Important note: Information in this article was accurate in 2007. The state of the art may have changed since the publication date.
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San Francisco Examiner - May 29, 2007
Karl B. Hille, khille@baltimoreexaminer.com
Flu, staphylococcus aureus, tuberculosis and gonorrhea, to name a few, have rendered some of medical science's best antibiotics and anti-virals impotent, according to the Centers for Disease Control and Prevention and other research institutes, and multiple strains of HIV have adapted to ignore treatments.
Dr. Janaki Kuruppu, assistant professor of medicine at the University of Maryland School of Medicine's Institute of Human Virology, studies drug resistance in tuberculosis.
"It becomes a larger threat and becomes more difficult to treat," she said.
Doctors have to rely on second-line antibiotics, which have been around longer, but have more harmful side effects than modern drugs. Discovering drug resistance in the hospital usually means the patient has deteriorated under the first course of treatment, she said, making turnaround more difficult.
So far, Baltimore has been spared.
"To my knowledge to date, we haven't had a case of the extremely drug-resistant TB in Maryland," Kuruppu said.
The disease resists almost all drugs used to treat TB, including the best two first-line drugs, isoniazid and rifampin, according to the CDC. It also sidelines some second-line drugs like fluoroquinolones and other injectible drugs, and is 70 percent fatal.
And similar problems are preventing treatment of diseases beyond TB.
In April the CDC published new guidelines taking the quinolone family of anti-microbials off the shelf for treating gonorrhea in Hawaii and the West Coast. Resistant strains in San Francisco accounted for 31.3 percent of all gonorrhea cases.
In Baltimore, the epidemic is much more low-key, but resistant gonorrhea has tripled from 1 percent to more than 3 percent of all cases since 2004.
Resistance to ciprofloxacin - a fluoroquinolone - was first identified in 1991, according to the CDC. Through the 1990s, the disease was fairly uncommon, but resistant strains now account for almost 10 percent nationwide.
Hospitals in Baltimore and nationwide are trying to clamp down on staphylococcus strains that have overcome methicillin, and U.S. and Canadian authorities are monitoring anti-viral resistant flu strains.
Last year, the CDC reported that 92 percent of influenza A (H3N2) viruses isolated from patients in 26 states could withstand amantadine-based anti-virals, as well as two of eight influenza A (H1N1) cases.
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