# How bacteria become resistant to antibiotics

> A process map exported from forks.world (https://forks.world). Author: Brian. Source: https://forks.world/p/cmv21nlze0007l206u7zyu86x
> It describes who does what, in what order, and with which technology. Read the plain-language sections first; the JSON at the end is the exact, complete data.

## Summary

- 13 steps across 1 layer
- Persona: Doctor, Patient, Bacteria, Hospital lab

## Pain points

Where this process hurts, worst first:

- **Feels better after a few days and stops early** (How bacteria become resistant to antibiotics; critical): Stopping early leaves the toughest bacteria alive
- **Prescribes a course of antibiotics** (How bacteria become resistant to antibiotics; painful): Many prescriptions are for infections that did not need one

## How to read this file

- A process is made of **layers**. The main layer is the top level; any step of kind `subprocess` opens a detail layer with its own lanes and steps.
- **Lanes** are either persona (people/roles) or technology (systems). Each step belongs to one lane; `using` lists tools a person uses for that step.
- Step kinds: `start`, `task`, `decision` (its arrows carry the answer as a label), `subprocess`, `end`.

## How bacteria become resistant to antibiotics

Lanes:
- Doctor: person / role (id `dr`)
- Patient: person / role (id `pt`)
- Bacteria: person / role (id `bac`)
- Hospital lab: person / role (id `lab`)

Steps, in the order they run:

1. **Gets sick and asks for antibiotics** [start; Patient; id `a1`]
   - then Is it actually bacterial?
2. **Is it actually bacterial?** [decision; Doctor; id `a2`]
   - if "Yes" go to Prescribes a course of antibiotics; if "No" go to Antibiotics will not work on a virus, so rest and fluids
3. **Prescribes a course of antibiotics** [task; Doctor; id `a3`] ⚠ PAIN POINT (painful): Many prescriptions are for infections that did not need one
   - then Feels better after a few days and stops early
4. **Feels better after a few days and stops early** [task; Patient; id `a4`] ⚠ PAIN POINT (critical): Stopping early leaves the toughest bacteria alive
   - then The weak bacteria die, a few with a lucky mutation survive
5. **The weak bacteria die, a few with a lucky mutation survive** [task; Bacteria; id `a5`]
   - then Survivors multiply and pass the resistance on
6. **Survivors multiply and pass the resistance on** [task; Bacteria; id `a6`]
   - then Bacteria swap resistance genes with other species
7. **Bacteria swap resistance genes with other species** [task; Bacteria; id `a7`]
   - then The next infection does not respond to the same drug
8. **The next infection does not respond to the same drug** [task; Patient; id `a8`]
   - then Test which antibiotics still work
9. **Test which antibiotics still work** [task; Hospital lab; id `a9`]
   - then Is there a drug that still works?
10. **Is there a drug that still works?** [decision; Doctor; id `a10`]
   - if "Yes" go to Prescribe a stronger or different antibiotic; if "No" go to A superbug: few or no options left, and the search for new drugs begins
11. **Prescribe a stronger or different antibiotic** [end; Doctor; id `a11`]
12. **A superbug: few or no options left, and the search for new drugs begins** [end; Hospital lab; id `a12`]
13. **Antibiotics will not work on a virus, so rest and fluids** [subprocess; Doctor; id `a2a`], links to the published process "How your immune system fights an infection" (https://forks.world/p/cmv21nlb90002l206rdu6yn55; full text at https://forks.world/api/public/cmv21nlb90002l206rdu6yn55/export)
   - (no next step recorded)

```mermaid
flowchart LR
  subgraph l_dr["Doctor"]
    n_a2{"Is it actually bacterial?"}
    n_a2a[["Antibiotics will not work on a virus, so rest and fluids"]]
    n_a3["Prescribes a course of antibiotics"]
    n_a10{"Is there a drug that still works?"}
    n_a11(["Prescribe a stronger or different antibiotic"])
  end
  subgraph l_pt["Patient"]
    n_a1(["Gets sick and asks for antibiotics"])
    n_a4["Feels better after a few days and stops early"]
    n_a8["The next infection does not respond to the same drug"]
  end
  subgraph l_bac["Bacteria"]
    n_a5["The weak bacteria die, a few with a lucky mutation survive"]
    n_a6["Survivors multiply and pass the resistance on"]
    n_a7["Bacteria swap resistance genes with other species"]
  end
  subgraph l_lab["Hospital lab"]
    n_a9["Test which antibiotics still work"]
    n_a12(["A superbug: few or no options left, and the search for new drugs begins"])
  end
  n_a1 --> n_a2
  n_a2 -->|"Yes"| n_a3
  n_a2 -->|"No"| n_a2a
  n_a3 --> n_a4
  n_a4 --> n_a5
  n_a5 --> n_a6
  n_a6 --> n_a7
  n_a7 --> n_a8
  n_a8 --> n_a9
  n_a9 --> n_a10
  n_a10 -->|"Yes"| n_a11
  n_a10 -->|"No"| n_a12
```

## Full data (JSON)

```json
{
  "title": "How bacteria become resistant to antibiotics",
  "maps": {
    "m_root": {
      "id": "m_root",
      "lanes": [
        {
          "id": "dr",
          "name": "Doctor",
          "type": "person"
        },
        {
          "id": "pt",
          "name": "Patient",
          "type": "person"
        },
        {
          "id": "bac",
          "name": "Bacteria",
          "type": "person"
        },
        {
          "id": "lab",
          "name": "Hospital lab",
          "type": "person"
        }
      ],
      "steps": [
        {
          "id": "a1",
          "kind": "start",
          "lane": "pt",
          "next": [
            {
              "to": "a2"
            }
          ],
          "uses": [],
          "label": "Gets sick and asks for antibiotics"
        },
        {
          "id": "a2",
          "kind": "decision",
          "lane": "dr",
          "next": [
            {
              "to": "a3",
              "label": "Yes"
            },
            {
              "to": "a2a",
              "label": "No"
            }
          ],
          "uses": [],
          "label": "Is it actually bacterial?"
        },
        {
          "id": "a2a",
          "kind": "subprocess",
          "lane": "dr",
          "link": {
            "id": "cmv21nlb90002l206rdu6yn55",
            "scope": "public",
            "title": "How your immune system fights an infection"
          },
          "next": [],
          "uses": [],
          "label": "Antibiotics will not work on a virus, so rest and fluids"
        },
        {
          "id": "a3",
          "kind": "task",
          "lane": "dr",
          "next": [
            {
              "to": "a4"
            }
          ],
          "pain": {
            "note": "Many prescriptions are for infections that did not need one",
            "level": 2
          },
          "uses": [],
          "label": "Prescribes a course of antibiotics"
        },
        {
          "id": "a4",
          "kind": "task",
          "lane": "pt",
          "next": [
            {
              "to": "a5"
            }
          ],
          "pain": {
            "note": "Stopping early leaves the toughest bacteria alive",
            "level": 3
          },
          "uses": [],
          "label": "Feels better after a few days and stops early"
        },
        {
          "id": "a5",
          "kind": "task",
          "lane": "bac",
          "next": [
            {
              "to": "a6"
            }
          ],
          "uses": [],
          "label": "The weak bacteria die, a few with a lucky mutation survive"
        },
        {
          "id": "a6",
          "kind": "task",
          "lane": "bac",
          "next": [
            {
              "to": "a7"
            }
          ],
          "uses": [],
          "label": "Survivors multiply and pass the resistance on"
        },
        {
          "id": "a7",
          "kind": "task",
          "lane": "bac",
          "next": [
            {
              "to": "a8"
            }
          ],
          "uses": [],
          "label": "Bacteria swap resistance genes with other species"
        },
        {
          "id": "a8",
          "kind": "task",
          "lane": "pt",
          "next": [
            {
              "to": "a9"
            }
          ],
          "uses": [],
          "label": "The next infection does not respond to the same drug"
        },
        {
          "id": "a9",
          "kind": "task",
          "lane": "lab",
          "next": [
            {
              "to": "a10"
            }
          ],
          "uses": [],
          "label": "Test which antibiotics still work"
        },
        {
          "id": "a10",
          "kind": "decision",
          "lane": "dr",
          "next": [
            {
              "to": "a11",
              "label": "Yes"
            },
            {
              "to": "a12",
              "label": "No"
            }
          ],
          "uses": [],
          "label": "Is there a drug that still works?"
        },
        {
          "id": "a11",
          "kind": "end",
          "lane": "dr",
          "next": [],
          "uses": [],
          "label": "Prescribe a stronger or different antibiotic"
        },
        {
          "id": "a12",
          "kind": "end",
          "lane": "lab",
          "next": [],
          "uses": [],
          "label": "A superbug: few or no options left, and the search for new drugs begins"
        }
      ],
      "title": "How bacteria become resistant to antibiotics",
      "parent": null
    }
  }
}
```