RE: Why is Antibiotic Resistance So Hard to Combat?

[atorres]

Hi as someone who has struggled with chronic UTI's and bacterial resistance i really appreciate your post. As a physician do you think alternative treatments can help us with this problem? For example I have been able to manage symptoms though drastic dietary changes and I am also seeing a traditional chinese Herbalist, taking probiotics, drinking kambucha, exercising, taking cranberry pills and plenty of water. I am also taking a drug called methanamine prescribed by my urologist. I know most Western doctors will be against alternative treatments but I personally have decided to stop taking antibiotics, and let my immune system recover. I still don't know if I am bacteria free but I can tell you I feel so much better physically. My symptoms are also at this point vary atypical for a UTI.
My next question is if there is any data about correlation with gender. Could lack of political will be related to the fact that this is a problem affecting mostly women? Are men equally affected by antibiotic resistance? I think this is a very important conversation that we need to start having.
I also think necessary to generate more information about what we can do as patients. At this point I only take antibiotics after a urine culture. I never skip a dose and I avoid alcohol at all costs when taking antibiotics. And yet after a week or so the infection comes back. I think we also need more information about how antibiotics affect our bodies (for example digestive and immune system) in order to find real solutions to this problem.
Again thanks for your post!

Comments

[tfcoates]

Alrighty... let's get going!

First, thanks for the response, it's great when people take the time to get involved! You've raised a lot of valid points, so I'll break it down issue by issue!

• First a disclaimer... I'm not a physician, just a medical student, so two years till I can officially claim the title of Dr and maybe a decade before I finish my training fully!
• With respect to using Complementary and Alternative Medicine (CAM) to treat the symptoms from your UTI's there are a few things to note.

1. You've turned to CAM because modern medicine isn't helping... and that's one of the most common reasons to turn to CAM.
2. Most CAM medicines don't have any negative effects, so there's no harm in taking them, but make sure your doctor and pharmacist know what you're using because some do have medication interactions.
3. With respect to the UTI it's quite an interesting infection... it's super common, can be very painful but generally not a dangerous infection. In most cases, if just left it will clear itself up. The reason it sticks around in so many people is because that in response to the pain when urinating they will stop drinking water, they urinate less and the infection doesn't get 'flushed out'.... so if you're finding benefit from anything you're doing it's probably drinking more water.
4. A good non-medical treatment for UTI is something called Ural... when you've a UTI the bacteria in your urinary tract make the urine more acidic which causes inflammation and pain... Ural doesn't combat the bacteria but it does correct this acidifcation of the urine and turn it alkali. The result is that it's easier to urinate and people flush out the infection easier.
5. Methanamine is an antibiotic, not something I've come across before though.
6. With respect to the comment "I know most Western doctors will be against alternative treatments but" I'm a little confused. Antibiotics don't damage, impact or otherwise suppress the immune system. They're given to clear infections that the immune system has failed to get control of, usually caused by bacteria that are very well adapted to infecting our cells.
7. You'll never be bacterially free... in fact one of the best things to prevent a UTI is the presence of a good native bacteria in the urinary tract to prevent infectious bacteria getting a hold. This is one of the down-sides to antibiotics because they can wipe out this good bacteria too.

• With respect to gender I think the issue is a little more homogenised than you may think. While UTIs are definitely an issue that 99% of the time occurs in women, most other infections where we're worried about antibiotic resistance (pneumonia, sepsis, meningitis etc.) occur equally in both genders. Remember that this is an issue that's more of a problem when the infection is potentially lethal... which in most healthy women is not the case for a UTI. I don't think gender has a large role to play in how seriously we take antibiotic resistance but I know gender has a large role into why women are less likely to be treated for symptoms than men. This is a well-documented problem and something that's being addressed quite a lot in the medical field at the moment.
• With respect to 'generating more information about what we can do as a patient' I think patient education is quite redily available. The problem is there is only so much you can do. Hygiene is #1 for UTIs and beyond this remaining relatively healthy is the best option. Unfortunately, health is not something we can always control 100% and sometimes some people are just more prone to infections, diseases or other issues than other people. There's only so much that can be done and sometimes even if we put all our preventative measures in place, we still don't hold off an infection or disease.
• The final point you raise is "I think we also need more information about how antibiotics affect our bodies (for example digestive and immune system) in order to find real solutions to this problem." and I think it's a little misguided. We have a very good idea of how each of the antibiotic we use works... they're one of our best-understood drugs (compared to anaesthetic agents or anti-psychotics). We understand their structure, their interactions with bacteria, we know which species and classes of bacteria each antibiotic will target. There are mountains and mountains of literature on the pharmacological and microbiological properties of antibiotics and because they're used so often we've a lot of patient data on things like side-effects and adverse events too. It's a common go-to trope that a lot of people use to say "we need to understand this better before we trust it" but in a lot of cases an incorrect one. We understand antibiotics enough that we know they're safe, but also enough that we know when and how they could potentially be risky... we avoid these circumstances and we get great results... antibiotic resistance isn't a problem so much with not properly understanding how our antibiotics work, but with not having any targets left in bacteria which would allow us to discriminately destroy them. With respect to the digestive system and our understanding of the microbiome that lives there... this was an awesome area of research about 10 years ago and it's sort of now just coming in to public attention. Unforunately it's being pushed a lot by people who really don't understand it. For example 'probiotics'... they completely miss the point of 'good gut bacteria'... in fact the probiotics all die in the stomach acid before they reach the gut. We know that the only way to properly affect someone's gut bacteria make-up is to either change their diet radically for a long time (like... 5 years) or to wipe out all their bacteria with antibiotics and do a fecal transplant (literally putting someone elses poo in you). We also know that bacterial species matter less than their individual metabolic functions (because bacteria vary so much even within their species)... so all the over-simplified information about 'good bacteria' and 'bad bacteria' that gets fed to the public is mostly a marketing scheme.
• Finally you've mentioned you've new "atypical" UTI symptoms, I'd advise keeping your GP aware of these. With such a drastic change in treatment approach and lifestyle, as well as all the CAMs you're taking it's always a good idea to have someone keeping an eye on any changes occuring.

Thanks again for commenting and sorry for all the spelling mistakes :P

[atorres]

Wow thank you so much for taking the time to reply point by point. My main takeaway is that hopefully I will not die because of this infection. I still wonder about antibiotics and the effect they've had on my body. I had a doctor prescribe a low dose antibiotic for 2 years and I wonder by the logic of bacterial resistance, eventually the bacteria will become resistant to that antibiotic. But anyway my story is very long and frustrating. I have also had my urethra dilated because apparently I do not empty my bladder fully, but these procedures have not been helpful of getting rid of UTI. I just know whatever I am doing now is working and I keep both my urologist and acupuncturist on the loop of things. But when I tell my urologist about my weird symptoms, like headaches and foggines he just looks at me like I am a crazy person. So I still think we need a more holistic understanding of how the body works, and how for examply wiping out all the bacteria in my body through years of antibiotic treatment may have had an effect on my current situation. But that's just my opinion. I will keep persevering and hopefully one day I'll find the antibiotic that works.
I will ask my urologist about Ural, seems like a great option. And you mentioned this "one of the best things to prevent a UTI is the presence of a good native bacteria in the urinary tract to prevent infectious bacteria getting a hold" how can this be improved? Nutrition? Other ways?

[tfcoates]

he just looks at me like I am a crazy person

This is what I was saying about women getting ignored for some symptoms :( I'm sorry you have to go through this!

2 years low dose antibiotics is a very odd approach... perhaps it had a very narrow spectrum and only affected the infectious bacteria? I wouldn't know but it's a though :P

[atorres]

I don't really know the specifics, that was early on in the process (2012) a doctor at an NYU Urology Center, so I was following orders... that is why now I am more of a rebel and don't trust everything doctors tell me. Ok, I didn't understand that part about women being ignored. Now I totally get it.

[atorres]

Lastly, I know every body is different but I think we need more spaces where we can share succesful treatments for antibiotic resistant infections. I personally have been dealing with this for years, have seen many doctors and, as researcher myself, I have never stopped looking for an answer.

[tfcoates]

Funding!

Haha, yeah I think every doctor wishes they had a designated unit or space to deal with their problem, but funding is such that we have to rely on generalized hospitals, wards and units to face problems that are very specific in nature.

Some hospitals do have specific infectious disease units which deal with antibiotic-resistant systemic infections, and entire deparments dedicated to sharing information and research on the topic... but again due to the problems outlined above we're not making a great amount of progress. For antibiotic resistance there's a dual issue of logistic AND technical barriers we're just not able to surpass at the moment.

[tfcoates]

Give me a bit and I'll respond properly :)