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Commentary : Will We Win the Fight Against the Superbugs? : Health: More research, funding and consumer awareness are needed to beat resistance to antibiotics.

September 05, 1999|RICHARD P. WENZEL | Richard P. Wenzel is chairman of the department of internal medicine at Virginia Commonwealth University, Richmond, Va

The antibiotic era heralded by penicillin, streptomycin and sulfonamides is barely 60 years old yet is threatened with extinction unless we act quickly and wisely. The epicenter of the problem is found in our nation's hospitals, where 5% to 10% of the most seriously ill patients will develop a hospital-acquired infection caused--70% of the time--by an antibiotic-resistant bacterium.

Antibiotic resistance will contribute to the more than 100,000 deaths each year related to hospital-acquired infections in the United States. Equally worrisome is a recent report of more than 200 people becoming sick and four children dying over the course of two years in the Midwest from a drug-resistant germ usually confined to hospitals. The Centers for Disease Control and Prevention are taking a very close look at these and other similar cases because they appear to indicate that resistance is spreading from hospitals into our communitiies. If we do not stop the increase in hospital-acquired antibiotic resistance, our cities and towns may be more vulnerable than ever to deadly infection-causing bacteria.

For decades, medical experts have underestimated the versatility of microbes, which are capable of activating a set of genes and thereby creating resistance in hours or days. By comparison, it takes more than seven years to develop a new antibiotic.

Thirty years ago, the U.S. surgeon general thought we had closed the book on infections with the use of penicillin and other antibiotics that easily treated once-fatal conditions like strep throat or staph skin infections. However, from 1980 to 1992, the death rate from infectious diseases rose nearly 60%, and they remain the third-leading cause of death in the United States.

Even outside the hospital, antibiotic resistance is a problem. An increasing number of the 500,000 cases of pneumonia diagnosed each year are resistant to one or more antibiotics.

So how will we respond to the superbugs?

While many pharmaceutical manufacturers believed that "the book was closed" on infectious diseases and had moved on to invest in more pressing health concerns, some companies maintained an interest in antibiotic research. Those companies have submitted or have plans to submit new drugs to the U.S. Food and Drug Administration for approval--drugs that are needed now.

Next, we need to identify better surveillance and reporting. Hospitals should be encouraged to identify and report antibiotic resistance cases. Sharing case information among doctors and hospitals throughout the country will help physicians choose the best drugs to treat specific bacterial infections. Information for tracking disease trends and drug-resistance patterns should be shared at all levels with medical and public health officials. Admittedly, this is a huge undertaking that may require more hospital personnel and testing equipment, but the long-term benefits surely outweigh the short-term investment.

Physicians and patients alike contribute to misuse, overuse and abuse of antibiotics. According to the Centers for Disease Control and Prevention, about a third of the 150 million prescriptions for antibiotics written in the United States each year are unnecessarily prescribed for viral ailments, like colds, which do not react to antibiotics. A contributing factor is that patients frequently ask their doctors to write these prescriptions, "just in case" they have a bacterial infection.

Then there are patients who frequently ignore the label instruction on antibiotics and stop taking the drug as soon as they feel better, unaware that a full course of treatment is required to help fend off not only recurrent infection but also the development of antibiotic resistance.

Funding for independent researchers through agencies such as the National Institute of Allergy and Infectious Diseases also is imperative. In the past 30 years, we have learned that medical science may never conquer the remarkable ability of bacteria to resist our best treatments, but continued research and development will help in preventing and resisting such infections.

A misstep in the race between man and microbe could land us back in the pre-antibiotic era, erase the medical progress of the past several decades and cause hundreds of thousands of unnecessary deaths each year. Federal policy, national education programs and research and development may not ultimately destroy the superbugs but will make it possible for us to continue to improve the quality of life.

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