and bacteriostatic antibiotics, i.e. those that kill and those that just inhibit reproduction. The potency of antibiotics is expressed as the minimum inhibitory concentration – it's all about the lack of bacterial growth, not killing them. "The clear rings where bacteria have died" is not correct, the bacteria have not grown in these zones. Graham Beards (talk) 18:43, 26 January 2015 (UTC)

thanks for the correction. fixed it.

missing talk page after page move

Doc James please move talk from antibiotic resistance here. I did not agree with the page move and am awaiting your reply.--Wuerzele (talk) 07:15, 28 January 2015 (UTC)

Wuerzele Agree - please, let's have missing Talk page restored. I will go to WP:chat for advice on how to do this. Regards, IiKkEe (talk) 12:29, 28 January 2015 (UTC)

Moving and merging. Please note I was not the one who did the original move. Doc James (talk · contribs · email) 18:25, 28 January 2015 (UTC)

false information in lede

"In medical therapy AMR is most problematic, but viruses, fungi and parasites can also occasionally become resistant."

This is an embarrassingly false sentence on 2 levels.

• First, AMR ≠ antibiotic resistance

AMR =antibiotic resistance + antiviral drug resistance + antifungal drug resistance + antiprotozoal drug resistance

So, the sentence should be "In medical therapy antibiotic resistance is most problematic, but viruses, fungi and parasites can also occasionally become resistant."

• Second, "In medical therapy antibiotic resistance is most problematic"? according to whom? An HIV doc doesnt say that The person with MDR Malaria or a MDRfungal infection doesnt. Imagine a soil biologist reading this, must think these medical folks cant look beyond their plate. So: "Most problematic" is in the eye of the beholder, unless qualified "for the healthcare system, for public health etc. I think what you want to say is "most common", not most problematic.
• Third, whats occasionally? defined by whom and how ? For me influenza doesnt occasionally become drug resistant, it is regularly amantadine resistant, and Tamiflu resistance is common depending on the strain. The sentence may be correct for Herpes simplex virus, but in an immunosuppressed patient not so. therefore, this is weasely, vague and not very thoughtful( it honestly sounds like a student wrote this) and not encyclopedic. This is way too sloppy for a lede sentence.

I also think, that AMR shouldnt be equated with drug resistance, as in the first sentence, since there is a separate WP page on. Cancer cells certainly become drug resistant to cancer drugs, but that's not AMR.--Wuerzele (talk) 09:29, 29 January 2015 (UTC)

Causes section a mess

Just starting to read article - Causes section is a mess. Here's how I might organize it:

Causes: Widespread use. Causes of Widespread use:

 low cost of generics, 
 uncontrolled access  
 (does globally widely available have to be mentioned as well? is it separate from the previous two?),  
 perception that antibiotics are a harmless panacea
 ubiquitous use in the meat industry to increase yields
 ? convenience of dosing (development of potent, qd po drugs)
 ...

Broadspectrum antibiotics

Lower and less frequent dosing - this area requires some research as to the dosing patterns that are more likely to create antibiotic resistance. See doi: 10.1097/CCM.0b013e318180fe62, doi: 10.1128/AAC.01053-05, doi: 10.1093/jac/dkm511, doi: 10.1128/AAC.01486-06, DOI: 10.1007/978-1-4614-1400-1_14

dissemination of resistance - ? in-patient-community links, agriculture-community links, high-risk patients. again, this area requires some research (see DOI: 10.1111/j.1469-0691.2008.02081.x) — Preceding unsigned comment added by Levydav (talk • contribs) 13:24, 8 February 2015 (UTC)

Edit

User replaced "Antibacterials in soaps and other products may contribute to antibiotic resistance" will "Antibacterials in soaps and other products do not contribute to antibiotic resistance, but are discouraged for other reasons" [2]

Ref says "A link between antibacterial chemicals used in personal cleaning products and bacterial resistance has been shown in vitro studies (in a controlled environment)." Thoughts? Doc James (talk · contribs · email) 05:36, 7 March 2015 (UTC)

I replaced the incorrect (above) sentence with the status quo which is correct. YOu, inserted a maybe which is uncited or original research. Read the reference again. --Wuerzele (talk) 05:50, 7 March 2015 (UTC)

I removed the link to microevolution as this has nothing specific to do with the mechanism of AMR. — Preceding unsigned comment added by 128.243.180.82 (talk) 11:41, 15 February 2016 (UTC)

Revert

In this edit [3] this material was restored to the lead

"Resistance may take the form of a spontaneous or induced genetic mutation, or the acquisition of resistance genes from other bacterial species by horizontal gene transfer via conjugation, transduction, or transformation. Many antibiotic resistance genes reside on transmissible plasmids, facilitating their transfer. Antibiotic-resistance plasmids frequently contain genes conferring resistance to several different antibiotics."

For one it was covered in the second sentence. Two it is overly complicated for the lead. Doc James (talk · contribs · email) 05:39, 7 March 2015 (UTC)

(edit conflict)why picking and choosing? you made much more massive changes than just that, which I reverted per WP:BRD, you ll have to discuss way more than the above- or make each edit separately.--Wuerzele (talk) 05:57, 7 March 2015 (UTC)

new topic: lede in general

Without getting too involved in the specifics of the reverts I need to mention I did some work on this article in November, and one of the major things I worked on was simplifying the lede. This is very important because this article is an excellent candidate for translation of the lede through the Medical Translation Project.

This means we need something that can be read by as many as possible, as it will be translated into 108+ different languages, many spoken where schooling is very limited. Discussing the ways in which resistance can occur is overly complicated for the lede and even so that paragraph is complicated even for a native English reader. That isn't as much of a problem down in the article, but remember the lede is supposed to be written for high-school reading level or below WP:LEDE. We have to remember the goal of the article – to inform people (not only college educated people) about antibiotic resistance. -- CFCF 🍌 (email) 10:55, 7 March 2015 (UTC)

• I came here because of a notice at WikiProject Medicine. The information seems a bit technical for the lead as compared to the kind of language which I think is common. Almost every term here is a jargon term. This may be warranted or may not be. If the article focuses on health, then typically less jargon is used, but if it is science focused, then more is acceptable. If this content is to be included then the proposer should talk through why it is important to include. It might be, but an argument should be made. Blue Rasberry (talk) 15:39, 10 March 2015 (UTC)
• the lede is absolutely horrible. it's the only thing we IiKkEe and I havent touched in our day long work over. I will take a stab at it doing it gradually and not 40 changes in one. I want to remind everybody that this article is a mongrel of a recent move that docJames refuses to discuss ( see above). I think it should be moved back to antibiotic resistance for reasons outlined above. please supply link of notice in wikiproject medicine on this talkpage for transparency.--06:23, 11 March 2015 (UTC)

Length of therapy

I modified the paragraph about length of therapy under human medicine because to me it seemed to conflate discussion of best length of therapy based on studies of effectiveness vs a patient deciding to shorten a prescribed length of therapy on the belief that it might increase probability of resistance developing. I see the editorial in BMJ that recommends ignoring advice about taking complete course of recommended therapy, stopping 72 hours after symptoms subside, but is this generally accepted? If not, seems there should be a statement that generally accepted recommendation is to continue the prescribed course of therapy (based on guidelines from Stuart Levy and others. juanTamad 05:51, 7 March 2015 (UTC) — Preceding unsigned comment added by Jtamad (talk • contribs)

Yes there are two different sources of evidence. 1) what guidelines / policy statements recommend 2) what review articles conclude. We should contain both ideally. Doc James (talk · contribs · email) 06:14, 7 March 2015 (UTC)

Current status on the topic seems to be: Need more RCTs before conservative official recommendations can change. http://hicsigwiki.asid.net.au/images/4/41/Should_you_stop_an_antibiotic_course_early_if_you_feel_better_R._Everts.pdf juanTamad 06:53, 7 March 2015 (UTC)

A powerpoint presentation is not a very good source though. But yes they can. Doc James (talk · contribs · email) 06:55, 7 March 2015 (UTC)

Right, will look for better. Someone else added that not me. The current version is good IMHO. juanTamad 07:01, 7 March 2015 (UTC)

Off topic

This content is sort of off topic and thus I propose deleting it " - the term now preferred to hospital-acquired infections or nosocomial infections {from New Latin nosocomium ("hospital"), from Ancient Greek νοσοκομείον (nosokomeíon, "hospital"), from νόσος (nósos, "disease, illness") + κομέω (koméō, "to take care of")}." Doc James (talk · contribs · email) 06:18, 7 March 2015 (UTC)

if it's just the part you indicate above, I agree.--Wuerzele (talk) 06:22, 7 March 2015 (UTC)

Trouble archiving links on the article

Hello. I am finding myself repeatedly archiving links on this page. This usually happens when the archive doesn't recognize the archive to be good.

This could be because the link is either a redirect, or I am unknowingly archiving a dead link. Please check the following links to see if it's redirecting, or in anyway bad, and fix them, if possible.

• http://therealnews.com/t2/index.php?option=com_content&task=view&id=31&Itemid=74&jumival=11872
• http://www.nytimes.com/2014/05/11/opinion/sunday/the-rise-of-antibiotic-resistance.html?ref=opinion&_r=0
• http://www.fiercebiotech.com/story/antibiotics-rd-get-critical-lift-executive-order-obama-advisory-group/2014-09-19
• http://www.technologyreview.com/news/513461/nanoparticle-disguised-as-a-blood-cell-fights-bacterial-infection/
• http://purl.fdlp.gov/GPO/gpo52306

In any event this will be the only notification in regards to these links, and I will discontinue my attempts to archive these pages.

Cheers.—^{cyberbot II}_{Talk to my owner:Online} 14:41, 13 July 2015 (UTC)

Prevention

Following a "doctor's advice" though recommended by WHO may not decrease resistance to antibiotics as we already state doctors often make bad recommendations when it comes to antibiotics. If we look at the Antimicrobial_resistance#Human_medicine a number of sources state that we should be using shorter courses of antibiotics for bacterial infections much of the time. We need to balance this. Doc James (talk · contribs · email) 22:11, 22 July 2015 (UTC)

what do you want? this looks like self talk.

and who is we? you and other docs ( me not included )?

you want to balance what with what? using shorter courses in general ?

that is an ignorant and unsourced statement.--Wuerzele (talk) 03:00, 24 July 2015 (UTC)

We as in Wikipedia needs to balance the evidence and positions of both parties in the debate. The position is neither ignorant or unsourced, but I agree it is a difficult question and my suggestion is to increasingly mention the benefit of using evidence based course lengths. -- CFCF 🍌 (email) 18:00, 24 July 2015 (UTC)

Poor compliance IS an important problem, the article sounds misleading in this aspect

"Increasing bacterial resistance is linked with the volume of antibiotic prescribed, not the lack of compliance with taking antibiotics." suggests very directly that poor compliance is a minor concern.

"Antibiotic resistance increases with duration of treatment; therefore, as long as an effective minimum is kept, shorter courses of antibiotics are likely to decrease rates of resistance, reduce cost, and have better outcomes due to fewer complications." It continues to correctly state the 72 hour idea, but the initial line suggests it to be of minor importance.

"In some situations a short course is inferior to a long course." This is extremely misleading. The cited paper refers to the effectiveness of treatment, but does not claim that antibiotic resistance growth is more limited (than long courses).

There are a few antibiotics with special properties (e.g. unusual half-time), which require different treatment, though these are rare.

I will edit the article accordingly. If you disagree, please let me know. --mafutrct (talk) 10:38, 14 August 2015 (UTC)

In this edit] you took paraphrased content and replaced it with copied and pasted content.

You added "In selected cases, it may be appropriate to stop antibiotic therapy early. However, if a person takes an inadequate course of antibiotics, they may relapse and require further treatment. This increases the risk of developing resistance, as it would expose the person to antibiotics for longer."

The source says "Therefore, in selected cases, it may be appropriate to stop antibiotic therapy early. However, if a person takes an inadequate course of antibiotics, they may relapse and require further treatment.12 This increases the risk of developing resistance, as it would expose the person to antibiotics for longer."

This is not allowed. We must paraphrase none open source content. Doc James (talk · contribs · email) 12:58, 14 August 2015 (UTC)

Agree with the issue wrt poor complience. It appears that only one type of poor compliance (using less meds than recommended rather than stopping early) generally causes problems. Exception of course exist such as TB. And have adjusted the text further.Doc James (talk · contribs · email) 13:00, 14 August 2015 (UTC)

Opening sentence seems awkward

Currently the opening sentence of the article reads, "Antimicrobial resistance (AMR) is when microbes are less treatable with one or more drugs used to treat infection." This strikes me as an bizarre and awkward first sentence, possibly stemming from being taught throughout my life to avoid ever writing, "<noun> is when...". It also misses the fact that the use of antimicrobials can be preventive rather than curative. I would propose changing the first sentence to, "Antimicrobial resistance is the resistance of a microbe to one or more drugs used to treat or prevent infection." Or something more along those lines. Someguy1221 (talk) 00:01, 24 August 2015 (UTC)

One however does not want to use a word in the definition that is part of the term you are trying to describe. Have adjusted per your other suggestions. Doc James (talk · contribs · email) 01:35, 24 August 2015 (UTC)

External links modified

Hello fellow Wikipedians,

I have just added archive links to one external link on Antimicrobial resistance. Please take a moment to review my edit. If necessary, add {{cbignore}} after the link to keep me from modifying it. Alternatively, you can add {{nobots|deny=InternetArchiveBot}} to keep me off the page altogether. I made the following changes:

• Added archive https://web.archive.org/20150414174401/https://www.wp.dh.gov.uk/publications/files/2013/03/CMO-Annual-Report-Volume-2-20111.pdf to https://www.wp.dh.gov.uk/publications/files/2013/03/CMO-Annual-Report-Volume-2-20111.pdf

When you have finished reviewing my changes, please set the —^{cyberbot II}_{Talk to my owner:Online} 08:46, 25 August 2015 (UTC)

Animal use: Claims regarding FDA announcements need editing

The article states “On April 11, 2012 the FDA announced a voluntary program to phase out unsupervised use of drugs as feed additives and convert approved over-the-counter uses for antibiotics to prescription use only, requiring veterinarian supervision of their use and a prescription. In December 2013, the FDA announced the commencement of these steps to phase out the use of antibiotics for the purposes of promoting livestock growth. “ These claims need editing to avoid misleading readers.

The FDA announcement of April 11, 2012, a news release, refers to Guidance for Industry #209 (which was published on April 13, 2012), indicating conversion from OTC to VFD status for drugs administered through feed, and from OTC to prescription status for drugs administered through water. In fact, the scope of Guidance for Industry #209 is more narrow, explicitly focused on medically important antimicrobials. The draft Veterinary Feed Directive document published on April 13, 2012 identifies requirements for VFD status. The third FDA document in the Federal Register of April 13, 2012 uses the term “prescription” only in reference to “prescription or veterinary feed directive products”, and does so only in the context of medically important antimicrobials.

The FDA list of medically important antimicrobials does not include such ionophores as lasalocid and monensin, which are both coccidiostatic and antibiotic. These are active ingredients in some products labeled for use in growth promotion. Also, there is no suggestion in Guidance for Industry #209 that conversion from OTC to prescription use only would apply to all uses of medically important antimicrobials, and the document recognizes that the nature of veterinary involvement in some uses must depend on circumstances. In this connection, see Part VII of the document.Schafhirt (talk) 20:20, 2 September 2015 (UTC)

Text

"The first bacteria resistant to all antibiotics was discovered in China in November 2015, before spreading to Denmark and the UK in December 2015.."

• The first source is poor.
• The BBC does not say all antibiotics just "resists the most common antibiotic of last resort". There are other antibiotics of last resort.
• Third source is not very good.

Would like to see something better. Doc James (talk · contribs · email) 03:38, 22 December 2015 (UTC)

Here is the Lancet study.[4] Basically the resistance has existed for some time but this is just the first time it has been found in a plasmid which makes transfer easier.

It is not clear they are resistant to all antibiotics just that they are resistant to polymyxin antibiotics. Doc James (talk · contribs · email) 03:44, 22 December 2015 (UTC)

This source is better [5] Doc James (talk · contribs · email) 03:54, 22 December 2015 (UTC)

agree (Nature is very good)--Ozzie10aaaa (talk) 15:08, 22 December 2015 (UTC)

References

Where next

doi:10.1016/S1473-3099(15)00466-1 - pipeline review of non-antibiotic antimicrobial treatment. JFW | T@lk 10:47, 27 January 2016 (UTC)

Adding a hyperlink and more information to another topic

As I was reading, in the introductory sentences, it mentions the concept of Horizontal Gene Transfer (HGT) and I think it would be beneficial to link the Wikipedia article about HGT to this article. Although the two topics aren't completely related, HGT isn't described in this article and I found myself looking up what it was anyway. The hyperlink would allow readers to research it as necessary and allow for a better understanding of the introductory paragraphs of this article. Also, I believe that there should be an addition to the subtopic of "Develop New Drugs" to include some of the facts about the role of pharmaceutical companies in treating antimicrobial resistance. These companies aren't creating enough drugs due to the lack of incentive (profit) involved, and I have sources to back this up. I think it's a really important issue for readers to understand about the pharmaceutical industry and it directly correlates to the creation of a treatment for antimicrobial resistance. Mckenzie1818 (talk) 16:52, 18 April 2016 (UTC)

yeah the problems with the lack of financial incentive to develop new anti-infectives are well known; not a big controversial thing, nor secret. The problem of resistance is not driven by lack of new drugs; we need new drugs b/c the existing ones have been poorly used and resistance is becoming more widespread. you have it backwards. Jytdog (talk) 18:31, 18 April 2016 (UTC)

This article has deteriorated greatly through 2016, and the previous lede explained and linked HGT while also being shorter. I will restore once I've gone through the edits properly. CFCF 💌 📧 19:40, 18 April 2016 (UTC)

I'm sorry, I'm not sure I understand your recent edit. Did you just revert all of the last 30 or so edits en masse? Seems like overkill. Looks like most of those edits were minor reference improvements which are helpful to the article and which no one wants to go back through and redo. Wouldn't it be easier to just remove those few sentences/paragraphs you have problems with? It looks like your edit removed a couple of sentences here and there (which looked ready to be trimmed out) and restructured a paragraph in the lede. Could you instead remove those extraneous sentences (see the diffs from your edit) and paste in the lead from a prior revision? Seems like that would have less collateral damage... Thoughts? Ajpolino (talk) 01:43, 19 April 2016 (UTC)

(@CFCF: pinging User:CFCF)

Just a comment: I can't believe what a battleground the lede has been and evidently still is in this article and that it is still rather inadequate.McortNGHH (talk) 13:20, 8 May 2016 (UTC)

Adding recent information/statistics

This article seems to have a lot of great information and is very informative! It does jump around a lot, however, and could use a little organizing for more clear thoughts. I also think a lot of the different subtopics have information lacking. Maybe newer, recent statistics should be added? I found an article regarding a 2016 EU Antimicrobial Resistance Conference that could be very useful with this, especially with data regarding other countries. Under the "Animal Use" European area, the conference explained that a substantial reduction in antibiotic use showed no effect of farmer's profits. This could be useful to explain that "As of 2004, several European countries established a decline of antimicrobial resistance...without jeopardizing economic costs. It also gives a graph explaining these trends. The Strategies topic has a good amount of information, but maybe adding that "Screen and treat" strategies have become cost-efficient in terms of decreasing the number of patients seen a day, because it reduces surgical infections. A couple other ideas that could be started/added after strategies, could be a subtopic for "Challenges" or "Education/Intervention." Challenges, being, what is getting in the way of solving the issue of antimicrobial resistance, and education being how physicians, healthcare, providers, or even the media can have an effect in terms of the education. Again, statistics could be inserted here. The article explains many studies, one being that a 2011 intervention (consisting of hand hygiene, well-informed staff, and separation of infected patients) showed a large decrease in the incidence of a carbabenem resistant microbe, again with more graphs. These are just some ideas!

References

-- Jessicasibal (talk) 00:36, 5 November 2016 (UTC)

Assessment comment

The comment(s) below were originally left at Talk:Antimicrobial resistance/Comments, and are posted here for posterity. Following several discussions in past years, these subpages are now deprecated. The comments may be irrelevant or outdated; if so, please feel free to remove this section.

rated top as important medical problem with considerable media coverage

Substituted at 01:09, 22 May 2016 (UTC)

A "disaster management" section for e.g. alternative ways of treatments such as genome editing

What do you think of adding a "disaster management"-type section that includes info on what might be done when things go bad and microbes actually develop antibiotic resistance? I'm not sure how it should be called but it could include a subsection or at least info on alternative ways of treatment that could be used in such a case such as genome editing/genetic engineering.

For this see e.g.: https://www.geneticliteracyproject.org/2016/08/22/crispr-genome-editing-game-changer-war-antibiotic-resistance/

Of course it should also state that prevention should / is considered to be the highest priority etc.

--Fixuture (talk) 01:43, 27 December 2016 (UTC)

unclear what is being suggested. many kinds of microbes are already resistant to many kinds of antimicrobials; this is a natural process and has gone on for a very long time. There is a more recent problem having to do with misuse of antibiotics but this too is not some future single apocalypse but is already happening in various ways, to various extents, in various places. Jytdog (talk) 06:51, 27 December 2016 (UTC)

@Jytdog: Not sure how to make it clearer. Many sources say that it can become a disaster (and potentially usher in a "post-antibiotic era of medicine") and this section would be about dealing with that. It would also be about alternative ways of treatment which doesn't require it to be a disaster. As said I'm unsure about the name of the section.

--Fixuture (talk) 13:17, 27 December 2016 (UTC)

you wrote "when...microbes actually develop antibiotic resistance?" but they already have and do. you don't seem to understand this subject matter. but whatever. we can only add content about X to WP if there are reliable sources that give sufficient discussion to X. if you would bring some refs that are OK per RS or MEDRS as relevant, about whatever it is that you are suggesting, then we can discuss content based on them. Please bring refs. (the blog is not helpful) thanks Jytdog (talk) 19:06, 27 December 2016 (UTC)

@Jytdog: Alright. Here are some:

• http://www.nytimes.com/2016/09/18/magazine/could-ancient-remedies-hold-the-answer-to-the-looming-antibiotics-crisis.html
• http://www.dw.com/en/plant-magic-scientists-return-to-roots-to-fight-superbugs/a-36559926
• http://www.popsci.com/heres-how-well-fight-superbugs-antibiotic-resistance
• http://phys.org/news/2016-04-fall-antibiotic-age.html
• http://www.bbc.com/future/story/20161010-all-you-need-to-know-about-the-antibiotic-apocalypse

For the usage of genetic engineering:

• http://www.the-scientist.com/?articles.view/articleNo/42992/title/Targeting-Antibiotic-Resistant-Bacteria-with-CRISPR-and-Phages/
• https://news.mit.edu/2014/fighting-drug-resistant-bacteria-0921
• http://www.popsci.com/article/science/editing-genes-superbugs-turn-antibiotic-resistance
• http://www.nature.com/scibx/journal/v7/n41/full/scibx.2014.1198.html
• http://mbio.asm.org/content/5/1/e00928-13.full (?)
• http://arep.med.harvard.edu/pdf/Byrne_MethEnz_ch6_2014.pdf (?)

--Fixuture (talk) 04:45, 29 December 2016 (UTC)

Thanks. The first set of refs - yes, everyone knows that antibiotic resistance is a growing problem, driven mostly by inappropriate use of antibiotics. The second set of refs. You have there the mBio paper which is about killing bacteria with CRISPR, and the chapter from the Harvard people about using CRISPR to edit human stem cells (not relevant, yes). The others with the exception of the SciBx piece, are popular media or press releases (gah) covering one or more of three research papers about using CRISPR delivered via phages to remove resistance plasmids in resistant bacteria. Nothing about disaster preparation. Even the SciBx paper is poor in some ways because it makes it seem like the CRISPR alone killed the bugs, but all it does is sensitize them to the antibiotic. It is good in that it points out how far there is to, to make this anything useful. This is all very early stage and anything we would add would be very WP:CRYSTALBALL. Jytdog (talk) 06:02, 29 December 2016 (UTC)

Alternative names

Super bug (bacteria) redirects to Antimicrobial resistance. I think Superbacteria should also redirect here (at this moment it redirects to Escherichia coli). I suggest mentioning these two alternative names in the article, somewhere, since those words are used frequently. I think that would be helpful for the reader (and for those who search the terms on Google). —  Ark25  (talk) 18:17, 16 January 2017 (UTC)

Bacteriophage

Someone thinks it would be useful to include this paragraph Bacteriophage in the strategies? Assianir (talk) 16:47, 31 January 2017 (UTC)

@Assianir: Better Phage therapy PawełS (talk) 00:53, 17 May 2017 (UTC)

Cochrane review update

I added the conclusion of a new Cochrane review on antibiotic stewardship to the strategies section under prevention. This is an active task on the Cochrane Task Exchange and the WP:Cochrane Collaboration. Conclusions from the review might fit elsewhere on this page. JuanTamad (talk) 01:27, 10 April 2017 (UTC)

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Have you tried...

shaking a dish of bacteria vigerously?

May sound daft but they may not be capable of multiplying before they die? Give your entire body a vigerous shake for an hour and half and over a few days your feel 15 and I'm 43.

May need to build a body shake machine. I do predict a fluorescent pink/?? colour. Paul.g.griffiths (talk) 20:55, 25 July 2017 (UTC)

Tried it. Doesn't make a big difference. Ajpolino (talk) 22:19, 25 July 2017 (UTC)

OK is before me but as writen: The stroke length of both devices c ould be varied at ½”, 1”, and 1 ½” (13, 25 and 38mm) but was left at 1 ” (25mm) except for specific experiments , and the frequency was set at a range from 20-60 rpm , or 0.33 and 1 Hz .

That's somewhere between rocking them to sleep and giving a nice little massage. I'm thinking 6 inches at 4hz, a serious shake. I'm starting to believe the idea of the only thing in the body is you, no so called good gut bateria, and even possibility of white or red blood cells too. Swinging my head hard as possible in a no fashion 100 times many times over an hour and half with as much enertia as possible gave a serious impressive feeling once my brain muscle became hard(try it it's very enoyable, go easy first until muscles go hard and stop going dizzy :) ). Side effect I have a half inch quite special looking skin area of fluorescent pink above eye , even a year later. Also in area of dark patches beneth the eyes. Also idea of vigerous shaking dislodging contaminantes too. Guess Ill have to build one, anyone want to donate me a suitable motor? :) May be OK with my old washing machine motor and large wheel and rod. Fortunatly I can't create a live forever underground group due to turning fluorescent pink. No real disrespect but I thought NASA was hard. I understand cautious but why to bacteria?