Medical microbiologists and hygiene experts are warning against the excessive use of antibiotics for years now. They observe more and more resistances which have been forced by the constant misuse of antibiotics.

Now, a July 2002 article in the online issue of the journal New Scientist reported that vancomycin – one of the final weapons in the fight against infectious bacteria – lost his power. A strain of Staphylococcus bacteria that is insensitive to vancomycin-treatment was found by medical staff in a hospital in Michigan (USA). Furthermore, VRSA strains (vancomycin-resistant Staphylococcus aureus) already turned up in Japan.

Bacteria are distributing (that should not really be a surprise), and during their travels they are “talking” with each other (if you allow me to call information exchange a talk). Vancomycin-resistant enterococci, bacteria from the gut, are well known already since 15 years. Enterococcus is a low-grade opportunistic pathogen which is completely harmless unless a person has reduced immunity. But scientists already expected to find other species carrying the information for the resistance sooner or later as a result of “talks with colleagues”.

Staphylococcus aureus now is much more of a problem with greater pathogenic potential. The bacteria are common inhabitants of human skin and nose. Under normal conditions the species is a harmless microfloral companion like many others living in and on our body. But when Staphylococcus aureus enters open wounds it is able to cause inflammations up to – sometimes fatal – blood poisoning.

The finding of penicillin by Alexander Fleming in 1928 and the following development of a variety of antibiotics helped to fight these infections as well as a broad range of bacterial diseases that let people around the world suffer till the middle of the past century. The following age of the antibiotics had also been a period where the believe that there is a pill against everything dominated common thinking as well as public health programmes including medical education. But today common antibiotics do not work anymore with many ubiquitous germs – many of them already carrying multi-resistances. For example the methicillin-resistant Staphylococci, an extremely harmful variation who is resistant to all standard penicillin antibiotics. In these cases only glycopeptides like vancomycin have been the last bastion against often deadly infections. Vancomycin has always been known as the antibiotic of last resort. Another bastion that fell now.

If we stay in this military view and language one has to realize that we had a lot of furious and quite successful tactical manoeuvres during the past decades, but the overriding strategy is going into the wrong direction. Latest findings of scientific disciplines like population biology and population genetics need to be much more included. And – as bacteria do not care about national borders – there still is a deep need to improve international standards for medical education. Progressive strategies for the usage of antibiotics must not be under control of national authorities anymore.

The escalation of the bacteriological arms race has been caused by people who should really know it better: doctors. Doctors who are using the antibiotic tool not correctly. To my opinion latest issues of medical microbiology and population biology should be far more integrated in university courses and further education.

Let me give you an example. When I had been in France last Christmas, I got a painful ear infection. I need to explain that I had had an operation some years earlier that left this ear without tympanic membrane, and so every infection is a reason to take care. But I was already used to it, and knew the standard procedures from my ‘doctor in charge’ at home in Germany, that always included a detailed diagnosis of the infecting germ. So, coming back to Christmas in France, I went to a local hospital (quite modern and fashionable, by the way) to see an otologist, an ear specialist. I was surprised! Everything was going very fast. It seemed that this entire diagnosis stuff was not really necessary. I finally left the hospital after 15 minutes with a prescription. Later in the hotel I had a closer view to the drugs I was honoured with. I had three heavy-stuff antibiotics and cortisone in my hands. Someone seemed to think that I was really close to death. And that without any state-of-the-art diagnosis of the causing agent, if it was viral, bacterial or fungal type ¹.

Sorry for my open words, but to my opinion this had been an irresponsible conduct. Not irresponsible regarding the single patient (me in that case), but to a general health situation that finally affects every ‘single patient’ again sooner or later. My wife – who is French by the way (“o la la”) – later told me that this a normal behaviour in France. Many doctors are giving antibiotics for everything, even a simple viral (sic!) cold. And this for sure is not a French problem. Meanwhile I heard similar reports about some German practitioners, who take the easiest way by prescribing pills without any clear diagnosis, too. And in the United States everybody can buy antibiotics on one’s own in a pharmacy without any prescription???

Hey folks, we are not talking about vitamin C or Aspirin! These are drugs that need to be used under strict control and with a certain strategy. These are drugs that are pillars of our health systems. And everybody knows that there is no other group of drugs that are under such a pressure by emerging resistances. I would not waste a thought about some stupid doctors who are not aware what they are doing. But I am deeply concerned about the basic faults in our health systems that lead to misuse along a wide front.

Yes, I am really angry. Meanwhile I have become somehow an extremist targeting medics as well as public health systems … as regards the antibiotics misuse. I am sad about the current situation because if some people would have had just used their brains but their prescription pads we might not need to worry about it today. Just go to any university hospital and ask them for ‘hospital infections’. These people are in the front line. They know the problems we already have. And they have to pay for it.

The Michigan patient infected by the vancomycin-resistant Staphylococcus finally survived after treatment with an “antiquated” antibiotic called chloramphenicol, but – according to doctors – the VRSA’s susceptibility to this drug was fortunate.

We need to change the direction. Now!

¹ I have to note that in past cases it has been always bacterial or fungal, and I am not sure if there is any causative viral agent of the middle ear.

Read more …

• Antimicrobial Use and Antimicrobial Resistance: A Population Perspective, Marc Lipsitch, Matthew H. Samore, Emerging Infectious Diseases 8(4), 2002
• CDC Antimicrobial Resistance and Antibiotic Resistance

Revised version of the article “Superbugs knockin’ on the door”, originally published in August 2002 by Inside-Lifescience, ISSN 1610-0255.