To many Americans, Third World health problems often seem reassuringly remote. But in the shrinking global village, many of the world`s toughest bugs are finding their way to the local hospital, the day-care center or the hooker on the nearest street corner.
”You don`t have to go to exotic places to find penicillin-resistant gonorrhea now,” says Dr. Brown. ”It`s just around the corner. And it`s not getting better.”
Antibiotic-resistant gonorrhea was once primarily an Asian problem. Today, it accounts for about 10 percent of the 700,000 cases of the disease a year in the United States – and the rate is still rising. Georgia, for reasons that mystify health officials, has become the de facto capital of the country`s spreading ”superclap” epidemic. The state has the highest rate of resistant gonorrhea in the country. Ten years ago, it had virtually none.
Globe-trotting germs aren`t a new phenomenon. Christopher Columbus and his men brought smallpox, measles and typhus to the New World – and may have taken syphilis home with them. Each year, flu viruses circle the world, infecting millions, and then fade away.
Since the advent of penicillin 50 years ago, antibiotics have dramatically reduced the toll of bacterial disease, saving millions of lives. But today, many of the bugs reaching U.S. shores come prepared to beat the drugs that once controlled them.
Drug-resistant strains of mankind`s worst enemies – malaria, tuberculosis, pneumonia and deadly diarrheal diseases, which together claim 10 million lives a year – are undercutting decades of progress in public health, both here and abroad. In many cases, their existence is a result of antibiotic abuses – the medicinal equivalent of carpet-bombing – occurring half a world away.
The spread of drug-resistant gonorrhea is only one example of the problem.
The chance encounter in the Philippines between two bacteria , Neisseria gonorrhoeae and an intestinal germ that had probably been exposed to too much penicillin, hardly seemed like the kind of thing that could shake the public health system of an industrialized nation half a world away.
But that is exactly what has occurred since Philippine doctors discovered, in the mid-1970s, that the gonorrhea germ had somehow acquired a packet of genetic information that conferred high-level resistance to penicillin.
Penicillin-resistant gonorrhea, probably introduced by servicemen returning from Southeast Asia, didn`t become established in the United States until 1983. It quickly made up for lost time. Spreading from centers in New York, Miami and Los Angeles, it was so widespread by 1987 that public health clinics had to stop using penicillin.
By 1989, a dozen cities, including Atlanta, were overrun with even tougher bugs that were resistant to both tetracycline and penicillin. Nationwide, there are now an estimated 70,000 drug-resistant cases a year.
So far, the race to stay a step ahead of gonorrhea has been costly, but not impossible. Ceftriaxone, the antibiotic currently recommended by the Centers for Disease Control, costs eight times more than penicillin, but has helped to keep overall gonorrhea rates in decline.
But some health officials worry that they may be running out of options.
”We have been seeing an upward trend in gonorrhea isolates that are less sensitive to antibiotics in general,” says John Moran, associate director of the centers` division of sexually transmitted diseases. ”We don`t want to scare people by calling it resistance. We refer to it as decreased
susceptibility.”
Joan Knapp, the centers` chief of molecular epidemiology for sexually transmitted diseases, said, ”We are standing at the edge of a crisis. Every new antibiotic we have thrown at this bug has ended up making it more resistant. What do we do if we wear out all of these drugs?”
Even more alarming to some officials is the global spread of penicillin-resistant strains of pneumonia, a disease that kills more than 3.5 million people a year, mostly infants and young children.
Although most of the deaths occur in underdeveloped countries, Streptococcus pneumoniae also kills up to 50,000 Americans a year – mostly among the elderly – and causes up to 1 million cases of pneumonia, as well as middle-ear infections, meningitis, and severe blood and heart infections.
Antibiotics can`t prevent pneumonia, but the death toll would be far higher if it were not for the effectiveness over the last 50 years of penicillin and its derivatives. But to the dismay of doctors worldwide, penicillin is losing its punch.
Today, penicillin-resistant pneumonia can no longer be explained away as byproducts of Third World poverty and poor medical care. It now accounts for as much as 70 percent of the Streptococcus pneumoniae infections in some European countries, and is increasingly prevalent in the United States.
”The misuse of an antibiotic anywhere in the world can cause problems far beyond the borders of that country,” says Thomas F. O`Brien, an infectious disease specialist at Brigham and Women`s Hospital in Boston, who is developing a computerized network of labs to track resistant strains of bacteria worldwide.
”To some extent, the United States can still buy its way out of some of these problems with newer and more costly drugs,” he says. ”But the big lead we thought we had over these problems a few years ago is shrinking. And in the developing world it has disappeared altogether.”
