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Cystitis battles and AMR: Looking at both sides




For most of my >40-years career as a doctor, the conventional wisdom was that bacterial mutations occurred purely as random events. Nevertheless, AMR could occur, because the Law of Large Numbers indicates a multitude of rare events occur through replication in bacterial populations sufficient to cause infection.


The “pure randomness” dogma was challenged in the last decade by people such as Susan Rosenberg in Texas and others whose research suggested bacteria under antibiotic threat can actively target and accelerate their mutation capabilities. Nevertheless, today, some microbiologists remain skeptical.


Now research published in Front Microbiol. 2024;15:1373344, by Bergum et al (doi: 10.3389/fmicb.2024.1373344), having studied E.coli responses to exposure to DNA-damaging ciprofloxacin, suggests that DNA damage provokes the bacteria into full-throttle damage repair activity, even at the expense of replication, but if that intense activity fails, they will mutate to adapt. Bacteria aren’t bowling pins passively hanging around to be smacked down.


But repair and mutation still take time, although sometimes not much. Antibiotics must hit hard and fast to overwhelm the pathogens before they can adjust to the threat with biofilm secretion or AMR mutations. Protracted battles favour the bacteria.


The oral route of antibiotic administration for treating cystitis seems far too slow to be reliably effective. The symptom relief produced may be mere palliation in many cases and likely accounts for the AMR that we see progressively more on our MSU test reports, because some bacteria survive the Rx assault.


AMR is rising due to great drugs being used more and more by us for the right reasons, but too inefficiently and, consequently, become ineffective.


To my antibiotic steward colleagues: if the right drug is used in the wrong way.

don’t blame “over-prescribing.” We need better treatments.

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