Time for a name change

This bit is well overdue……

Science is a process of investigation. We ask questions, find answers, and expand our knowledge. It never stops. Everything we know is under constant scrutiny and re-examination. Sometimes what we thought was the most likely answer turns out to be incorrect, or needs a slight change.

What am I rambling on about? Well when I set this blog up I named it “Ten2one”. I had intended to eventually write a piece explaining the background to this name. Two years on however, it seems the name is no longer accurate. The blog name was derived from a widely held concept at the time; that the number of human cells in our body are outnumbered by the microbes living in and on us (link here). The number of microbes was thought to be ten times that of human cells, outnumbering us 10 to 1.

As microbiologists, this was great news. The critters we study are top of the pile and we live in a world dominated by the wonderful microbes. This figure however was not widely accepted and after much more counting, the actual ratio of human cells to bacteria cells in the human body has been revised down to a 1:1 ratio (link here). This is a great example of the constant improvement in our knowledge, even in a short amount of time. Science never stops.

While this might seem like a big drop, we are still living our daily lives in the company of an equal number of microbial companions. Still though, the new information means I must change the name of my blog. It wouldn’t be good to stick with such an inaccuracy.

In all honesty, I hadn’t spent too long coming up with the first name. This time maybe I can get some good suggestions from you. Please feel free to drop some suggestions into the comments below and I’ll make a change in the coming weeks.…..

Finish the course?

You go in to the doctor feeling quite unwell. They prescribe you a course of antibiotics and say "Finish the entire course". This message is repeated to you by the pharmacist once you collect your drugs.
Indeed, I say the same thing to my own family and friends when they tell me they have started a course of antibiotics.

But why?

The discovery of penicillin and subsequently several other antibiotics was a landmark in the improvement of human health (nice read). Infections that killed millions could now be treated. The microbes however don't give in that easily. Bacteria evolve readily to changes around them and soon after we started using antibiotics, we started to see bacteria that had resistance to them.

Antibiotic resistance is now listed as one of the key challenges to global health by the United Nations. Regularly we see reports of more and more bacteria resistant to multiple antibiotics. To curb this, we need to better manage the usage of antibiotics (and find new antimicrobials of course).

By not finishing a course of antibiotics, not only do you risk suffering a relapse of the illness but you may also provide the opportunity for the bacteria to develop resistance. This concept is based on the idea that you will not have used enough antibiotic to kill all the bacteria and a small few that had developed resistance to the low dose can now emerge and cause a greater problem.

Is this an accurate assumption though?

An opinion article recently published in The British Medical Journal has stoked the debate on this issue
(Article found here). The authors claim that the notion of finishing a course of antibiotics is not backed by clear evidence from robust trials. Resistance does not seem to emerge as a result of shortened treatment and extended use can do more harm than good. The article however does not actually cover in any depth what this harm may be.

As an alternative to the rule of "finish the course", the authors suggest that instead we could consider a rule of "stop treatment when they feel better". The big problem with this however is that it is very subjective. When we are sick, we can often have periods of temporary respite from the pain for one reason or another. Improvements in how we feel are measured against how bad we have just felt rather than how we used to feel when we were fit and healthy. This means there is a great risk of us stopping antibiotic treatment too early.

Already the scientific and medical community have responded to this article with words of caution (here). Clearly we need to build evidence to back both sides of this debate.

What is important however, is that despite all the news headlines this article is drawing, it is not a definitive answer. It is just a comment on a crucial area of medicine. I worry that headlines like "British exerts discredit 'complete the course' advise on antibiotics" confuse things and suggest there is a new consensus on the issue. Best practice remains to see your antibiotic course out until the end.

If you want to learn more about antibiotic resistance, the World Health Organisation has a nice site here.