Infectious disease specialists are hoping that new attention to the problem will lead to changes that slow the inevitable rise of resistance. The general prescription for controlling the problem includes changes in medical behavior to protect the power of existing anti-microbial weapons, increased research to find new killers for the little infectious killers, and reductions in non-medical uses.
An ounce of prevention
The basic rule is to avoid using antibiotics unnecessarily. Although that's a decision for doctors, patients who implore physicians to treat viral diseases like the common cold with antibiotics are not doing themselves any favors, since antibiotics are worthless against viruses. Presently, there are no national guidelines for using antibiotics.
Says microbiologist Julian Davies of the University of British Columbia, "It's largely left to the physician, who decides whether an antibiotic is given." The American Medical Association has proposed a combination of responses, including education of physicians and patients and more vigorous drug development. But it does not favor national standards on medical practice. Here's how resistance can arise in places where antibiotic usage is uncontrolled.
A pound of cure
Take your meds until the bottle is empty, or however long your doctor specifies. "If you have leftover antibiotic in your medicine chest, you're part of the antibiotic problem," says Barry Kreiswirth, head of the TB program at the Public Health Research Institute in New York City. His reasoning? Many people quit taking the drugs after the symptoms of their infection have disappeared, but some partly-resistant microbes might remain. If you quit taking your meds at that point, you're allowing the partly-resistant organisms to survive and multiply. It's the same dynamic with TB -- but with "tragic consequences," he says.
Be specific
Use the most specific antibiotic possible. Targeted, or "narrow-spectrum," antibiotics will kill the offending bug without sparking resistance among other bacteria living in the patient, as broader-spectrum drugs might. This would call for greater use of susceptibility testing -- exposing colonies of human pathogen to various antibiotics to see which kill the bacteria. (Alarmed that you might be carrying other bacteria? Don't be. The human gut is a veritable zoo of bacteria -- most are helpful, and many are essential for life. In fact, in terms of cells, your own body cells are outnumbered by the bacterial cells you carry, mainly in the gut.)
Be logical
Use the common antibiotics first. If they work, there will be no need to expose the bugs to more exotic drugs, which serve as a second line of defense.
Reduce hospital-transmitted infections
Improve infection control in hospitals. In other words, kill the bugs before they get inside patients. That can be done with ultraviolet lights, better sanitation, and putting patients with recalcitrant infections in isolation wards. One example of how this would work was a recent experiment by Dennis Maki, a University of Wisconsin Hospital specialist in hospital-transmitted infections, who showed that coating intravenous catheters with antiseptic reduced infections by 80 percent.
New drugs
Invent antibiotics that have new mechanisms for killing microbes. Ideally, notes Kreiswirth, two new drugs could be used at once, to slow the development of resistance. The Why Files discussed the evolution of microbial resistance in the context of HIV and AIDS.
Find drugs that improve the action of existing antibiotics.
New vaccines
Invent vaccines against common microbial diseases to prevent infection in the first place. Although vaccines make people immune to specific diseases and eliminate the need for drug treatment, Kreiswirth says they aren't perfect: "People don't take vaccines today," he notes. Many elderly people who could benefit from flu shots don't get them, and "measles spreads like wildfire" among the Amish, who refuse vaccination.
Reduce widespread use
Consider reducing the widespread use of antibiotics in animal feeds. "There are real questions about whether we should be feeding antibiotics to animals and spraying them on fruit trees to prevent rot," says Abigail Salyers, a microbiologist at the University of Illinois. But what seems like a good idea is, she admits, not backed up by much evidence -- either way.
Reality check
Is this reality, or is this overkill? Use a Telecondom "in the operational mode."
Realistically speaking
Indeed, the important infectious diseases are not medical problems so much as social ones, Kreiswirth argues. AIDS, after all, is entirely preventable by changes in behavior. And if you get TB "because the guy next door did a bad job of treating himself," he says, "that's bad luck." But by refusing to take his medicines until it killed the bacterium, "the guy next door has had a failure of personal and social responsibility."
If you've reached this far in the article, it's important to stress that, while we've offered some speculation about the mechanisms that cause antibiotic resistance, the actual problem is not speculation, not theory. According to Kreiswirth, some strains of TB now in New York City and elsewhere are resistant to as many as nine drugs. "We've reached the point where some cases of TB are essentially untreatable."
These measures might go a long way toward preserving the life-giving gift of antibiotics, but most experts figure the bugs will win in the end. It's not just that single-celled organisms have been around since the dawn of life -- more than three billion years back. It's also their huge numbers, their short generation times, and their ability to swap genes that makes them so flexible and dangerous. "There's no ultimate solution to the antibiotic resistance problem," says Davies. "Microbes will always become resistant to agents that are put out to kill them. It's a fact of life. But we, as intelligent people, can slow that down."
More -- much, much more -- information on antibiotic resistance.
