Doctors, researchers frustrated with new strains of bacteria

Dr. Grant Allen looks down the list of children he'll treat in a single day at the Infants' and Children's Clinic in Florence.

On a chilly autumn day on the brink of winter and flu season, he could see as many as 50 or 60 kids, some of whom will need an antibiotic to treat an infection. With that prescription will come the risk, however, that the antibiotic won't be as effective the next time the patient comes in for treatment.

"I might be in the first generation of doctors who have fewer antibiotics to treat their patients when they retire than when they entered the practice," Allen said of the growing number of antibiotic-resistent bacteria.

Antibiotics are the first line of defense for hospitals and physicians when treating bacterial infections, such as sinusitis and ear and urinary tract infections. What health-care experts have realized is that existing antibiotics are losing their effectiveness at an alarming rate, while the development of new antibiotics is declining.

Already, Allen said, the future of useless antibiotics is here.

"Keflex for urinary tract infections is essentially worthless today because it's not effective against MRSA (an antibiotic-resistant form of the staph bacteria)," Allen said. "It was the standard antibiotic for staph and strep, and it took good care of skin infections, too, but today, we don't even think of it."

It took only fours years from the time Keflex came on to the market until it waned in its ability to fight a bacterial infection. When antibiotics first emerged in the health-care marketplace in the 1940s, they were universally hailed as miracle medicines, the superheroes of the pharmacy world when diseases like smallpox, tuberculosis and other infections could destroy a population.

Murkesh Patel, an infectious diseases doctor at the University of Alabama at Birmingham, said the antibiotic crisis we're experiencing in 2008 is the result of a number of things, most specifically overprescribing of the drugs by doctors and inappropriate use by the consumer.

"In the 1970s and '80s, most people just didn't think that drug resistance would be an issue, but MRSA has been around for more than 40 years," he said. "In the late 1980s and '90s, it became a big issue, and it's become unprecedented how important it is to deal with these drug-resistant bacteria. It takes just a few short years for bacteria to become resistant to a drug, but drug development takes many years."

Major pharmaceutical companies, such as Eli Lilly and Co. and Bristol-Myers-Squibb, have closed their antibacterial programs. GlaxoSmithKline has committed to research in this field, but scientists with the company say there are specific challenges to bringing a new class of antibiotics to the market, not the least of which is money. They say it could take an estimated $80 million to $1.7 billion to create and market a new class of drugs.

"So why should they?" said Rich Gatlin, clinical pharmacist at Eliza Coffee Memorial Hospital in Florence. "A lack of research and development has been a big deficiency in the last few years. There's a huge financial incentive to create drugs to care for chronic health problems, but there's very little incentive to create a drug that might be used once in awhile and, even then, for one to two weeks."

Gatlin estimates that a drug ready for testing today would still take between four and five years to get it to health-care providers and in use by the public. And that's if it were fast-tracked. More than a dozen new classes of antibiotics were developed between 1930 and 1970, but only two new classes have been developed since then.

Classes of antibiotics are important. Several different antibiotics can be members of the same class of drugs and used to treat an array of infections. Amoxicillin, for instance, is the pink, bubblegum-flavored medicine in the penicillin class of antibiotics, and is often prescribed for children to treat ear infections.

"A new class (of antibiotics) is like having totally new weapons in your arsenal to fight a bug," Allen said. "When a bug becomes resistant to one drug, it's usually not just to that drug but to the entire class of drugs. So you have to develop a whole new method, or weapon, to fight them off."

But bacteria are smart creatures, Allen said, and can mutate rapidly - so rapidly that doctors are looking for ways to fight infections that had been thought of as under control, such as tuberculosis and hospital-acquired pneumonia.

Compounding the problem are antibiotics given to livestock as preventative medicine that eventually make it into the human food supply in the form of meat products. That also has the potential to reduce the efficiency of the drugs.

Hospitals have a particular interest in antibiotics research and development. Many, including ECM and Helen Keller Hospital in Sheffield, have developed unique ways to deal with the antibiotics they have on hand so bacteria have a harder time becoming resistant to them.

But there are superbugs on the horizon that are virtually untreatable with the medicines available.

Debbie Thompson, infection control coordinator at Keller, keeps an eye on clostridium difficile, or C-diff for short. It's a bad bug, she said, that makes its way into the colon of its victims, sweeping out the good bacteria along with the bad by altering the antibiotics used to treat it.

"We're familiar with MRSA and seeing it in the community, but I'm more afraid of C-diff because we're beginning to see more of it," she said. "The frightening thing is that it's serious in that it can cause the loss of the colon, and it can be life-threatening."

Thompson and Angie Finch, her counterpart at ECM, agree that education and prevention are the keys to keeping these superbugs at bay.

"You're looking at all these different superbugs, and, if they were to get in the right environment where people didn't wash their hands or use hand sanitizers or all the best practices, you could see more problems with them," Finch said. "That's why you'll see these patients we suspect to have these infections admitted to the hospital, put into isolation and get treatment."

Vancomycin is the most powerful weapon in the hospitals' antibiotic arsenal, but it could be only a matter of time before it, too, is useless in treating bacterial infections.

"We haven't seen Vancomycin resistance here, but we know of two in the U.S. who have died of an infection resistant to it," Gatlin said. "But it's inevitable these bacteria will breed resistance."

Michelle Rupe Eubanks can be reached at 740-5745 or michelle.eubanks@TimesDaily.com.