When penicillin became widely available during the second world war, it was a medical miracle, rapidly
vanquishing the biggest wartime killer--infected wounds. Discovered initially by a French medical student,
Ernest Duchesne, in 1896, and then rediscovered by Scottish physician Alexander Fleming in 1928, the
product of the soil mold Penicillium crippled many types of disease-causing bacteria. But just four years
after drug companies began mass-producing penicillin in 1943, microbes began appearing that could resist it.
The first bug to battle penicillin was Staphylococcus aureus. This bacterium is often a harmless passenger
in the human body, but it can cause illness, such as pneumonia or toxic shock syndrome, when it overgrows
or produces a toxin.
In 1967, another type of penicillin-resistant pneumonia, caused by Streptococcus pneumoniae and called
pneumococcus, surfaced in a remote village in Papua New Guinea. At about the same time, American military
personnel in southeast Asia were acquiring penicillin-resistant gonorrhea from prostitutes. By 1976, when the
soldiers had come home, they brought the new strain of gonorrhea with them, and physicians had to find new
drugs to treat it. In 1983, a hospital-acquired intestinal infection caused by the bacterium Enterococcus
faecium joined the list of bugs that outwit penicillin.
Antibiotic resistance spreads fast. Between 1979 and 1987, for example, only 0.02 percent of pneumococcus
strains infecting a large number of patients surveyed by the national Centers for Disease Control and
Prevention were penicillin-resistant. CDC's survey included 13 hospitals in 12 states. Today, 6.6 percent of
pneumococcus strains are resistant, according to a report in the June 15, 1994, Journal of the American Medical
Association by Robert F. Breiman, M.D., and colleagues at CDC. The agency also reports that in 1992, 13,300
hospital patients died of bacterial infections that were resistant to antibiotic treatment.
Why has this happened?
"There was complacency in the 1980s. The perception was that we had licked the bacterial infection problem.
Drug companies weren't working on new agents. They were concentrating on other areas, such as viral infections,"
says Michael Blum, M.D., medical officer in the Food and Drug Administration's division of anti-infective drug
products. "In the meantime, resistance increased to a number of commonly used antibiotics, possibly related to
overuse of antibiotics. In the 1990s, we've come to a point for certain infections that we don't have agents
available."
According to a report in the April 28, 1994, New England Journal of Medicine, researchers have identified
bacteria in patient samples that resist all currently available antibiotic drugs.
Survival of the fittest...
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