Those Overworked Miracle Drugs

More and more antibiotics are less and less successful

In the 1940s, when penicillin came into wide use, it was seen as the miracle drug to save the world from pneumococcal pneumonia, an infection that then had a mortality rate as high as 85%. But as more and more antibiotics came into use, nature fought back, creating more resistant bacteria. When first used, penicillin was nearly 100% effective against the most prevalent Staphylococci aureus that spread hospital-related infection among patients. Today the drug is far less effective. Both tetracycline and penicillin, once used to cure gonorrhea, now have a failure rate of more than 20% against certain strains. For years a growing body of evidence has suggested that the overuse of antibiotics is helping to make the miracle drugs less effective. Last week a group of 150 doctors and medical scientists from 26 nations issued reports calling for more control.

"In this country antibiotics are prescribed for everything, including ailments such as the common cold," says Dr. Stuart Levy, a professor at Tufts University Medical School in Boston and one of the contributors to the report. Indeed, drug companies promote antibiotics heavily, patients badger doctors for quick cures, and busy physicians sometimes write prescriptions without ordering the costly but appropriate backup tests. Furthermore, some surgeons routinely prescribe antibiotics before operations to prevent the possibility of infection later.

Miracle drugs are even more overworked in Third World countries, because they are often sold over the counter, with out a prescription, even though antibiotics can have toxic side effects. U.S. physicians, for instance, know that Chloramphenicol should be prescribed only for life-threatening infections, since it can cause a breakdown in red blood cells. Physicians in Latin America, however, have been urged by manufacturers to use the drug for such minor ailments as tonsillitis and whooping cough.

In the U.S. the overuse of wonder drugs is caused not only by indiscriminate prescriptions. An astonishing 40% of all the antibiotics used in this country are put into livestock feed to make animals grow fatter. As a result, bacteria resistant to antibiotics are accumulating rapidly in the environment. In 1977 the Food and Drug Administration tried to limit such stock-feed boosters, but under heavy pressure from drug companies, Congress simply ordered more research.

Says Harvard University Professor Walter Gilbert, a Nobel prizewinner in chemistry: "There may be a time down the road when 80% to 90% of infections will be resistant to all known antibiotics."

Before such a disaster strikes, the medical group urges setting international standards for prescription, distribution and advertising. At the third annual National Conference on Antibiotic Review being held this week in Washington, D.C., 300 participants, doctors, nurses and pharmacists, are grappling with practical ways to correct overuse in hospitals. Two possibilities: setting up a review of how antibiotics are used and requiring lab tests to justify renewed prescriptions.

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