Fighting Antibiotic Immunity

The ad shows a tantalizing glimpse of gold inside a treasure chest. No, not a pirate's doubloon: The message is that antibiotics are one of the nation's great treasures and it's everybody's responsibility,  not just doctors', to make sure they keep working.

With more bacteria becoming immune to leading antibiotics, worried federal scientists are preparing new measures to try to save the drugs, ranging from nationwide ad campaigns that will urge patients to do their part to rules that may make it tougher to sell antibiotics for livestock.

"The problem of resistance is here to stay. Our hope is that it becomes a problem that everyone is familiar with, and knows how to take steps to minimize its impact,'' says Dr. J. Todd Weber of the Centers for Disease Control and Prevention.

Antibiotic resistance is basic evolution: Anytime the drugs are used, survivor germs can emerge stronger, and spread. That's why antibiotics are supposed to be used judiciously, picking the best one for each bacterial infection, and not using them against viruses that they cannot fight.

Scientists once thought the best approach to stem resistance was teaching doctors to prescribe more carefully, such as refusing parents' demands for antibiotics that little Johnny's earache doesn't need.

But there are many additional contributors: cross-border supergerms from developing countries where the drugs sell without a prescription; antibiotics given to animals that potentially can pass resistant germs through food; horticulturists who apply them to fruit trees, even wilting orchids. And patients play a big role.

"Every medicine cabinet in this country has leftover antibiotics,'' laments Lester Crawford, the Food and Drug Administration's acting chief.

Taken as prescribed, there should be no leftovers. Yet patients often stop the pills early and then share leftovers with relatives or save them, wrongly, for the next sniffles.

Improper patient use of one antibiotic, Cipro, made headlines during last fall's anthrax attacks, when some people never exposed to the germ used it out of fear, while others who needed it didn't take a full course.

On June 26, the government will hold the first of planned yearly meetings to assess efforts to stem antibiotic resistance.

There's some good news. A new childhood vaccine called Prevnar has not only dramatically cut meningitis and other pneumococcal infections, it also apparently helped nudge down penicillin-resistant cases by blocking their spread. And the number of antibiotic prescriptions doctors wrote during office or clinic visits dropped 24 percent during the 1990s, says a new CDC study that calls the trend encouraging.

But resistance remains a growing problem, and officials are planning new attacks.

Among them:

A big focus on consumers. The FDA's treasure-chest ads, to begin running in newspapers and magazines later this year, will be accompanied by a question-and-answer brochure that doctors can keep in their offices. Additional CDC ads should begin in October.

New labels for antibiotics, being finalized, will remind doctors to prescribe them only against bacterial infections.

FDA is debating how new antibiotics could be tested more efficiently, to encourage now-lagging development of supergerm killers.

And this summer, FDA will issue rules requiring proof that new animal antibiotics won't endanger people by spurring germs immune to human drugs. Manufacturers will have to show how closely related the animal antibiotic is to important human antibiotics, and how quickly germs are likely to mutate.

"It's all one big ecosystem out there of bacteria coming and going between animals and humans,'' noted FDA veterinary chief Stephen Sundlof.

Companies that produce drugs for animals anxiously await the rules, having bitterly fought other FDA efforts to curb resistant food-poisoning germs by restricting animal antibiotics.

The industry argues overuse of human drugs, not animal usage, should be the focus.

Two years ago, FDA banned a poultry antibiotic because of evidence it makes people more vulnerable to drug-resistant campylobacter infections. But the drug, Baytril, still sells as manufacturer Bayer fights the ban, arguing most illnesses aren't caused by tainted grocery-store chicken.

A trial is set for April.

It's a crucial case for FDA, which already is studying whether to ban another poultry drug, virginiamycin, after supermarket chicken was found carrying sometimes fatal germs resistant to a similar human drug called Synercid.