Healthy Skepticism Library item: 436
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Publication type: news
Yallop R.
Use it and lose it: end looms for antibiotics era
The Australian 2004 Jun 12
Full text:
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.
