He said patients are in a post antibiotic age, and microbes are. If the microbes are, then the infections created by those microbes are (both fall into the category of microbes being in a post antibiotic age). Yes, patients who are infected by a microbe which is resistant may well die - because the microbe is post antibiotic. Yes - everyone should be extremely cautious using antibiotics, particularly vancomycin. I am not one to push careless or unnecessary use of antibiotics. I recently insisted my doctor use a cephalosporin during surgery when he had ordered vancomycin. I am allergic to penicillin, and there is some cross-reaction with cephalosporins - so it was appropriate for him to be cautious. But not every patient has the cross reaction, and I am one who does not - so vancomycin was not the appropriate medication for me to be using.
So - I am well aware of the concerns of antibiotic resistance, and more insistent than most on appropriate and limited use of antibiotics. But, on the flip side, I am equally critical of the careless use of the suggestion that patients become resistant. It is only microbes (and the specific infections they cause) which are in a post antibiotic age not patients as a whole. This is a critical distinction. A patient who is infected with a non-resistant microbe can still be treated with the most appropriate antibiotic - even if they have previously been infected or colonized with a microbe which is resistant to that same antibiotic.
My daughter has a disease for which this distinction matters, because the myth of patients becoming resistant (making the antibiotic unavailable to treat them for any condition - even those not caused by resistant strains) is currently playing a significant role in discouraging patients from enrolling patients in clinical trials. Vancomycin has been shown in initial small trials (fewer than 100 individuals) to be correlated with disease remission in a statistically significant number of patients (100% of children & around 30% of adults) - even when the disease has progressed enough for patients to have been listed for transplant. Remission has been maintained, in the earliest patients in the trials, for as much as 16 years - unheard of in this disease for which there is currently no medical treatment and a median time from diagnosis to death or transplant of around 18 years. And, while not risk free, the protocol is designed to minimize the risk of creating vancomycin resistance.
But resistance to these trials among patient advocates and some doctors is strong, in part because of the myth that the patients might become resistant, and then vancomycin could not be used to treat other infections which are common with this disease (infections not typically caused by vancomycin resistant microbes)
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