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Arsenal of Antibiotics Failing as Resistant Bacteria Develop : Medicine: 'Close calls' getting closer as deadly strains invade and esoteric drugs lose potency. People are dying and more will die.


NEW YORK — The woman's prognosis was grim. She had undergone extensive surgery for blocked arteries and had developed an inexorable infection in a blood vessel deep in her abdomen.

Not a single antibiotic in the nation's arsenal, not even the big gun, vancomycin, could destroy the bacteria ravaging her.

So Dr. Jim Rahal went to the Food and Drug Administration with a plea: He needed the agency's permission to try an antibiotic that had never been used or even tested in the United States. The FDA consented and doctors gave the middle-aged women pristinamycin, a French drug.

She survived. But her story is really only a subplot of a much larger and frightening tale: the beginning of the end of the antibiotic miracle.

"This is just the harbinger of things to come," said Rahal, head of the infectious disease center at the New York Hospital Medical Center of Queens. "There's not a plague upon us as yet. But it's an example of what's likely to happen."

"We've had other close calls," he said, "and they are getting closer and closer."

Since 1942, when the government dispatched a relatively new drug called penicillin to save the burn victims of a nightclub fire in Boston, the world largely has been safe from killer bacteria.

Penicillin and other antibiotics, natural substances found in mold and in soil, saved millions of lives. Bacteria that invaded the body through nasty cuts and infected the blood no longer killed. Pneumonia and tuberculosis, almost certain killers, were vanquished.

In 1979, Surgeon General William Stewart declared that it was time to "close the books on infectious diseases" and concentrate on killers such as cancer.

But in the last decade, a broad resistance to antibiotics has begun to emerge. And because bacteria can transfer genes among themselves, experts only expect the resistance to grow.

The potential nightmare is an Andromeda strain, a super-microbe immune to all antibiotics that could wreak havoc.

Enter the post-antibiotic era, when people could die of infections that once were treatable.

"It's a major crisis because people are dying, and people are going to die in the future," said Dr. Stuart B. Levy of Tufts University and the author of "The Antibiotic Paradox: How Miracle Drugs Are Destroying the Miracle."

"People say, 'Oh, it's a rare event.' But now we know that the rare event is happening again and again."

Making matters worse, no new antibiotics are expected on the market by the end of the century. The pharmaceutical industry listened to Stewart and turned its attention to more profitable drugs.

But not all the blame for the growing resistance can be ascribed to the drug companies. Indiscriminate use of antibiotics also is to blame, and the main culprit is the average person with sniffles.

Many people, at the slightest sign of a cold, demand the drugs--never mind that colds are caused by viruses and antibiotics are useless.

"Patients come in and just demand antibiotics and say, 'If I don't get them, I'll just go elsewhere.' And there will be a doctor who will prescribe it," Levy said.

"Once they have antibiotics in their hands, they act like they're aspirin. This is 50% of the misuse that is leading to resistance."

Resistance occurs when bacteria survive the onslaught of an antibiotic. Doctors say this happens largely when patients do not follow their prescriptions.

A common scenario: A doctor prescribes an antibiotic, to be taken three times a day for 10 days. The dosage is meant to destroy the bacteria entirely. But the patient takes the drug haphazardly, feels better and doesn't finish the prescription, and then saves the drug and takes it later or gives it to a family member who doesn't feel well.

Chances are the bacteria causing the infection have been knocked down, but not out. Those that survive will be resistant, and the patient could pass on the bacteria to others.

Although experts insist that people must begin using antibiotics more judiciously, there is no consensus on what that means. Levy goes so far as to question the common use of tetracycline by teen-agers trying to save their skin from acne.

In his book, he tells the story of a young woman who threw a fit when a doctor refused to give her the antibiotic for a minor case of acne. The doctor insisted she could control the blemishes with the proper diet and skin care. The woman resorted to yelling. He didn't give in, but many doctors do for fear of losing patients.

Chris Foreman, a senior fellow at the Brookings Institution in Washington, is writing a book that looks at this and other emerging medical issues.

An obvious answer to the problem could be restricting the use of antibiotics, but that would be difficult, Foreman said, particularly in the case of livestock.

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