To combat the emergence of "super bacteria" resistant to antibiotics, the nation's public health officials yesterday launched a far-reaching campaign calling on patients and physicians to stop misusing antibiotics.
An excessive dependence on these drugs, which are among the most commonly prescribed in the United States, has led to the creation of many drug-resistant strains. Children and adults are landing in hospitals, and many are dying, from bacterial infections that don't respond to treatment.
"Don't pressure your doctor into giving your child antibiotics," said Ann Cotten of Gambrills, whose infant son, Nicholas, developed a bacterial infection this summer so resistant and severe that it broke his arm. The infection went from the blood to the bone, where it created a hole.
After more than two months of treatment, including orthopedic surgery, Nicholas and his parents appeared yesterday with health officials as they announced their initiative at the annual meeting of the Association of State and Territorial Health Officials.
The organization's president-elect, Dr. Jack Dillenberg, director of the Arizona Department of Health Services, called the rise in drug resistant strains an "explosion" and a "public health crisis of the first order."
"If left unchecked, we face potentially devastating consequences as a nation, including widespread sickness and death from once-curable diseases," he said.
The Centers for Disease Control said 13,300 hospital patients died of bacterial infections resistant to antibiotics in 1992.
Unlike other health issues that may focus on one segment of the population, this problem affects everyone. The five most common reasons that Americans go to the doctor's office are upper respiratory conditions -- ear infections, colds, sore throats, bronchitis and sinusitis -- for which they often demand antibiotics.
But in the case of sore throat, only one in seven is caused by strep, a bacteria. That means most throat infections are caused by viruses, which antibiotics can't cure.
Dr. David Satcher, director of the U.S. Centers for Disease Control and Prevention in Atlanta, said yesterday that more than one-third of children under 6 are inappropriately treated with antibiotics for viral infections. These children, and others who take unneeded antibiotics, are more likely to contract resistant strains of bacteria, Satcher warned.
Drug-resistant strains emerge through the process of natural selection. When a person takes an antibiotic, many bacteria will be killed. Some may be strong enough to resist, because of some biological variant, and will survive and multiply.
The likelihood of wiping out all of the invading bacteria in the body is much greater if someone finishes the course of antibiotics prescribed. If a person starts and then quits taking medicine, that teaches some of the bacteria how to mutate and evade it, allowing those mutants to thrive and spread.
People can get drug-resistant infections by catching a resistant bug, or by having a resistant strain emerge in the body once antibiotic treatment has begun. These infections cause longer, more complicated and costly illnesses, such as the one Nicholas Cotten had.
"This is an innocent child who is a victim of this problem. Nicholas never had antibiotics in his life," said Dr. Martin P. Wasserman, Maryland's health secretary, shaking Nicholas' hand. Trying to reach for him, the apple-cheeked 10-month-old boy smiled and looked out, bright-eyed, over the packed room.
Just a few months ago, Nicholas had surgery to clean out the infection and blood from the bone in his arm.
Because the infection was resistant to standard antibiotics, physicians had to use stronger ones that were given intravenously. After a month at the University of Maryland Medical Center, he still needed antibiotics at home for two weeks, administered through a catheter implanted in his chest.
"Because of [society's] misuse of antibiotics, my son ended up in this condition," said his mother, explaining how Nicholas contracted a resistant strain. Initially, Nicholas' parents were told his arm might not heal, but he has fully recovered.
As much as half of antibiotic use for many common conditions is inappropriate; yet from 1980 to 1992, the rate of prescriptions for antibiotics among children increased by 48 percent, said Dr. George Lundberg, editor of the Journal of the American Medical Association.
Social and economic realities play into the situation. Many times parents pressure physicians to give children antibiotics so the .. children can get back to school quickly -- and parents can get back to work. Physicians say it also reflects on them if they don't hand over the prescriptions.
"Patients do go around the corner to Dr. Y if you don't come through with the antibiotics," said Dr. Kevin Clark, a local pediatrician who has only been in private practice a year and is trying to build his patient base. "Many colleagues and I have been waiting for a campaign like this to get the word out."