The demise of antibiotics: an exaggerated notion - says Mark Greener

Perhaps it's just pre-millennium tension, but the doom watchers wouldhave us believe that the demise of the antibiotic miracle lies just around the corner. Certainly, you don't have to look far for evidence that current antibiotics are failing. Today, staphylococci and enterococci account for one-third of all blood infections and perhaps half of nosocomial blood infections. Yet staphylococci, enterococci and other Gram-positive pathogens show increasing resistance to available antimicrobials (Diagn Microbiol Infect Dis 1999;33:101-12).

For example, around a quarter of Staphylococcus aureus isolates in the UK are multiply-resistant. But in some parts of the world, the problem is even more widespread; in Japan and Korea, 70% of S aureus isolates are multiply-resistant. Moreover, a growing number of other Gram-positive organisms show resistance to glycopeptides, aminoglycosides, penicillins and macrolides, and the increasing problem posed by vancomycin-resistant enterococci strains - which account for 20% of isolates in the intensive care wards of some US hospitals - have raised fears that these may spread resistance to the more virulent methicillin-resistant S aureus (MRSA).

The recent isolation of S aureus strains showing resistance to vancomycin - the current drug of last resort - suggested that these fears are well founded. And each new isolate - from Japan, the USA, France and Scotland - sent panic waves around the world, hitting the headlines in both the medical and lay press.