• People who do what I did are contributing to an emerging public health crisis. At its core is the ability of bacteria to develop resistance to antibiotics. Among the millions of bacteria that infected my throat, for example, was a hardy handful slightly better equipped to fight off the effects of a given antibiotic. If only enough medicine is taken to kill the most susceptible germs, the hardy handful may survive to grow a new colony; this new breed of bacteria will be more resistant to the medication. An additional exposure to the antibiotic could kill all but the hardiest of this hardier bunch, producing an even more resistant strain.
• I was a classic antibiotics abuser, by cutting short my treatment and then selfprescribing a second, inadequate dose of the drug. I may have reduced the drug's effectiveness against my strep. If so, anyone who contracted the illness from me would have found ampicillin of little help.
• So far the deadly new TB has been detected mostly in prisons and homeless shelters, which often serve as bacterial breeding grounds, and in AIDS sufferers, who are highly susceptible to infections. But according to some experts, multidrug-resistant TB is a harbinger of a host of currently curable diseases that will become immune to antibiotics if dramatic steps aren't taken to curb medication misuse.
Unit Thirteen
Text A Good Drugs Dangerous DosesA growing threat to public and personal health
• A few years ago, I came down with a vicious case of strep throat, feverish and in pain. I finally went to see my doctor. He prescribed ampicillin, to be taken three times a day for ten days. Feeling much better after only four days, I stopped taking it. When the sore throat recurred a week later, I took the rest of the ampicillin, which again cleared up my symptoms. The days later I was sick again and got a new prescription for ampicillin.
• Explains Joseph: "The realities of a private practice are that you don't have fast access to labs, and you don't want to send a patient away in pain and ask him to call back two days later to see how a culture turned out. So, many doctors just prescribe a broad-spectrum antibiotic." • Meanwhile, drug companies are developing fewer truly new antibiotics. Variations, because their molecular structures and their actions are still similar to the originals, only temporarily fend off the problem of resistance. Unfortunately, it takes little time for the bacteria to develop still hardier strains. • We can't count on variations of existing antibiotics to protect us from resistance over the long term. So, Levy contends, the medical community and the public must mobilize. “If we can whittle down the reckless use of antibiotics," he says, "we may revitalize the older ones and protect the newer ones.”
• Already, several strains of Staphylococcus aureus (or "staph"), which cause blood poisoning and surgicalwound infections, have, over the past decade, become resistant to all but one of the dozen or so antibiotics that were used against them. Penicillin drugs, which cured nearly all bacterial urinary-tract infections several decades ago, are now much less effective against them. And more than five percent of pneumococcus infections, one of the most common causes of pneumonia, are now proving resistant to penicillin and other standard antibiotics. Patients infected with one of these strains may even die, unless given a less conunon and very expensive antibiotic.
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"And doctors misprescribe antibiotics all too often," adds Levy. Many routinely capitulate to patients who demand antibiotics for colds, even though colds are caused by viruses and not bacteria. • Faced with many penicillin-resistant infections, doctors may opt to prescribe a more powerful drug, a broadspectrum antibiotic that mows down many kinds of bacteriaboth helpful and unhelpful ones. According to Dr. Robert R. Joseph of Framingham, Mass., often the more prudent course would be to take a culture of the infection and, based on the results, prescribe a narrow-spectrum antibiotic.But prudent for whom? If you are the one suffering, you would rather be cured as soon as possiblelet other patients worry about the possible resistances that may occur later.
• This process has led to the outbreak of multidrug-resistant tuberculosis, a lifethreatening bacterial disease of the lungs. According to the Centers for Disease Control and Prevention in Atlanta, there were more than 26,000 cases of TB in the United States in 1990s, up 20 percent from 1980s. Until a few years ago, TB was relatively easy to treat with a combination of three antibiotics. Now some patients require up to seven.