Orlando Sentinel | Nov. 26, 2001 | Robyn Suriano
More than a dozen antibiotics are proven killers of bacteria that cause lung infections in people with cystic fibrosis. For a few scary weeks last year, none could help Jerry Remington.
Remington spent a month in an Orlando hospital, receiving several antibiotics intravenously after a laboratory custom-designed a combination that eventually subdued the lung infection.
While Remington fought for every breath, the bacteria fought to keep their hold. His case illustrates the growing problem of antibiotic resistance, or the emergence of particularly tough bacteria that scoff at some of the world's most powerful drugs.
"It was just so frustrating that they didn't have anything to help me get better faster," said Remington, 22, of Edgewater. "I remember I was so sick; it's the worst I've ever been."
Many cystic-fibrosis patients deal with antibiotic resistance. The chronic lung condition makes them vulnerable to repeated bacterial infections and dependent on antibiotics to get better.
But the phenomenon ultimately threatens everyone. Someday, it could be the difference between knocking out a routine sinus infection at home with 10 days' worth of pills or checking into the hospital for lengthy intravenous drug therapy.
"We are seeing dramatic increases in resistance in just about every drug class that we look at," said Dr. Richard Besser from the Centers for Disease Control and Prevention. "We are moving toward the day when ear infections, sinus infections and the like can no longer be treated in an outpatient setting."
ANTIBIOTICS' DARK SIDE
It is the irony of antibiotics that the drugs cure infections while simultaneously creating the potential for future super bacteria.
The trouble starts when someone picks up an infection and legitimately needs antibiotics to clear it up. A small percentage of every infection includes some bacteria that will not succumb to the medication.
Antibiotics will attack the malevolent bacteria, causing most of them to perish but leaving the small group of resistant bugs behind.
These resilient bacteria take advantage of the situation and increase in number once their brethren are gone. They will multiply continually with repeated antibiotic use, although resistance does not work the same from one person to the next.
Someone might take penicillin once for a lung infection and become resistant to it forever. Another might take penicillin repeatedly throughout a lifetime and never develop resistance.
But one thing is certain: Growing use of antibiotics worldwide is undermining their future usefulness for everyone. This was why doctors strongly discouraged people from unnecessarily taking the powerful antibiotic Cipro in the recent spate of anthrax attacks.
Once resistance sets in, doctors must resort to exotic cocktails of several drugs to make any leeway against an infection.
"We've really begun to worry, since the 1980s, how long it will take to run out of antibiotics," said Dr. Jennifer Janelle, an infectious-disease specialist at Shands Hospital in Gainesville.
WHAT CAUSES RESISTANCE?
Several factors are contributing to resistance:
Misuse of antibiotics. The drugs work only against bacterial infections, but many people want antibiotics even if they are suffering from viruses. Moms and dads can be particularly adamant about leaving a pediatrician's office with an antibiotic prescription. Some day-care centers will not allow kids back at school unless they are taking something."Most illnesses that we go to a doctor for are benign and self-limiting. But when people take the time out of their busy schedules to see a doctor, they feel like they want to leave with something. They don't want to hear that it's just something that has to run its course," said Dr. Ira Pinnelas, a physician with Nemours Children's Clinic in Orlando.
Failure to finish a prescription. People usually need to take an antibiotic for seven to 10 days to cure an infection completely. But some people stop taking the drug after a few days when they start to feel better. This contributes to resistance.
Additionally, if the same person comes down with a sore throat in the future, he or she may take the remainder of the drug -- without even knowing whether they have a bacterial infection or whether their former antibiotic is appropriate for the new illness.
Use of antibiotics in animal feed. The drugs have been used in feed for nearly 50 years, both as a way to prevent disease and to promote growth of the animals.
The New England Journal of Medicine recently published two studies that connected antibiotics in animal feed to an increase in drug- resistant strains of bacteria that cause food-borne illnesses.
Doctors say the threat of antibiotic resistance could be reduced if people treated the drugs with respect and restraint. They can be powerful allies when needed, but only if used prudently. The ultimate goal should be to prevent illness to begin with.
"The answer is not to have someone develop a faster, stronger pill," said Dr. Cornelia Franz, an Orlando pediatrician. "The answer is to look at your nutrition, your exercise, your sleep and overall health. The whole point is to prevent illness so we don't have to take medications and worry about the emergence of these super- resistant bugs in the first place."Orlando Sentinel:
