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Microbes winning war { June 13 2000 }

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Microbes Winning War
Resistance to Antibiotics Raises Disease Peril, Agency Says

By Marc Kaufman
Washington Post Staff Writer
Tuesday, June 13, 2000; Page A01

Microbes that cause diseases ranging from sore throats and pneumonia to malaria and AIDS are mutating at an alarming rate around the globe into much more dangerous infections that fail to respond to drugs, the World Health Organization warned yesterday.

If the current pattern continues, the world could be plunged back into the "preantibiotic era" when people commonly died from diseases that in modern times have been easily treated with antibiotics and other drugs, the WHO concluded in its first major report on the issue.

"The world may only have a decade or two to make optimal use of many of the medicines presently available to stop infectious diseases," said David Heymann, executive director of the WHO's communicable disease program. "We are literally in a race against time to bring levels of infectious disease down worldwide, before the disease wears the drugs down first."

Drug resistance is spreading mainly due to overuse of antibiotics in wealthy nations, incomplete and under-use of medications (and especially "counterfeit" drugs) in poor nations, and the widespread practice of feeding livestock low levels of antibiotics to promote growth, the report concluded.

The WHO called on doctors in developed nations to sharply reduce their prescribing of antibiotics, which the agency estimates are necessary only half of the times they are used. It also recommended a major international effort to bring more anti-infection medications to poor nations.

Public health experts around the world have been concerned about the rise of resistant microbes for years. The report from the WHO, an affiliate of the United Nations based in Geneva, is the most comprehensive--and perhaps the most alarming--account to date.

The ability of bacteria, viruses and parasites to become resistant to drugs is a naturally occurring phenomenon involving mutation and survival of the fittest microbes. It becomes a problem only when disease-causing organisms develop the ability to fight off otherwise disease-curing drugs. These resistant organisms develop and grow stronger when medications are only partially used (as with antibiotics in the poorer nations) and when they are used even when they are not needed (as in the United States).

Because the pharmaceutical industry developed so many effective antibiotics in the post-World War II era, many believed the need for more had declined and most drug companies lost interest in researching more. As a result, Heymann said, "Currently, there are no new drugs or vaccines ready to quickly emerge from the research and development pipeline."

The WHO report described numerous examples of serious health consequences of drug resistance, including:

* In the United States, an estimated 14,000 people die each year from drug-resistant microbes that infect them in hospitals.

* A decade ago in India, typhoid could be cured with the use of three inexpensive drugs. Today, those drugs are largely ineffective against the life-threatening disease.

* In Eastern Europe and parts of Russia, more than 10 percent of tuberculosis patients have strains resistant to the two most powerful antibiotics.

* In much of Southeast Asia, 98 percent of gonorrhea strains are resistant to penicillin--which had been the first-line treatment for decades.

Jeffrey Koplan, director of the U.S. Centers for Disease Control and Prevention, was also present today to unveil the WHO report, and he said the WHO and CDC "are at one on this issue."

He also voiced more optimism, however, that drug companies will be able to produce effective new antibiotics soon, and that antibiotic usage rates in the United States can be reduced. After an intensive campaign to limit antibiotic use in Canada several years ago, prescribing rates dropped dramatically.

The president-elect of the American Medical Association, Randolph D. Smoak Jr., said yesterday that he supported the WHO conclusions, and that his organization will be formally considering guidelines later this week encouraging doctors to better educate their patients and themselves about the dangers of antimicrobial resistance.

But he also said the problem of antibiotic overuse in particular will be difficult to solve. "When physicians are pushed and pressed to see patients more rapidly, it's a great temptation to just write an antibiotic prescription rather than to spend five minutes explaining to that mother why not it might be better in the long term not to prescribe it," he said.

The WHO also recommended that antibiotics used to treat humans not be fed as growth promoters for animals. The European Union already has banned the animal use of several antibiotics, but the U.S. Food and Drug Administration has proposed a more limited program of heightening surveillance and testing of antibiotic resistance in animals. The agency has been under pressure from livestock and pharmaceutical companies not to tighten animal drug restrictions.

The House International Affairs Committee announced yesterday that it would hold a hearing on June 29 to examine the threat to American security and health posed by infectious diseases. "The world is a smaller place and no country, including the United States, is safe from diseases which are able to traverse the globe in a matter of week," said committee member Rep. Sam Gejdenson (D-Conn.).

2000 The Washington Post Company

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