Antibiotics Nearly Obsolete

I mentioned this as a comparison in another thread, but the Chron ran an interesting story on how antibiotics are becoming ineffective in treating disease due to disease mutations and overprescribibing by physicians.

I have wondered for a while where the "germ terror" would lead. You can't turn on a TV without seeing an ad for some product that is "anti bacterial." Everyone forgets that there are symbiotic bacteria that live in our bodies and help us to survive. The bacteria that exists in our intestines is extremely important in breaking down waste.

Anyway, good read.

Antibiotics falter; vaccines hold hope
By RICHARD A. MARINI
Copyright 2001 San Antonio Express-News


It the late 1960s, U.S. Surgeon General William Stewart announced that the development of new and powerful antibiotics meant it was time to "close the book" on infectious diseases.

Such medical hubris seems almost criminally negligent today, especially in light of the emergence of drug-resistant microorganisms: bacteria, viruses, fungi and parasites. These threaten to reverse the decades of progress that mankind has made over the diseases they cause.

As the list of drug-resistant microbes continues to grow, a new wave of powerful vaccines, either recently approved or still on the drawing board, someday may make the use of antibiotics obsolete in the treatment of many of these diseases.

Like all living things, microorganisms are genetically programmed to mutate, or change, in response to just the kind of environmental pressures presented by antibiotics and other drugs. The first signs that penicillin was losing its effectiveness became apparent not long after it was introduced in 1941.

In testimony before Congress last year, Dr. Jeffrey P. Koplan, director of the Centers for Disease Control and Prevention in Atlanta, said drug resistance affects virtually all disease-causing pathogens previously considered treatable. Many are resistant to more than one drug.

Scarier still, ancient scourges are making a comeback, including tuberculosis, gonorrhea and malaria.

But if the bugs are only doing what comes naturally, people are helping to hasten the process. The misuse of anti-microbial drugs is perhaps the biggest cause of drug resistance.

For example, antibiotics are effective only against bacteria, yet doctors often are pressured by their patients to prescribe them for viral infections. The American College of Physicians-American Society of Internal Medicine estimates that more than half of the 100 million antibiotics prescribed annually are unnecessary.

Many of the ailments they are intended for, such as bronchitis, sinusitis, sore throat and colds, are best treated with over-the-counter remedies.

Resistance is hastened by the use of antibiotics in agriculture, international travel and consumer products such as anti-bacterial soaps and children's toys impregnated with anti-microbial chemicals.

It should be noted, however, that despite these trends, there is a tendency to overestimate the extent to which drug resistance has spread. Doctors still have drugs in their arsenal capable of curing most infections.

Still, the trend is worrisome, according to Dr. William Hall, chief of the general medicine/geriatrics unit at the University of Rochester School of Medicine and Dentistry.

"Is there an immediate threat?" he said. "No. But the potential is there. If we don't do something now, it'll be the next generation that suffers."

The costs already are being felt. According to the World Health Organization, drug-resistant infections acquired in hospitals kill 14,000 people in the United States each year. And the Office of Technology Assessment pegs the added hospital cost of infections from just six drug-resistant bacteria at $1.3 billion in 1992 dollars, a figure that certainly has increased.

If the situation worsens, it probably will strike unevenly throughout the world. In the United States, for example, there is access to a wide variety of anti-microbial drugs, so germs, ironically, have more opportunities to develop resistance. That's not the case in much of the undeveloped world, where penicillin remains a powerful weapon in the treatment of infectious diseases.

Elsewhere, the situation could become even more dire.

"At least in the United States, antibiotics are available only by prescription," said Dr. John R. La Montagne, deputy director of the National Institute for Allergy and Infectious Disease. "In countries like Mexico and in parts of the Far East, these drugs are sold over the counter. So resistance is an even bigger problem."

It is only recently, however, that researchers have begun looking for new types of anti-microbials.

"There was a period 10 to 20 years ago when there was almost no investigative work into new drugs," said Karl Klose, assistant professor in the department of microbiology at the University of Texas Health Science Center.

That is no longer the case. And in the past few years, several new classes of anti-microbials have been developed.

In April, a Food and Drug Administration Advisory Committee recommended qualified approval of telithromycin, the first in a new class of antibiotics for the treatment of community-acquired pneumonia, a common form of the disease that strikes 4 million Americans annually. Previously, drugs such as erythromycin were used to treat the disease, but the germs that cause it have grown resistant.

Although new drugs such as telithromycin kill in new ways, few experts say they expect the bacteria to remain vulnerable for long.

"There's never been an antibiotic that infectious organisms didn't develop resistance to," Hall said.

In response, science has turned to vaccines to prevent, rather than control, these diseases. Indeed, efforts to create new vaccines represent one of the most active areas of medical research.

"Vaccines are most definitely making a comeback," said Dr. Gregory Poland, a professor of medicine at the Mayo Clinic in Rochester, Minn. "People who grew up in the '50s and '60s who saw little impact of infectious disease are now a lot more aware that they haven't disappeared completely.

"There's a compelling case to be made that with vaccines we're capable of preventing these diseases, rather than simply sitting back and treating them when they appear."

One difficulty in developing a vaccine to fight bacterial infections is in the way a vaccine works. Inoculating the body with a dead or modified portion of a pathogen teaches the body to defend itself against live invaders. But even a healthy body contains billions of bacteria. Many of these, such as those in the intestinal tract that aid in digestion, are vital to proper health. By teaching the body to fight the bad bugs, it might inadvertently attack the good ones, too.

Vaccines recently have been approved for diphtheria, whooping cough, chicken pox and lyme disease. According to Poland, there are no fewer than 300 vaccines in various stages of development. Those closest to completion include immunizations for rotavirus, chlamydia, and the respiratory syncytial virus (RSV), the strain of the human papilloma virus that causes cervical cancer. However, when vaccine researchers say they are close to an answer, they often are still talking five or more years down the road.

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How the hell should I know why God would allow the Holocaust. I don't even know how the electric can opener works. - from Hannah and Her Sisters

 

There was a really interesting story about that very thing on CNN last year. Apparently, modifying the antibiotics doesn't work because the change involves altering their chemical makeup. When they do, it either renders them ineffective or toxic.

Also, the bacteria continues to mutate as the drugs are created. As fast as they can turn out drugs, new diseases crop up.

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How the hell should I know why God would allow the Holocaust. I don't even know how the electric can opener works. - from Hannah and Her Sisters