The Antibiotic Resistance Problem Revisited

M

M i c h a e l A . L a ws o n

r. C was a wealthy 49-year-old
Table 1. Examples of Diseases/Pathogens Associated with
Argentine businessman who was generally too busy to
Antibiotic resistance.* see a physician when he felt ill, preferring to treat himself with antibiotics and other drugs he purchased at
Methicillin-Resistant Staphylococcus aureus (MRSA) Gonorrhea his local pharmacy. He experienced intermittent periVancomycin-Insensitive Staphylococcus aureus (VISA) Head lice ods of coughing, fever, and fatigue for several weeks, finally consulting his physician who found small
Vancomycin-Resistant Staphylococcus aureus (VRSA) Malaria bleeds under Mr. C’s skin, and decided to run blood
Vancomycin-Resistant Enterococcus (VRE) Pneumonias tests. The diagnosis was leukemia, and Mr. C sought treatment in Boston. The diagnosis was confirmed, and
Tuberculosis
appropriate treatment for his leukemia and a bacterial
*(CDC, 2006) infection, the source of the high fever, was begun. After
10 days of chemotherapy for the leukemia, no abnor• Shane Matthews, former Chicago Bears starting quarmal cells were seen in his blood. A bone marrow test on Day terback, underwent surgery for a hernia repair in 1999.
17 showed that he had responded to the leukemia treatment
He acquired a methicillin-resistant Staphylococcus and was on his way to remission. However, the Escherichia aureus (MRSA) infection while in the hospital, spendcoli infection responsible for his high fever was proving ing three months in the hospital fighting the infecintractable. Lab results revealed that it was resistant to eight tion. He survived, but lost 30 pounds and much of his different antibiotics, including the newer cephalosporins. strength in the battle. It took him almost two years to
On Day 20 Mr. C lost consciousness due to an intracranial regain his strength (Levy & Fischetti, 2004). bleed, and on Day 22 he died. Autopsy results showed no
• Salmonella typhimurium DT104, has been responsible trace of leukemia, but multiple sites of E. coli infection. His for three major human outbreaks in the U.S. since intestinal tract had become an incubator for the development
1996, all of animal origin. This organism often carof antibiotic resistant organisms, including the E. coli which ries multiple resistance determinants, evidenced by led to his death (Levy, 2002). Mr. C obviously had no difthe Food and Drug Administration’s isolation of one ficulty in simply walking in to a pharmacy and purchasing strain carrying resistance to 12 different antibiotics over-the-counter antibiotics, and most likely received little
(Walters, 2003). guidance as to antibiotic selection and course of treatment. In
• More than two billion of the world’s six billion populahis case, this practice undoubtedly was a significant factor in tion have latent tuberculosis, including 10-15 million his death. Over-the-counter (OTC) availability of antibiotics is
Americans. Eight million active cases are diagnosed a problem in nations other than Argentina. Amabile-Cuevas globally each year. In the tuberculosis epidemic in New
(2003) estimates that approximately 30% of antibiotic purYork City from 1979-92, over one-third of the cases were chases in Mexico City drugstores are OTC, and in the U.S. multi-drug resistant (MDR-TB). The city’s response soldiers often buy antibiotics intended for treating aquarium included local screening programs, Directly Observed fish to save money.
Therapy-Short Term (DOTS) clinics, improved health
E. coli is by no means the only microbe associated with care in city jails, plus quarantine for some patients antibiotic resistance. The Centers for Disease Control and
(only 11 % completed therapy voluntarily) at a total
Prevention list several other diseases and pathogens assocost of over a billion dollars (Markel, 2004). ciated with this public health problem (see