Map of life expectancy at birth from Global Education Project.

Friday, April 13, 2007

No rapture in this apocalypse

This story hasn't gotten major attention, as far as I can tell, but CDC has just reported that 13% of new gonorrhea infections are ciprofloxacin resistant, which means CDC is now advising doctors to stop using cipro and other fluoroquinolones for the clap in California and Hawaii, and for gay men everywhere. There is only one class of antibiotics left for gonorrhea, called cephalosporins. (Here are the updated treatment guidelines for M.D.s.)

I have mentioned here previously the problem of methicillin resistant staphylococcus aureus. Here's another recent report from CDC: n January 2007, CDC received reports of 10 cases of severe methicillin-resistant S. aureus (MRSA) CAP, including six deaths, among previously healthy children and adults in Louisiana and Georgia during December 2006--January 2007. Other growing problems include drug resistant (and especially nasty) Clostridium difficile, which causes indescribably severe bloody diarrhea, and extremely drug resistant tuberculosis, which so far is a problem mostly in immunocompromised people, and specifically people with HIV in poor countries, but that can easily change.

Very few people these days appreciate how different our world is from that of our great grandparents, or even our grandparents when they were children, because of the conquest of infectious disease. In the old days, no-one could take life for granted. Death lurked in the shadows every single day, and few people lived out their three-score years and ten. At the turn of the last century, urban dwellers in the U.S. could expect to live into their forties, which means that half of them did not.

Our common expectation of old age rests on three pillars: public health measures, such as provision of clean water and sanitary codes for the food production, sale and service industries; immunization; and antibiotics. The Bush administration has substantially weakened the first pillar, which has already led to some minor disasters. That is reversible. But the third is in real danger.

If we lose the ability to treat common infections before they develop into toxic shock or necrotizing fasciitis or pneumonia, that we cannot treat; if children's sore throats start turning into rheumatic fever; if eye infections start to mean lost eyeballs; if we can no longer safely perform surgery; we'll be living in a fundamentally different historic era.

The drug companies aren't interested in developing new antibiotics because they aren't nearly as profitable as products that are taken for a long term by large numbers of people. Obviously there's no way to pump up sales of overpriced antibiotics by advertising. Either you need 'em or you don't. And they can still sell tons of existing antibiotics to the livestock industry. Here's one place, in addition to stem cells, that NIH should be putting more research dollars. It's insufficiently glamorous, however.

Meanwhile, most urgently, we've got to preserve the antibiotics we still have, as much as possible. As always, check out my friends at APUA for the straight dope.

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