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Gareth Cook

The end of the era of antibiotics

By Gareth Cook
Globe Columnist / July 24, 2011

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IT MAY not be too early to start writing an obituary for the era of antibiotics.

For decades, we have lived in blissful ignorance of the infectious diseases that tormented earlier generations. Just take a pill, or get a shot, and they will go away. But the miracle drugs are starting to fail, even for common diseases - and we have ourselves to blame.

Consider gonorrhea, a nasty sexually transmitted disease which is now heading toward the point of breakout. This month, scientists announced that a Japanese sex worker had a case of the disease that was highly resistant to the antibiotics that are currently the last line of defense. At the same time, the Centers for Disease Control and Prevention reported that gonorrhea in the United States is showing signs of decreased susceptibility to those same final-resort antibiotics.

The CDC, not known for hysteria, stated the danger starkly: “Untreatable gonorrhea may become a reality in the U.S.’’

Gonorrhea is already fairly common in America, with more than 700,000 new infections annually. If untreated in women, it can lead to pelvic inflammatory disease, and even infertility. Men, too, can be left infertile. Gonorrhea can also spread to the blood. It can be fatal.

We can hope for a new medicine, but antibiotic development is not an area of great interest to Big Pharma. And if nobody devises a new treatment regimen in time, then gonorrhea will become super-gonorrhea. The number of cases will explode, and the vicious complications will move from rare to common. A scourge would come roaring back.

How did this happen? The driving forces are Darwin and human carelessness. Bacteria are constantly evolving, adapting to the changing conditions they face. Antibiotics usually kill bacteria. But sometimes a bacteria will develop a biological defense - particularly if too small a dose is used. Gonorrhea bacteria have proven especially adept at developing defenses, for reasons that remain mysterious.

But we have also hastened gonorrhea’s progress, says Dr. Stuart Levy, a professor at the Tufts University School of Medicine and president of the “Alliance for the Prudent Use of Antibiotics.’’ There was a time when penicillin, the original miracle drug, would cure gonorrhea. But it was not used carefully, and eventually, in brothels during the Vietnam war, a resistant strain arose and spread around the globe.

In many parts of the world, antibiotics are available without a prescription, which means that they are widely misused, giving our invisible enemies more chances to develop resistance.

Unfortunately, gonorrhea is not the only microbial enemy gaining on us. E. coli is gathering resistance: witness the disaster in Europe. Tuberculosis is also growing tougher and tougher, and there are terrifying staph infections that cannot be contained.

Antibiotics require a prescription in America, but our nation is still very much a part of the problem. Patients routinely demand these drugs, and doctors acquiesce, for respiratory infections and other ailments that will not respond to antibiotics because they are caused by a virus. We use soap with antimicrobial agents when regular soap does equally well. And we allow farmers to feed antibiotics to livestock in horrifying amounts, not to treat illnesses but to make farming more efficient.

Earlier this summer, I had an experience that changed how I thought about antibiotics. One morning, my son woke up feeling terrible. He had a high fever, an extremely sore throat, and was so tired he had trouble moving around. It turned out that he had strep throat.

The doctor gave him a single shot of antibiotics, and the next morning he woke up almost completely recovered. The fever was gone, and he had his energy back. I could stop worrying. It was a miracle.

Yet there was a time, before the era of antibiotics, when that very same infection could have led to scarlet fever and death. His brother could have caught it and died as well.

Of all the obstacles we face in the fight against antibiotic resistance, the greatest is our own complacency. We take the daily miracles for granted.

Gareth Cook can be reached at cook@globe.com. Follow him on Twitter@garethideas.