Thousands of times every day in cities around the world, people walk into a doctor's office with a hacking cough, an earache or some other relatively minor complaint and leave with a prescription for antibiotic drugs.

In many cases the antibiotics aren't really necessary, especially if the illness is caused by a virus, and taking the drugs is a waste of time and money.

But that's hardly the worst of it. Inappropriate prescriptions and the overuse of antibiotic drugs are making bacteria more resistant to treatment and could turn them into unstoppable killers.

The overuse of antibiotics goes beyond medicine. Antibiotics are fed to livestock and sprayed on fruits and vegetables to make them grow bigger faster. Antibacterial agents are often present in hand lotion and soaps. And the more antibiotics we use, the less effective the drugs become in killing bacteria.

Crisis seen looming

Doctors and scientists warn that unless we can halt or reverse the trend toward drug-resistant bacteria, we could find ourselves with no recourse for once easily treatable illnesses such as pneumonia and staph infections.

"It's a worldwide crisis upon us," said Dr. James Hargreaves, an infectious-disease physician with Altru Health System in Grand Forks.

Altru recently became a sentinel site to collect data about bacteria strains in the region and what antibiotics are effective against them. The Surveillance Network Database is being developed among hospitals and clinics by MRL Pharmaceutical Services.

Health officials say it is crucial to keep track of disease-causing organisms and their treatment, just as it's important to recognize the threat of drug-resistant bacteria and to educate health professionals and consumers about the dangers.

Hargreaves said doctors in North Dakota are starting to note drug-resistant bacteria, including the potentially deadly staphylococcus aureus, the source of many skin infections, abscesses and heart infections; pneumococcus and strep pneumonia, bacteria that cause respiratory and ear infections. All these conditions have become more difficult to treat.

Resistance more common

Across the United States and around the world, bacteria that resist treatment to single and multiple antibiotics are becoming more common. The severity of the problem varies. In some places up to half the population is resistant to penicillin to treat streptococcus pneumonia, Hargreaves said.

How and why is this happening? In part because too many antibiotics are prescribed and taken when they aren't really needed. The more antibiotics we take, the more bacteria change to survive. Some types of resistance also can be passed on to other bacteria so a growing number of infections can no longer be treated with antibiotic drugs.

Resistant bacteria spread readily to their surroundings and to new hosts, according to a March 1998 article in the journal Scientific American. Investigators have shown that when one member of a household takes an antibiotic to treat acne, the concentration of antibiotic resistant bacteria rises on the skin of other family members.

The heavy use of antibiotics in places like hospitals, day care centers and farms increases the levels of resistant bacteria in people and other organisms not being treated. Some suggest people should think twice about routinely using hand lotions, soaps and other products that contain antibacterial agents.

That doesn't mean antibiotics are bad, said Hargreaves, because we need them. But it does mean antibiotics should be taken only when necessary.

Still, antibiotic use and misuse continues to soar. In 1954, about 2 million pounds of antibiotics were produced in the United States. Today that figure exceeds 50 million pounds. According to some estimates, only about half the antibiotics we take each year are given and taken correctly.

"The price we're paying is going to be that what used to be easy to treat, now we don't have the antibiotics to deal with it," Hargreaves said.

Consumer demand

Why is this happening? One factor is consumer demand, he said. Sick patients expect their doctors to give them something and some physicians may find it quicker and easier to prescribe an antibiotic than to explain that most viral infections, such as the common cold, go away on their own and cannot be cured by antibiotics.

Many doctors overprescribe with good intentions.

"In medicine you often don't know what is going to work, so the doctor may think they should add an antibiotic to be on the safe side," Hargreaves said.

Drug companies must also take some responsibility. The more drugs they sell, the more money they make. That's good for profits but doesn't always mesh with efforts to curtail inappropriate drug use.

Hargreaves said one drug salesperson had been telling local doctors that they should use the drug he was selling to treat acute bronchitis.

"In acute bronchitis an antibiotic doesn't work," Hargreaves said, "or hasn't been proven to work. When I mentioned it to the physician, that there were no data to support this claim, he was surprised."

Short-term benefit

Then there's the issue of antibiotics in our food supply, of the drugs that are fed to cattle and chickens to make them grow bigger and increase profits for livestock producers.

"The short-term benefit is bigger cows and more money. The long-term effect is that we are going to pay in terms of people dying," he said.

Minnesota and North Dakota have both begun collecting data about drug resistance and other states and agencies, such as the Centers for Disease Control, are setting up databases to share information.

At Altru, Hargreaves said, doctors regularly have access to information about trends of drug resistance. Altru also was one of the first medical facilities in North Dakota to restrict the antibiotic vancomycin to special use. Once the use of the drug was curtailed, the hospital also noted less bacterial resistance to the drug.

The Grand Forks doctor believes physicians and other health care professionals are becoming more aware of the problem of drug-resistant bacteria.

"The public, I don't think they realize what is coming down the road yet," Hargreaves said. "It's hard to say."

Altru helps physicians keep tabs on bacteria

A doctor has a patient whose infection isn't responding to commonly used antibiotics. Where can the physician go for the latest information about bacterial strains and drug treatment options?

One place might be The Surveillance Network being developed by MRL Pharmaceutical Services, a division of a company with services and products directed at diagnosis and management of infectious and immunological diseases.

Altru Health System has become one of the sentinel sites for collecting data for the network, says Dr. James Hargreaves, an infectious-disease physician.

Being part of the network requires a facility to prove it can provide good data on a daily basis. Then the data is subject to checking and sampling, he said.

"The value for the community is that we have very extensive, very accurate information about what our (bacteria resistance) trends are in the community and in the hospital," Hargreaves said.

MRL's Clyde Thornsberry, a Ph.D. and chief scientific adviser, was one of the first to recognize the need for real-time information about the microbes that cause disease and their treatments, Hargreaves said.

MRL headquarters are in Herndon, Va., a suburb of Washington, D.C.