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Monday, August 13, 2012

Are we losing the war against bacteria?

Antibiotics came to the forefront during World War II when sulfa and penicillin saved many lives and limbs. Over the next 50 years an antibiotic was identified for nearly every bacterial scourge of humankind from strep throat to tuberculosis, but then a not-so-funny thing happened: drug resistance.

The Atlantic just published a chilling account of drug-resistant Gonorrhea, but it's not a new topic. Methicillin-resistant Staphylococcus aureus, or MRSA, is being superseded as the medical community's nightmare by vancomycin intermediate-resistant Staphylococcus aureus, or VISA. Vancomycin lasted a long time as a silver bullet or "drug of last resort" because it is administered I.V. and therefore isn't as susceptible to indiscriminate misuse as its predecessors. Nevertheless, the success of bacteria in evolving resistance is remarkable.

Is production of new antibiotics keeping pace with the emergence of drug-resistant germs? I read conflicting information about that. Some argue that drug companies have cut back on research for new antibiotics because more profitable targets exist for R&D. On the other hand, new antibiotics have been brought to market. Examples are linezolid (trade name Zyvox) and daptomycin (trade name Cubicin). They work -- for now, at least -- but they are also patent-protected and consequently quite expensive. Suppliers respond that prices of these drugs are lower than the costs of prolonged and often unsuccessful attempts to treat infections with older antibiotics. The marketing-minded reader will recognize this as pricing on the basis of value rather than on the basis of competition or the basis of cost. Such a pricing argument in the context of human lives is more acceptable in capitalistic-leaning countries like the USA than in socialist-leaning countries who see it as profiting from the misfortunes of others. The irony of an expensive antibiotic is that it's less likely to be overused and therefore to lose its efficacy anytime soon.

We all have a stake in the ongoing race between researcher and germ. I hope the researchers continue to stay ahead. As we saw with SARS -- even though it was viral, not bacterial -- the mechanisms of global and national commerce can quickly be disrupted by an epidemic or even a perceived one.