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Old drugs for new bugsVaccination News Home Page subscribe Vaccination NewsLetter http://bmj.com/cgi/content/full/326/7383/235?etoc
EditorialsOld drugs for new bugsAnecdotes suggest that some bacteria have lost their resistance to older antibiotics
Recent reports have lent support to the potential use of previous generation
antibacterial drugs to treat infections caused by new resistant
bacteria. The Morbidity and Mortality Weekly Report recently
described two isolates from the United States of vancomycin resistant
Staphylococcus aureus with a minimum inhibitory concentration
Chloramphenicol, a drug introduced 50 years ago and essentially abandoned in
the past three decades, has been reintroduced recently to treat
severe infections caused by vancomycin resistant enterococci.6
A report from India describes the re-emergence of susceptibility to
chloramphenicol in Salmonella typhi isolates that are
increasingly resistant to quinolones and
In a recent report from France, Stein and Raoult used colistin, an old and rarely used antibiotic, to treat bone infections caused by a strain of Pseudomonas aeruginosa with resistance to all other antibiotics tested.8 The same drug has been used to treat infections caused by multiresistant strains of Acinetobacter baumannii.9 Sulbactam, a drug introduced in the early 1980s, is increasingly being used for the same purpose.10 As an alternative to third generation cephalosporins and vancomycin, high doses of penicillin are being proposed to treat pneumococcal infections caused by strains with intermediate levels of penicillin resistance (minimum inhibitory concentration 4-8 µg/ml).11 Despite extensive research the pace of development of antibacterial drugs has not kept up with the increase in bacterial resistance. As more and more organisms develop resistance, concern is growing that we may be approaching the end of the antibiotic era. The intensive use and excessive abuse of antibiotics have resulted in the selection of bacteria that are resistant to many and sometimes all antibiotics. For unclear reasons, these multiresistant organisms either retain or regain susceptibility to certain antimicrobials. Measures to counter the threat of rapidly escalating antimicrobial resistance include surveillance of susceptibility to and consumption of antibiotics, rational use of antibiotics, better compliance with measures to control infection, and increasing development and use of vaccines. Are we reverting to the pre-antibiotic era or advancing into the post-antibiotic era? One of the crucial questions is whether the above mentioned examples will remain anecdotal or whether a real chance exists for the strategic use of forgotten drugs on a large enough scale to affect clinical management. The recovery of sensitivity to specific antimicrobials by pathogenic bacteria
is a complex issue. Two important factors determine rates of
resistant bacteria in a specific community The impact of either the discontinuation or the reintroduction of a specific
drug on the rate of resistance will differ for various
microorganisms. In addition to the information obtained from
mathematical models of population dynamics,12
continuous surveillance of in vitro susceptibility will inform us
about the effect of reintroducing older drugs. In some instances,
resistance could rapidly re-emerge owing to the presence of low rates
of resistant genes in a population that once was predominantly
resistant. In the future, older antimicrobials will be relied on more
and more, either as isolated "no other choice" options or as part
of a programmed policy of antibiotic cycling. Department of Medicine and Infectious Diseases, Rabin Medical Center, 49100 Petah
Tiqva, Israel (spitlik@clalit.org.il)
Footnotes Competing interests: None declared.
© 2003 BMJ
Publishing Group Ltd
Rapid responses:Read all Rapid responses
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DISCLAIMER: All information, data, and material contained, presented, or provided here is for general information purposes only and is not to be construed as reflecting the knowledge or opinions of the publisher, and is not to be construed or intended as providing medical or legal advice. The decision whether or not to vaccinate is an important and complex issue and should be made by you, and you alone, in consultation with your health care provider.
Copyright 2012 by Vaccination News, A Non-Profit Corporation. All Rights Reserved. This content may not be copied unless permission in writing from Sandy Gottstein has been obtained. 
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 "A foolish faith in authority is the worst enemy of truth." -- Albert Einstein, letter to a friend, 1901 "I know of no safe depository of the ultimate powers of the society but the people themselves, and if we think them not enlightened enough to exercise control with a wholesome discretion, the remedy is not to take it from them, but to inform their discretion by education." -- Thomas Jefferson, letter to William C. Jarvis, September 28, 1820 "What's the point of vaccination if it doesn't protect you from the unvaccinated?" -- Sandy Gottstein "Who gets to decide what the greater good is and how many will be sacrificed to it?" -- Sandy Gottstein |
32 µg/ml, both of which were found
to be sensitive in vitro to co-trimoxazole as well as to other older
antimicrobials. 
lactams.
the
"human" factor, which is the amount of antimicrobials used, and the
"biological" factor, which is the burden that the resistance encoding
genes impose on the fitness of the bacteria.