Drug Resistance

CHICAGO -- Illinois is poised to become the first state to require hospitals to implement programs combating a dangerous, drug-resistant bacterium that kills thousands of people in the U.S. each year. Under a bill moving through the Legislature, hospitals would be required to test for methicillin-resistant Staphylococcus aureus, or MRSA, in all intensive-care and "at-risk" patients, such as those transferred from nursing homes. If it is detected, aggressive measures to prevent transmission would kick in. MRSA is a potentially virulent bacterium that has developed strong defenses against common antibiotics such as penicillin.

Detecting tuberculosis and preventing its spread could become easier with a new test that produces results in days rather than weeks and quickly indicates whether patients carry drug-resistant strains, researchers report today. Doctors who studied tuberculosis in Peru said the test could become a major tool in taming a disease that preys mostly on people in developing nations but is also becoming a threat in Europe. TB kills close to 2 million people worldwide each year. "It's taken a long time, but our mission is to basically take this test now that it's been evaluated and implement it in developing countries," Dr. Robert H. Gilman, a professor at the Johns Hopkins Bloomberg School of Public Health, said yesterday.

Deadly drug-resistant staph infections - rarely seen in patients a decade ago - have become the leading type of skin infections treated in emergency rooms, scientists reported yesterday. The study in The New England Journal of Medicine was the first to demonstrate the extent to which drug-resistant Staphylococcus aureus has spread throughout the United States. The bacterium accounted for 59 percent of skin infections in the study, researchers said. Local prevalence ranged from 15 percent in New York to 74 percent in Kansas City, Mo. In Los Angeles, drug-resistant staph accounted for 51 percent of skin infections, researchers said.

WASHINGTON -- AIDS and HIV patients, who have been seeking ever simpler treatments since struggling with a complicated regimen of as many as 25 pills a day a decade ago, can now take one daily pill. The new pill, Atripla, was approved yesterday by the Food and Drug Administration after an accelerated three-month review reflecting the major public health benefits anticipated by activists, doctors and health officials. Dr. Andrew C. von Eschenbach, the acting FDA commissioner, hailed the combination drug as a "landmark" that would "fundamentally change treatment" of acquired immune deficiency syndrome and the virus causing it. Since the difficult early days of treatment, AIDS cocktails have become simple enough that some patients swallow just a few medications a day. Atripla melds three widely prescribed drugs that have been available for several years and are often taken together.

For the first time, doctors have diagnosed a form of HIV that New York City health officials say has two striking characteristics: It is highly resistant to antiviral drugs in a patient who had never been treated with the medications, and it quickly developed into full-blown AIDS. The infection defied the typical profile by apparently developing into AIDS in a matter of months, officials said. New York City Health Commissioner Thomas Frieden said that the strain is one that "is difficult or impossible to treat and which appears to progress rapidly to AIDS."

Every day, Dorothy Murray files into a downtown clinic, raises a glass of grape juice and downs three pills under the eye of a pharmacist. It has been her routine since March, when she left the hospital after nearly dying from an AIDS-related infection that reduced her weight to 70 pounds. "I was an intravenous drug user, but I didn't like taking pills," said Murray, 38, who's back to 100 pounds, which sit well on her diminutive frame. "I figured this was the only way I'd take my medication."

Donald Ross worked for years in poultry plants on the Eastern Shore, hanging chickens on hooks, weighing them, packing them and wielding a knife in the "kill room." About four months ago, he nicked the middle finger on his left hand. The tiny cut should have healed quickly, but it ballooned instead into a festering golf ball-size lesion. Months of antibiotic treatments failed to shrink it, and it had to be surgically removed. Ross, 46, and a Johns Hopkins Bloomberg School of Public Health researcher suspect his infection was caused by drug-resistant bacteria in chickens at the Temperanceville, Va., plant where he worked.

Both war and peace had a role in making Americans some of the most clean-conscious people on the face of the planet. The lethality of germs was brought home during the Civil War, when three times as many soldiers died from infectious diseases as from combat. After World War II, as women returned from the factories to resume household roles, the demand for more modern home appliances increased, and vacuum cleaners and washing machines made cleanliness an end in itself. Today antibacterials - germ-fighting compounds - are in products as wide-ranging as sponges, children's toys, mattresses and pantyhose.

A "bumper crop" of new AIDS medicines being developed in laboratories or already in human trials is fueling hopes among researchers that a new era of treatment is dawning, seven years after powerful drug cocktails significantly improved the survival rate for patients. Scientists attending the nation's premier gathering of AIDS specialists, in Boston, revealed details of at least 10 promising drugs that would substantially expand the arsenal of medicines available to thwart the virus. With the development of these drugs, researchers can attack the AIDS virus at eight different points, making it harder for the resilient bug to build up a resistance to treatment.

Hoping to prevent the spread of drug-resistant strains of the AIDS virus, the city Health Department plans to monitor patients to make sure they take their medications twice a day, every day. Dr. Peter L. Beilenson, the city health commissioner, said yesterday that the department will initially enroll 200 patients, who will receive their drugs at either a van, a pharmacy or a public health clinic - all in West Baltimore neighborhoods devastated by...