Towards Solving the Problem
Antibiotic resistance is inevitable, say scientists, but there are measures we can take to slow it.
Efforts are under way on several fronts--improving infection control, developing new antibiotics, and
using drugs more appropriately.
Barbara E. Murray, M.D., of the University of Texas Medical School at Houston writes in the April 28, 1994,
New England Journal of Medicine that simple improvements in public health measures can go a long way
towards preventing infection. Such approaches include more frequent hand washing by health-care workers,
quick identification and isolation of patients with drug-resistant infections, and improving sewage systems
and water purity in developing nations.
Drug manufacturers are once again becoming interested in developing new antibiotics. These efforts have been
spurred both by the appearance of new bacterial illnesses, such as Lyme disease and Legionnaire's disease,
and resurgences of old foes, such as tuberculosis, due to drug resistance.
FDA is doing all it can to speed development and availability of new antibiotic drugs. "We can't identify new
agents--that's the job of the pharmaceutical industry. But once they have identified a promising new drug for
resistant infections, what we can do is to meet with the company very early and help design the development
plan and clinical trials," says Blum.
In addition, drugs in development can be used for patients with multi-drug-resistant infections on an "emergency
IND (compassionate use)" basis, if the physician requests this of FDA, Blum adds. This is done for people with
AIDS or cancer, for example.
No one really has a good idea of the extent of antibiotic resistance, because it hasn't been monitored in a
coordinated fashion. "Each hospital monitors its own resistance, but there is no good national system to test for
antibiotic resistance," says Blum.
This may soon change. CDC is encouraging local health officials to track resistance data, and the World Health
Organization has initiated a global computer database for physicians to report outbreaks of drug-resistant bacterial
infections.
Experts agree that antibiotics should be restricted to patients who can truly benefit from them--that is, people
with bacterial infections. Already this is being done in the hospital setting, where the routine use of antibiotics
to prevent infection in certain surgical patients is being reexamined.
"We have known since way back in the antibiotic era that these drugs have been used inappropriately in surgical
prophylaxis [preventing infections in surgical patients]. But there is more success [in limiting antibiotic use]
in hospital settings, where guidelines are established, than in the more typical outpatient settings," says Cranston.
Murray points out an example of antibiotic prophylaxis in the outpatient setting--children with recurrent ear
infections given extended antibiotic prescriptions to prevent future infections. (See "Protecting Little Pitchers'
Ears" in the December 1994 FDA Consumer.)
Another problem with antibiotic use is that patients often stop taking the drug too soon, because symptoms improve.
However, this merely encourages resistant microbes to proliferate. The infection returns a few weeks later, and this
time a different drug must be used to treat it.
The Greatest Fear...
|
