Antibiotic problem lingers like resistant strain
Greenville News

A healthy medical student involved in a research project feigns being sick and visits 40 physicians. Thirty-seven times he walks out with an antibiotic.

Dozens of studies producing similar results have created a wave of concern. Because with each passing decade, bacteria have found more efficient ways to elude destruction of antibiotics once hailed as magic bullets.

In South Carolina, the bacterium responsible for ear infections and pneumonia has a 35 percent resistance rate to penicillin, a commonly prescribed antibiotic, according to a survey answered by 62 state laboratories.

The national resistance rate to the same drug is 26 percent, Centers for Disease Control and Prevention officials said.

Medical experts said education is the key to keeping germs under control, and South Carolina is one of a handful of states taking a statewide educational approach in an attempt to curb antibiotic misuse, said Dixie Roberts, a nurse epidemiologist with the state Department of Health and Environmental Control.

The South Carolina Careful Antibiotic Use Taskforce, coordinated by DHEC, will have a full-fledged campaign under way by early 2000.

"Bacteria have become much more savvy, and we need to make people aware of the problem," said Dr. Robin Kelley, director of pediatric infectious disease at the Greenville Hospital System's Children's Hospital and a member of the task force.

"We need to educate families to be good consumers and ask, 'Does my child really need this antibiotic?' Some TLC and chicken soup may be the answer."

In communities throughout the state, volunteers will present resistancy data and encourage physicians to be less willing to prescribe antibiotics and patients to be more careful taking them.

"We also want to promote dialogue between patients and physicians," Roberts said.

When patients take antibiotics improperly -- at doses too low or for too short a time to kill all the bacteria -- the drug can only kill the weakest bacteria. The ones strong enough to fight longer survive.

Medical journals have reported the emergence of antibiotic-resistant strains of foodborne bacteria, including salmonella and E. coli. Both cause intestinal infections in humans. Strains of drug-resistant staphylococcus and enterococcus, organisms found in hospitals, also have raised alarms.

"For now, it's a race we are slowly losing," said Dr. Armando Correa, an infectious disease expert at Baylor College of Medicine and Texas Children's Hospital in Houston. "A couple of years ago the problem was confined to hospitalized patients. This problem has now spread into the community."

There are clear geographic differences when it comes to specific forms of resistance, he said.

Rates of resistance for pneumococcus, a respiratory bacteria, are as high as 50 percent in Atlanta and as little as 15 percent in North Carolina, Correa said. He didn't have data on resistance rates in South Carolina.

Those at highest risk for antibiotic resistance are people with compromised immune systems, including organ transplant recipients, cancer patients and HIV-infected patients. Each group grows larger each year.

When antibiotic resistance develops, doctors must prescribe a different antibiotic to fight the infection. And some believe doctors are prescribing too many antibiotics to begin with -- many times for viral infections, which aren't affected by antibiotics.

"Parents feel like because they're paying for a doctor visit they should come out there with a prescription," Correa said. "In this day and age of managed care, sometimes it's easier to write the prescription than to educate the patient."

Dr. Scott Grubbs, of Cornerstone Family Practice in Greenville, said the pressure from patients and parents is high. "People want to get better today, and kids need to get back to day care," he said.

But oftentimes, those prescribed antibiotics will have no effect.

"Most of us are aware that a large percentage of what comes through our doors is viral and will improve on its own," Grubbs said. Some pharmaceutical companies have renewed their research into new antibacterial drugs. Several major companies stopped research in that area in the mid-1980s.

But the cost to consumers is high.

"Right now a pharmacy has to spend more than 4 million dollars in research before bringing an antibiotic to the market," Correa said. "In order to compensate, the new antibiotics are much more expensive."

Scientists are fighting an uphill battle, trying to create new drugs to battle life-threatening illnesses, while more surgery is being performed on an increasing elderly population that is at high risk for infection.

Antibiotic use has soared since the first commercial versions were introduced, said Dr. Stuart Levy, director of the Center for Adaption Genetics and Drug Resistance at Tufts University School of Medicine.

In 1954, 2 million pounds were produced in the United States; today the figure exceeds 50 million pounds.

According to the CDC, a survey done in Atlanta found that from 1981 to 1995, the portion of cases resistant to antibiotics increased from 2 percent to 25 percent.

Antibiotic misuse is a worldwide problem, Levy said. In many countries, a prescription isn't required to buy antibiotics. People crossing national borders take bacteria back and forth, spreading the resistance genes, he said.