This article appeared on the front page of today's Washington Post.


Microbes Winning War

By Marc Kaufman
Washington Post Staff Writer
Tuesday , June 13, 2000 ; 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.).



c 2000 The Washington Post Company

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