- The Washington Times - Monday, June 21, 2004

The war between antibiotics and the bacteria they kill is taking a turn for the worse, says Dr. Ligia Pic-Aluas of the Washington Hospital Center.

Dr. Pic-Aluas, an epidemiologist with the District hospital, echoes the concerns of some in her field that more bacteria are becoming resistant to our best medicines.

These “superbugs” won’t be fooled by the same old antibiotics, in part because for years doctors overprescribed existing antibiotics and, in turn, patients clamored for the drugs even when they weren’t needed.

The U.S. Food and Drug Administration reports that diseases such as gonorrhea, malaria, tuberculosis and childhood ear infections all are becoming harder to treat because of increasing levels of antibiotic resistance.

Doctors often are required to use a potent antibiotic to treat sick patients, when in the past, a mild medication would do. That threatens to make the stronger medication more open to resistance in the future, which one day could rob physicians of a vital weapon against disease.

Doctors already have changed some of their attitudes toward dispensing antibiotics, and patients, too, are beginning to use them more rationally. It still may take some time, however, before the war shifts back to favor science.

The more we use antibiotics, Dr. Pic-Aluas says, the more we “select out the organisms resistant to it. We’ve exacerbated the problem by using more and more antibiotics.”

Part of the problem is that in an increasingly mobile society, bacteria can travel from one coast to the other in the time it takes to fly cross-country.

“Once it shows up in one place, it takes no time for it to show up in another place,” she says.

Dr. Pic-Aluas says researchers once were able to create new antibiotic drugs to counter many resistant bacteria. Today, few new medicines are being counted on to stave off tomorrow’s bacteria. The process, alas, isn’t quick or inexpensive.

“Creating one takes 10 years to bring to the market,” she says. “The problem with antibiotics is they have a short life.”

Worse, she says, drug companies don’t have as much incentive to create them because they require plenty of funding and can be made obsolete, in some cases within a short time frame.

A bacteria like streptococcus, also known as strep, never became resistant to penicillin, the first antibiotic, she says. Staphylococcus, however, became resistant to it in a short period of time and then, one by one, it became resistant to other drugs, so it’s never certain when a bacteria strain will become resistant to a particular drug.

“There’s a lot of genetic change required [for bacteria] to become resistant,” she says.

Plus, a potentially helpful new drug may have side effects that make it impractical to administer.

One of the biggest areas of concern is battling bacteria within the country’s hospital system.

“Lots of procedures are done at a fast pace. It’s difficult to keep up with prescribed infection-control measures,” she says of the hospital setting.

Hospitals more often are placing incoming patients in private rooms until it’s determined they pose no risk of exposure to others, a practice to which European hospitals ascribe, she says.

Antibiotic resistance isn’t a new phenomenon. It started shortly after penicillin enjoyed wide usage for the first time in the late 1940s. Some bacteria naturally develop resistance to antibiotic drugs without human intervention, sometimes by exchanging genes with other bacteria.

Dr. Joseph Mercola, the medical mind behind the health Web site www.mercola.com, says a useful antibiotic can kill up to 99.99 percent of the bacteria in question.

“But due to random genetic mutations, a few develop the ability not to be destroyed. They’re resistant, so to speak,” Dr. Mercola says. That happened with staph, he says, which once didn’t exist in large quantities but does now.

A broader issue with antibiotic resistance, says Dr. Mercola, deals with livestock injected with antibiotics. Some farmers inject their animals not only to stave off potential illnesses, but also to promote growth.

Dr. Mercola and others worry about how the practice could increase the number of resistant bacteria because of overexposure to antibiotics. The FDA says the practice can cause microbes to become resistant to medicines needed to treat human disease.

Some bacteria, such as salmonella, could be transferred to humans as a result, Dr. Mercola says.

Dr. Earl Harley, a pediatric ear, nose and throat specialist at Georgetown University Hospital, strikes a more optimistic note about the fight against antibiotic resistance.

“In the early to mid-‘90s, there was a great deal of overuse,” Dr. Harley says, particularly in his field. “We had a high level of resistance to the common bacteria that causes ear infections.”

At the time, up to 50 percent of bacteria such as streptococcus pneumonia were resistant to the more commonly used antibiotics, such as amoxicillin.

An aggressive awareness campaign has improved the situation.

“We’ve been able to scale back and refine our indications for antibiotics,” he says.

Some parents still haven’t heard the message, he says.

“There are still parents who want an antibiotic,” he says. “You have to talk them down.”

Dr. David Hooper, chief of the infection control unit of Massachusetts General Hospital, says one way physicians are educating patients on the situation is through symptomatic medication prescription pads. When a doctor signs off on a medication, he or she does so on a special pad with educational nuggets patients can take home and read.

Another area where antibiotics tend to be overused is with respiratory tract infections. These conditions often stem from viral illnesses that don’t respond to antibiotics, Dr. Hooper says.

One strain of bacteria physicians are having a hard time dealing with involves a variation of streptococcus that causes skin infections.

“We’ve had resistant strains [of the bacteria] in hospitals and nursing homes,” he says.

Dr. Mercola advises a simple way patients can do their part in the fight against resistant bacteria: Live a healthier lifestyle.

“Develop an intrinsic resistance,” Dr. Mercola says. “Reducing sugar, sleeping well, addressing stress, all have significant impact on the immune system.”

The FDA also recommends that patients not take leftover antibiotics because the medicine may not be appropriate for the current condition, and that they take medicine precisely as instructed by the doctor.

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