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Use it and lose it: end looms for antibiotics era By Richard
Yallop 12 June 2004
THE death knell for antibiotics was sounded two years ago
during a confidential meeting of senior executives of the
pharmaceutical giant Roche. Even though the Swiss company
had 2 million antibiotic trial compounds in storage, it
was halting all future research because they had no
commercial future.
The company had decided there was no point spending millions
on drugs that doctors were urging should be used less, not
more. The evidence suggested antibiotics generated
resistance in the very germs they were trying to kill.
It was more profitable for companies to concentrate on
growth areas such as anti-depressants and tranquillisers.
Roche's move was a grim portent of the post-antibiotic age
foreshadowed by the most pessimistic US, British and
Australian microbiologists.
Peter Collignon, an infectious diseases specialist at
Canberra hospital and a lecturer at the Australian National
University, is one of the pessimists.
"We are heading for the post-antibiotic age -- though it
won't happen overnight," he said.
"There are already bugs here which don't respond and unless
we change what we do, it will get worse, and more people
will die of infections that are impossible to treat."
John Tapsall, a Sydney microbiologist, recently spent a
year in Switzerland working on the WHO's bacterial
resistance program.
"We do have a chronic problem, and we need chronic
solutions," Dr Tapsall said.
Globally, tuberculosis, one of the world's three big killers
(along with HIV and malaria), has shown alarming resistance
to antibiotics. But the problem of resistance is now coming
dangerously close to home.
A lethal new bacteria called acinetobacter has proved
resistant to all antibiotics in some intensive care units,
and certain types of urinary tract infection no longer
respond to amoxil. In other cases, one germ causing
pneumonia no longer responds to penicillin, and a type of
gonorrhoea can be treated only by injectable antibiotics.
Then there is the enormous problem of hospital-acquired MRSA
(methicillin resistant staphylococcus aureus), which does
not respond to treatment with flucloxacillin, the drug
doctors used for golden staph once the bug developed
resistance to penicillin in the late 1950s.
If you do get MRSA, doctors can ramp up the treatment by
giving intravenous vancomycin, but it is considered less
effective than flucloxacillin.
The danger of resistance, according to specialists contacted
by The Weekend Australian, is not so much that you run out
of alternative antibiotics that will eventually kill the
bacteria (although that can happen in extreme cases): it is
that when a patient with a severe infection enters hospital,
it takes 48 hours to produce a blood culture of the bacteria
and, by the time the resistant strain is identified, and the
right antibiotic prescribed, it may be too late.
This is what happened to the young man who died last August
at Royal Brisbane hospital of community-acquired MRSA.
Clinton West, 21, an Aboriginal artist from Grovely near
Ipswich, was the first person to die of the new "Queensland
strain" of MRSA, which emerged spontaneously in the state's
southeast, with hospital healthcare apparently playing no
part in the outbreak.
Microbiologists say bacterial resistance began the moment
the first synthetic penicillin was prescribed in the
1950s, and grew as the use of antibiotics exploded in the
last 30 years.
Forced to defend themselves against attack, the bacteria
mutated into the most resistant forms. Dr Tapsall says
microbiologists have a saying about antibiotics: "Use it,
and lose it."
There is no one answer, according to Dr Tapsall. Antibiotic
use has to be restricted, with strict guidelines; more
effort has to go into education and disease prevention.