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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Live and let live? Why trying to ‘kill the bug’ is only spurring more antibiotic resistance

Antibiotics have saved many a life, but the resilient, patient microbe remains -- ever evolving resistance to render another drug useless against a spreading infection. As counterintuitive as it sounds, there may be another way.

An intriguing path forward is emerging in a new “damage response” paradigm that seeks less to eradicate pathogens than to mitigate their adverse effects, Brad Spellberg, MD, said recently in San Francisco at the closing session of IDWeek 2013.

“Maybe we should stop focusing on killing the bug,” said Spellberg, a leading antibiotic resistance expert and past president of the Infectious Disease Society of America.

Indeed, the whole image of a “battle” between the bugs and the drugs may be an analogy that is about as exhausted as the concept itself.

“We need to stop viewing our relationship with microbes as a war,” said Spellberg, an infectious disease physician at Harbor-UCLA Medical Center in Los Angeles. “Killing is only going to get us so far. The ideal goal is to achieve peaceful coexistence.”

Given the historical inevitability that antibiotics will always select out resistant strains, Spellberg and other self-described “renegades” in infectious diseases are arguing that it is time to consider alternative approaches that include altering host–microbe interactions in order to modify disease without directly attacking microbes.

In addition to implementing widespread antibiotic stewardship measures to preserve the dwindling efficacy of current drugs, Spellberg urges investment in a promising line of research that suggests bacteria can be “disarmed,” rendered benign without using an eradication approach that inevitably selects out resistant strains. Researchers are also looking into ways to target receptors for host inflammation, then mitigate human immune responses that may actually worsen disease. Another tactic is to suppress host nutrients to “starve” microbes or to use probiotics and other beneficial microbes to keep pathogens at bay.

For more on this story see the November issue of Hospital Infection Control & Prevention.