Visiting the Sawbones

I have been unwell and might still be. It’s not Covid, it’s something else entirely. So I had to visit the local sawbones office I registered with seven years ago and finally saw an actual doctor for the first time in many years. They look just like us! Except with masks so you can only see the top half of their faces. Perhaps they plan to rob banks someday so don’t want to be too easy to identify.

Right. Here’s a thing on why you should always finish a course of antibiotics, followed by the reason I didn’t this time. Any microbiologists or immunologists or endocrinologists are going to have a sharp intake of breath because this scenario ignores immune system input or any other factors. It’s simplified because I expect few readers here are any kind of biologist and many aren’t even scientists. It’s just the basics.

So you have an infection. Let’s say there are a million bacteria in this infection (if it’s a lively one it’ll be way over a million per millilitre, but we’re playing the simplified game). You want to get rid of it, of course, so you whack it with an antibiotic. We’ll say penicillin.

Now, in that million bacteria there are going to be some who are resistant to penicillin, because they can produce an enzyme called penicillinase that will break it down. Only a few, but they’re in there. Well, producing that enzyme makes them penicillin resistant but not penicillin-proof. You can overload their resistance and still kill them – but remember that penicillin is like bullets. It gets used up as it hits targets. At this stage, if you want to wipe out the lot in one go, you’d have to give a dose that risks killing the patient.

Most are easily killed with the first dose. Maybe 90%. So you’re down to 100,000. You’re still sick and none of the resistant ones have been touched. Your first dose was diluted among a million. They barely noticed it.

Second dose, another 90%. Down to 10,000. All the resistant ones are still there. Untouched.

Third dose, down to 1000. Barely any infection left. You feel fine. Should you stop here? Well maybe one more.

Fourth dose. Down to 100. No symptoms, you feel normal, you don’t want to bother any more with the pills.So you stop.

The infection grows back, but this time it’s composed almost entirely of the penicillin-resistant few because you already killed the susceptible ones. If you had finished the course you’d have wiped out the last 100 by overwhelming their defenses. Instead, you whittled out the weak and selected the strong as your next enemy. Now, penicillin won’t work unless the dose used is likely to kill you too.

Antibiotic resistance is not a new thing. Neither are antibiotics. Antibiotics were discovered, not invented, in the 1930s. The mould Penicillium had been producing antibacterials all along, to kill off competition from bacteria. Probably for many thousands of years, or longer. So had many other microbial species. We just couldn’t see it until we grew things on agar plates and could see the clear zones around the mould and wonder why they were there. People used penicillin for centuries before its discovery, in the use of mouldy bread poultices to stop infection in wounds. They knew it worked, they just didn’t know (and probably didn’t much care) why it worked.

When you consider a population of bacteria, remember we are talking in millions per millilitre. In water, that would only just start to look cloudy. They are not all identical clones, there’s going to be some variation. Normally, the few producing penicillinase are at a disadvantage, they’re wasting metabolism defending against a threat that isn’t there – but when it is there, they are the ‘preppers’ who were laughed at before the apocalypse hit. And if the apocalypse doesn’t manage to kill them all, they are the ones who will grow back and replace the old population.

So you need to finish the course even though you feel better because if you stop the apocalypse and let the preppers grow back, this time the infection is all preppers and your antibiotics will just be shrugged off.

So why didn’t I finish the course this time? The antibiotic they gave me was a bastard. I’d sleep about two hours and then be wide awake for a while, then get tired and go back to sleep for two hours… and so on. I also lost the ability to concentrate on anything, it was like thinking through sand. Then I had a phone call from the surgery that told me I had no infection at all, and they now suspect kidney stones. Could be, it certainly hurt like hell. Put it this way, it’s rare indeed for me to phone the doctors without being forced to do it. And when I do, I get an appointment the same day. They know a call from me is not trivial.

An infection can’t grow back if there wasn’t one there in the first place. If there was, my standard protocol for suspected bladder infection worked and cleared it. Drink lots of water, no booze, limited-to-zero caffeine and absolutely no sugar. All microbes love sugar and if they are growing in you, you really don’t want to feed them. There was still the lower back pain though, so maybe kidney stones are developing in me. I’m at the age where things do start to break after all.

A combination of the bad effects of the treatment, and the knowledge that there was nothing for the treatment to treat, led me to stop the antibiotic course halfway. Now I have given blood samples for a kidney stone check – apparently they can do that now – and will probably have to have a scan to see if there are more lurking. At least the pain has subsided and I don’t pee blood any more. In fact I’ve drunk so much water I’m probably peeing distilled water now.

Maybe I fixed it before the doctors got involved. It wouldn’t be the first time. They hate that, they get annoyed at my usual one-line response to their doomladen sayings.

‘It all grows back’.