When a person becomes ill due to the presence of a bacterial or parasitic infection, doctors sometimes prescribe antibiotics to help fight off these microbes (viruses are another kind of microbe, but they are not affected by antibiotics).

However, when anti-microbial substances are used with great frequency, there is an increasing chance that some of the microbes will, through the natural process of genetic mutation, develop characteristics that make them less susceptible, or even immune, to treatment. This microbe may then go on to multiply and generate billions of its own offspring, which acquire the same genetic properties that made the earlier variant immune to the antibiotic. When this happens, the new strain is considered to be “resistant” to treatment.

Physicians have been aware of this effect for some time. In the 1940s, doctors discovered that penicillin was extremely effective in treating infections caused by the Staphylococcus (or “staph”) bacterium. However, after years of penicillin use, resistant strains of the bug began to emerge. These strains multiplied, replacing the weaker versions that were susceptible to penicillin, and they became much more common.

By the 1950s, virtually all of the cases of staph that appeared were of the resistant variety, and penicillin was no longer effective as a treatment. Doctors then had to develop stronger drugs such as erythromycin and methicillin. As the years went by, staph bacteria became resistant to those drugs as well, making the new drugs ineffective. Although some very powerful drugs remain to fight staph, these too are losing their effectiveness, and scientists are struggling to develop new treatments that will be effective.

One of the biggest problems contributing to microbial resistance is the abuse of antibiotics. When antibiotics are used improperly or in widespread circumstances, this practice may actually encourage the development of resistant strains. Some doctors mistakenly prescribe antibiotics to treat people who are suffering from viral infections. In addition, many doctors have criticized the mass use of antibiotics as a standard supplement to animal feeds to help prevent infections in livestock.

One of the greatest concerns in international public health has been the emergence of strains of serious diseases such as tuberculosis (TB) that are drug resistant. In many cases, the new bacteria are multi-drug resistant, which are extremely difficult and often very expensive to treat.

Resistant TB has become an increasingly difficult problem in Russia and Eastern Europe. Within Russia’s crowded and squalid prisons, TB has become endemic. As much as 10 percent of Russia’s prison population is estimated to have active TB, and 20 percent of those cases appear to be multi-drug resistant. Public health officials are therefore watching the region of the world with great alarm, waiting for these super-bacteria to spread to the rest of the world.

A mini-epidemic of MDR-TB in New York City in 1992 led to a massive and rapid intervention by local and federal public health officials. Health authorities spent $1 billion containing the outbreak, which eventually caused the deaths of 500 people (most of whom had weakened immune systems due to HIV).

A high profile TB case in May 2007, in which a male (Andrew Speaker) with a rare, multi-drug resistant strain of TB took a international airplane despite warnings that he should not fly, raised awareness of the risks of TB and how globalization and the ease of air travel can help spread the disease worldwide.

The World Health Organization reports that in some areas of the world, such as north Western Russia one in four cases of tuberculosis can no longer be treated with standard medicines. An estimated 440 000 people worldwide have MDR-TB, approximately 50 percent of these cases occur in India and China.¹²

12 Source: http://www.who.int/mediacentre/news/releases/2010/drug_resistant_tb_20100318/en/index.html

Next: Breakdowns in Public Health Systems