Synercid

At 21, Amanda Marie May's biggest dilemma was whether to pursue a career on stage or screen. Then, last year, the actress-singer-dancer got a sore throat--inconvenient, but no crisis to the otherwise healthy Amanda.

But her acting classmates and family were shocked when she was hospitalized days later. Fusobacterium--germs that normally live harmlessly in the mouth and intestines--had invaded her bloodstream, causing her lungs to collapse and, soon afterward, a heart attack.

Doctors inserted a breathing tube, which allowed Pseudomonas bacteria to infiltrate her lungs. (Pseudomonas can cause hospital-acquired infections, with victims including individuals on respirators or with indwelling catheters, burn patients, and immunocompromised people.) The super-bug resisted all antibiotics in the hospital's arsenal.

Amanda died.

Such unexpected deaths have become frighteningly more common as germs appear to be gaining the upper hand in the fierce battle against antibiotics--quite a reversal of fortune from the late 1940s. Back then, people believed science had struck a blow against infectious diseases. Antibiotics were vanquishing tuberculosis and other life-threatening bacterial diseases. But in the 1950s, penicillin began to lose its power to cure infections caused by Staphylococcus aureus, a common bacteria found on the skin that can cause a range of problems, including stitch abscesses, pneumonia, meningitis, endocarditis, and sepsis. By the early 1990s, health experts no longer believed that infectious diseases were declining.

Today, drug-resistant bacteria strike with alarming results. They account for three of five hospital-acquired infections, affecting nearly 2 million Americans. Preferred antibiotic drugs used for years are now outgunned by certain strains of Mycobacterium tuberculosis, Enterococcus (which can be pathogenic in certain circumstances and cause urinary tract infections, wound infections, and endocarditis), Staphylococcus aureus, Pseudomonas, and Acinetobacter (linked with hospital-acquired infections, such as pneumonia, meningitis, and skin and wound infections). In addition, three of the most common antimalarial drugs are useless in Thailand and parts of Cambodia.

Germs can reproduce every half-hour. "When you hit bacteria with antibiotics, particularly at low doses, their response often is not to die but to become resistant," says Jerome Schentag, Pharm. D., pharmacy professor at State University. of New York at Buffalo. "One resistance leads to another."

Scientists have stepped up development of new antibiotics. But the math is not on their side. It takes at least 10 years, and hundreds of millions of dollars, to create a new antibiotic. Two new ones (Synercid and Zyvox) debuted in the past year; however, no others are on the near horizon.

So what can you do while waiting for future pharmaceutical warriors? Be conservative about taking antibiotics and arm yourself against lethal bugs. Here's how.

Don't demand or expect antibiotics. They offer no benefits in treating colds and other viral infections, the cause of 80 percent of all fevers and inflammations. Viruses, not bacteria, cause colds and flu.

As much as half of all antibiotics are prescribed wrongly, despite recent efforts to educate doctors and patients, according to the Institute of Medicine. "The overuse of antibiotics is the driving force of bacteria to become resistant," says David Bell, M.D., antimicrobial resistance coordinator at the Centers for Disease Control and Prevention (CDC) in Atlanta.

Neither you nor your child needs an antibiotic for green or thick nasal mucus, a normal progression of a cold, for which antibiotics are of no use. Just because you have a few days of fever or two weeks of a sore throat or cough does not mean you've got anything more than a cold.

"There are clear guidelines when to treat for sinusitis: tenderness over the sinuses around the nose or above on the forehead. If all you have is a snotty nose, there is no need to treat it for at least 10 days because it's probably the common cold and it is going to get better," says Jon Abramson, M.D., who is chair of pediatrics at Wake Forest University School of Medicine in Winston-Salem, North Carolina.

Similarly, avoid antibiotics for a sore throat, unless a culture or rapid strep test reveals strep throat. Monitor your symptoms. If they get worse or last longer than the doctor warned, contact him or her. for further treatment.

Proceed slowly and cautiously. "If you had an antibiotic recently, you're three to nine times more likely to have a resistant infection than someone who has not had an antibiotic," says Richard Besser, M.D., medical epidemiologist and pediatrician at the CDC's Respiratory Diseases Branch in Adanta.

The message gradually is getting out: An annual survey of 2,500 doctors conducted by the CDC's National Center for Health Statistics showed that the antibiotic prescription rate dropped 12 percent from 1989-90 to 1997-98 for children under the age of 15 brought to a doctor's office because of an earache, bronchitis, sore throat, sinus infection, or upper respiratory infection, many of which are viral in origin.

Don't consider antibiotics an automatic response to ear infections. If your doctor urges painkillers and watchful waiting for a day or two, follow his or her advice. And, once again, if your child appears to get noticeably worse, be sure to contact the doctor immediately.

Finish the full course of antibiotics, even if you feel better. Otherwise, you may leave behind the most virulent organisms to continue to grow and breed. Never share antibiotics or hoard them for another time or take "preventive" low doses, all of which spur resistance, explains Smart Levy, M.D., who is director of the Center for Adaptation Genetics and Drug Resistance at Tufts University in Boston.

Stick to the small guns. "The more often a drug is used, the more likely bacteria are to develop resistance to it," says Scott Fridkin, M.D., medical epidemiologist for hospital infections at the CDC. So you're best off using the antibiotic with the smallest group of bacteria affected--one for a particular illness.

Consider vancomycin, as well as the new big guns, Zyvox and Synercid, as the last resort. Zyvox (linezolid) debuted last April to treat hospital-acquired infections, pneumonia, and infections of soft tissue and skin that are resistant to current antibiotics.

Synercid (quinupristin/dalfopristin) is an intravenously administered antibiotic. Though it arrived on the market in late 1999, it's already viewed as one of the few drugs effective against the vancomycin-resistant Enterococcus and vancomycin-resistant Staphylococcus.

Don't overarm yourself with antibacterial scrubs, soaps, mouthwashes, and toys. Certain antimicrobials--triclosan, triclocarban, and chlorhexidine--may kill some bacteria strains, but they also can strengthen the survivors. "These products should be reserved for hospitals and sick patients coming home for treatment," says Levy. "All you need is soap and water in the healthy household.

"To avoid the spread of germs, wash before you eat and after you use the bathroom, change diapers, or shake hands. A lot of viral illnesses are passed hand-to-mouth," says Levy. Closing the toilet lid before flushing prevents the spray of germs.

"But don't get obsessive," Levy adds. "It's OK to expose kids to germs. If you confront an organism at an earlier age, you build immunity to it."

Lower your child's risk of ear infection by keeping him or her away from smokers. Studies show that children who are not exposed to tobacco smoke are less likely to get ear infections, says Bruce Canaday, Pharm. D., past president of the American Society of Health System Pharmacists in Bethesda, Maryland, and clinical professor of pharmacy and medicine at the University of North Carolina in Wilmington.

Have your kids vaccinated. The American Academy of Pediatrics suggests the new vaccine Prevnar for all children under 24 months. Released last summer, Prevnar helps prevent diseases caused by the most common invasive bacterium in kids: Streptococcus pneumoniae. Every year these cause meningitis, bloodstream infections, and pneumonia in children under 5.

Prevnar targets the seven strains of pneumococcus that cause up to 80 percent of all pneumococcal invasive disease in children under 6 years old in the United States. These strains also are among the most antibiotic resistant. Prevnar should be given along with other recommended childhood vaccines at 2, 4, and 6 months, and at 12 to 15 months. The number of doses required depends upon the age at which vaccination is initiated.

While Prevnar has little effect on ear infections, reducing the risk by a mere 10 percent, a new vaccine under development is expected to cut cases of ear infections by 30 percent in children who are under 6 years of age. The yet-to-be-named vaccine may be available in the 2001-2002 flu season, says S. Michael Marcy, M.D., a staff pediatrician at Kaiser Foundation Hospital in Panorama City, California.

Take precautions when caring for a patient at home. The Centers for Disease Control and Prevention suggest certain practices. Wash your hands regularly with soap and water after contact with the sick person. Use towels only once for drying. Wear disposable gloves if you expect to have contact with body fluids, and wash your hands after removing the gloves. Linens should be changed and washed if soiled and on a routine schedule. Clean the patient's surroundings on a regular basis and when soiled with body fluids.

Even as health professionals wage war against infectious diseases, it's important to note that most germs are not foes. They digest food, process vitamins, and protect us from bacteria that cause disease, explains Levy. "We should think of microbes as friends, with a few backstabbers in the bunch."

ANTIBIOTIC PRIMER

When it comes to antibiotics, you've got to be very careful. Taken with the wrong food or beverage, your medicine may be rendered ineffective or lethally potent.

Here are some things to keep in mind:

* Follow the timing schedule suggested by your doctor or pharmacist.

* Read warning labels to determine what foods should not be consumed with your medicine. Also, avoid hot beverages lest the heat render the drug ineffective. When in doubt, take drugs with water. Check with your doctor or pharmacist if you have questions about which foods and beverages can be consumed with your medication.

* Some antibiotics (such as cipro, or ciprofloxacin, commonly used for urinary tract infections) cannot be taken with calcium or calcium-fortified foods, such as fortified orange juice, because the mineral binds with the drug, decreasing its absorption. Products intended for the stomach, such as antacids, including Tums, Maalox, or Mylanta, and foods containing aluminum, magnesium, and iron may have the same effect. Take these drugs one hour before or two hours after a meal to avoid this problem.

* Don't take the widely used antibiotic penicillin with acidic foods or drinks--such as apple juice, wine, or cola--because they may destroy the antibiotic before it has time to work in the stomach.

* Don't stir medicine into your food, chew or crush pills, or open capsules unless your doctor or pharmacist tells you that it is safe to do so. Chewing or crushing the drug can release too much of the drug too soon. This can be toxic if a drug is sustained-release, and therefore intended to give its effect over a longer period of time.

COPYRIGHT 2001 Meredith Corporation