factors are involved in these new forms of resistance, but the most important
is that antibiotic use is out of control, Levy says. Since 1954, the
amount of antibiotics produced in the United States annually has increased
from two million pounds to 50 million pounds. Research suggests that about
half of these antibiotics arent medically necessary.
you look these days, doctors are prescribing antibiotics for colds and
earaches. But if all youve got is a common cold, you definitely dont
need an antibiotic, Levy says. Remember, colds are caused by viruses,
not bacteria, and viruses are completely unaffected by antibiotics. If
you use one, all youll get are side effects, resistant bacteria, and
no help on the virus! Instead of resorting to the antibiotic, you need
to eat well and drink lots of liquids. Get plenty of sleep, and take Tylenol
or other anti-inflammatories that you can buy over the counter.
also urges parents not to demand an antibiotic from their pediatrician
at the first signs of a childs earache. Most earaches in kids dont
require an antibiotic, at least not at first, he says. And in many parts
of Europe right now, 95 percent of kids are not given an antibiotic when
they present with an ear infection. Instead, they wait 24 to 48 hours,
and then there are only 10 or 15 percent who actually require it, because
most earaches will just get better on their own. In the U.S., our best
assessment is that two-thirds of earaches are caused by bacteria, but
of those two-thirds, more than half will cure themselves. So Id say that
no more than one in five really needs an antibiotic.
frustrating recent development is the proliferation of antibacterial
cleaning agents in household products. I think many people are paranoid
about germs, and thats what has led to this mania for antibacterial-containing
household products, Levy says. Antibacterial agents are in everything
these daysplastics, deodorants, detergents. But like [medicinal] antibiotics,
we want to reserve these products for the care of sick patients. They
are not needed for everyday use. They, too, create environments of surviving
resistant strainsand their use runs the risk of creating homes that are
like hospitals [containing many resistant bacteria].
cleanliness and personal hygiene are important to preventing infection,
soap and water are a fine combination to do the job, along with ammonia,
chlorinated compounds or alcohol. These products do not leave residues
for the selection of resistant bacteria, he says. The important thing
to remember is that bacteria are our allies. We need them to regenerate
life, and to protect us from the rare, disease-causing kinds. Their resilience
is what we rely on. They help our immune system mature, and to over-treat
them will only get us into trouble.
killing off bacteria with superfluous antibiotics gives a selective
advantage to those which survive the assault, Levy explains. When an
antibiotic such as penicillin attacks a group of bacteria cells, those
that are highly susceptible to the medicine will quickly die. Those cells
that have had some resistance from the start, or that have acquired it
through mutation or gene exchange with other bacteria, may manage to survive.
Those same cells now face reduced competition from susceptible bacteria,
and they will go on to proliferate. And so they become increasingly resistant
to our drugs.
The consequences can be
dire. In numerous published studies, Levy has demonstrated a link between
human overuse of anti-bacterial drugs and increasing resistance among
such formidable pathogens as tuberculosis, which, after being nearly eradicated,
is now making an alarming comeback in the industrialized world. He also
points to reports from the United States, Japan and Europe in recent years
of vancomycin-resistant strains of Staphylococcus aureus, an often-deadly
bacteria found in some hospitals. Vancomycin is a powerful antibiotic,
and its the last line of defense against a few strains of S. aureus,
he says. The problem is that those strains now appear to have become
resistant to all other antibiotics. So far, there have been four confirmed
deaths in the world from drug-resistant forms of S. aureus, and
thats quite troubling. These organisms can cause failure of treatment,
and if we dont keep finding new drugs to stop them, they could emerge
as a disaster for patients.
son of a family-practice M.D. in Wilmington, Delaware, Levy never doubted
that he would eventually become a physician, but he majored in English
at Williams Collegethe result of some very good advice from his father,
he says. My dad really understood the value of liberal arts for a doctor,
and he helped convince me to major in English as an undergrad.
After graduating with honors, Levy went directly to
medical school at Pennthough some highlights of his education occurred
far from campus. He spent the summer after his second year studying in
Italy, for example. I found Penn to be really open-minded and tolerant
toward its students, Levy recalls with a laugh. When I told them I wanted
to spend a summer studying at the Istituto di Microbiologia in
Milan, the people at the med school didnt go up in arms, shouting: You
cant do that!
They gave me a nice stipend, and I went offthis
was 1962to work under the late Dr. Giulio Maccacaro, who was a great
teacher and a great researcher. What a summer. An assistant professor
would pick me up at my dormitory each morning, and Id climb onto the
back of his Vespa, and together wed go roaring into Milan, to the laboratory.
We worked hard. But at the end of the day, Professor
Maccacaro would often take us to one of the bars in the neighborhood,
and hed buy us a little bit of vermouth. Cinzano, red, with a twist of
lemon. The Italians would quickly chug it up, like the Russians with their
vodka. And Id be sitting back, drinking it slowly, and theyd all say:
Hey, Stuart, andiamo! Andiamo!
Levy was enchanted by his summer in cosmopolitan Milan:
We went to La Scala, and sat high up near the top in the cheap seats.
[We heard operas by] Mozart and Rossini. Ive loved both of them ever
After returning to Philadelphia, he barely had time
to unpack his bags and take his two-year medical boards, before he again
set sail for Europethis time to spend a full academic year studying bacterial
drug-resistance under renowned researcher Raymond Latarjet at the Laboratoire
Pasteur in Paris.
Im still amazed by the way the med school helped
me arrange those two fellowships, he says. That was a terrific year,
on many different levels. Ive always felt grateful for the opportunities
I received at Penn.
Levy completed his internship and residency training
at New Yorks Mount Sinai Hospital, and by the late 1960s was studying
bacterial geneticsa growing interest during medical schoolon a three-year
fellowship at the National Institutes of Health in Bethesda, Maryland.
He joined the faculty at Tufts University medical school in 1971, becoming
a full professor in 1980. Meanwhile, his research into drug resistance
among bacterial species was gaining international attention.
The author or editor of five books and more than 200
scientific papers and journal articles on antibiotic use and resistance,
he is credited with achieving several breakthroughs in his field. These
include the discovery of the efflux pump resistance mechanism in bacteria,
along with major new insights into the ways in which antibiotic-resistant
bacteria are transferred from animals to humans and the location of the
protein master switch that controls bacterial resistance.
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