THE HINDU
Online edition of
Sunday, November 26, 2000
HOW far away are we from a
return to time when people die from a sore throat? At a press conference on May
23, 1997, scientists finally acknowledged the arrival of untreatable bacteria
they had feared for years - bacteria that resist antibiotics. Drugs which have
kept us safe for 50 years were beginning to fail, they said.
Today, superbugs look triumphant and this is a serious situation. Over the
last five years, scientists have clearly seen a change in their ability to
tackle what should have been easily treatable infections, because bacteria are
developing the ability to resist antibiotics. And the more antibiotics we use,
the more resistant bacteria become.
Every year, more than five million people die from infections that do not
respond to antibiotics. Things are going to get worse. Staphylococcus, one of
the most dangerous bacteria, now has only one antibiotic to keep it in check -
Vancomycin.
This year, Japanese doctors saw the world's first case of infection with
Vancomycin-resistant staphylococcus - a baby boy in hospital for major heart
surgery. When antibiotics failed, doctors had to pour strong disinfectants
directly into the wound on his chest. It was quite shocking because the outcome
of that infection was quite hideous. The patient suffered a lot.
Terrible bacteria will inevitably spread, and when they do, being in
hospital even for minor surgery, or a hip operation or to have a baby, could be
lethal. If even the smallest wound becomes infected, bacteria would most
probably kill you. It would be very hard to conduct major surgery that we have
got used to. Transplants, cancer chemotherapy, are all dependent on the ability
to kill off bacteria which may infect patients. We will lose all that.
It is hard to understand why no new drugs have been developed to save
mankind. Pharmaceutical companies should have come to grips with the situation.
But they thought that that was not profitable a decade ago. Now, it is too late.
Even today, drug companies do not promise a new class of antibiotics for at
least 10 years and they may never discover one. They have already exhausted
traditional chemistry and computer drug design. Today, they analyse the genes
of the bacteria, hoping to find new strategies. But the frightening truth is
that no fundamentally new antibiotic has been discovered for more than 30
years.
One begins to worry that we are indeed moving into what some people have
called the post-antibiotic era, where bacteria are supreme.
But there is a major remedy that kills even the most resistant bacteria.
Unknown to the rest of the world, in a small country in the heart of the
Caucasus Mountains, south of
In the central hospital in the
The doctors here know that there is a problem. It has become the breeding
ground for particularly nasty bacteria, which they suspect are resistant to all
the antibiotics they have. They are taking samples from every surface in the
ward to know exactly what they are up against. Some of the samples have traces
of staphylococcus strains.
Anywhere else in the world, this would be a death sentence. But here in
Two flasks contain bacteria. A few drops of the Georgian medicine have been
added to one and it has a magical effect. The bacteria have all been killed.
This astonishing effect is caused by something we usually fear - a virus, and
one that comes from sewage. Says Dr. Teimuraz Chanishvili,
The first to spot what happened was an irascible French-Canadian called
Felix d'Herelle. In 1917, he suggested that the viruses which killed bacteria
in the bottles could be used to treat disease. An ardent Communist, d'Herelle
was enticed to
With Stalin's blessing, d'Herelle founded an institute in
Phage have an extraordinary structure. Their bulk is a head in which their
genes are stored. They have six legs or filaments, which attach themselves to
the bacteria and a tail that works like a hypodermic syringe to infect it with
their genes. Inside the bacteria, the phage viruses grow and multiply.
Sometimes as many as 5,000 grow in a single cell.
When the new phage burst out, they kill the bacteria and then each goes on
to find another victim. Each phage only grows on a particular kind of bacteria.
That is why when we talk of Staphylococcus phage, it is known that it
reproduces only on Staphylococcus.
But being specific makes phage tricky to work with. Over the years, the
institute has trained specialists to find phage, grow them and turn them into
medicine. In the 1970s when antibiotic- resistant bacteria became a serious
problem in Soviet hospitals, phage became the saviours.
A decree was issued that all bacteria resistant to antibiotics and local
phages must be sent to the institute, where a new preparation was made. It was
very difficult to organise, but everything was done under one roof. The centralised
Soviet system was ideal for the labour-intensive work needed to make phage
effective. Together, Communism, phage and the institute thrived.
Phage medicine had its heyday in the 1980s. It was manufactured in factories
across the
Remembering those days they say, "We used to inject phage into one,
two, three, four vats. There were 500 litres in each vat, and remember we had
to take orders on top of that. We produced tablets and bottles. We made phages
for the
An old woman recalls how phage helped cure her son, "My son became ill
when he was young. They checked his throat and nose and found Staphylococcus. I
went to the institute and they gave him phage and cured him. Phage medicine is
a wonderful thing. It works against dysentery. They even give you phage in an
enema."
Today, when people in
They rub the healing viruses into their wounds, drink them for a bad
stomach, or swirl a solution in their months to cure a gum infection. A woman
developed gangrene in a wound on her thumb. The doctors cut away most of the
infected tissue, the rest they treated with phage. If the resistant bacteria
rife in the hospital got into this woman's wound, it would have caused fatal
blood poisoning. Phage does not work well in the bloodstream.
Being a virus, it is fought off by the immune system. But the surgeons make
sure infection does not take hold in the first place, by using phage to
sterilise the room and equipment as well as the wound. The doctor in attendance
says, "We think that the phage that was used during the first operation
helped the wound to be in such good condition." Phage works wonders in
A unique library of phage medicine exists in Tblisi. It is a national
treasure, built up over 50 years when problem bacteria was sent here from all
across the
Phage therapy has been so successful in the
In
Some of the claims made for some of these bacterial phages which are
isolated were, quite frankly, barmy. There was one commercial preparation, for
example, called Enterofagos, which supposedly had miraculous powers against
both herpes infections and eczema.
These claims were not fraudulent. In fact, a lack of understanding plagued
most phage work done around the world in the early days. In
It has to be said that some of the clinical trials that were carried out
were of exceedingly poor quality. For example, in some of the early work on
choleraphage in the 1920s and the 1930s, there were no control groups. So it
was impossible to see whether the phage had worked.
And some of the trials consisted merely in pouring bacteriophage down
drinking wells in a village and see whether it had any effect with no
understanding of dosage or the mechanisms whereby bacteria produced the
diseases.
Some of the problems with early studies though is the best phages for the
job were not selected. They did not check whether the organism was sensitive to
the phage. By 1941, phage was still thought to be too unreliable to be useful
by researchers in the West. W. When powerful antibiotics arrived a few years
later, it was quickly forgotten. Meanwhile, unknown to the outside world, the
Georgian scientists went on working.
Research that proves the worth of phage medicine was published by the
Georgian scientists, but only in the
And even today, it is ignored because of a strange phenomenon that is true
across the world of science. The articles were published either in Russian or
in Georgian. Thus, language has proved to be the final barrier. So, perhaps the
real problem was not because the science was bad, but because the findings
could not be read. And so the West could not get acquainted with it.
Modern medicine faces a crisis as new strains of antibiotic- resistant
bacteria threaten advanced treatments and intensive care. But there is an
unlikely saviour - a virus derived from sewage that can kill bacteria. To learn
more about this unlikely saviour watch "Vital Breakthroughs", Sunday,
from 7 to 8 p.m., on the Discovery Health Block, only on Discovery Channel.
Information and picture courtesy: Discovery Channel
