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The Killers Within: The Deadly Rise of Drug-Resistant Bacteria

The Killers Within: The Deadly Rise of Drug-Resistant Bacteria, by Michael Shnayerson and Mark Plotkin, Ph.D. Little, Brown and Company: Boston; 2002. 328 pp., hardcover, includes index. $24.95 ISBN 0-316-71331-7.

One of the oldest concerns of humans is to identify why some people get sick and others do not, especially when they have similar lifestyles, exposures, and diets. Only a little more than a century ago doctors and scientists discovered that perhaps microscopic things, called germs, can cause disease. Medical science in the twentieth century made Herculean strides in identifying bacteria, viruses, fungi, and a litany of other microbes related to various illnesses. Then came the wonder drugs during the middle and latter part of the century. Antibiotics, sulfa, and other drugs on the cutting edge of technology have healed millions, saved countless lives, and helped immensely in the longevity of the human species. Or have they?

As many physicians and microbiologists of the 21st century fear that the golden age of antibiotics and similar drugs is coming to an end, and as resistant bacteria become an urgent global issue, the stark reality of The Killers Within: The Deadly Rise of Drug-Resistant Bacteria emerges. The implications are horrifying. Today’s hospitals face increased antibiotic-resistant staphylococcus, frequently known as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Staphylococcus aureus (VRSA). Methicillin and vancomycin are powerful antibiotics and are considered drugs of last resort. If they cannot kill a particular bacterial strain, there are no other options for the patient.

Shnayerson and Plotkin convincingly point out that the principal cause is overuse – and misuse – of antibiotics. In 1954, two million pounds of antibiotics were produced in the United States. By the end of the century, the annual figure had risen by some estimates to more than 50 million pounds.

The authors’ timing could not have been more perfect. In December 2002, newspapers were printing front page stories about the overuse of antibiotics. They addressed the continuing campaigns to educate the public not to ask for antibiotics every time they get a cold, and urged doctors not to write these prescriptions due to patient pressure.

The book takes the reader on a global "sleuth" to track the invisible killers that seem to be winning the battle. Hospitals in the United States and Western Europe are in trouble, trying to deal with antibiotic-resistant strains of bacteria, and are losing more patients than they did years ago. Cases are cropping up in Russia and many Third World countries.

Moreover, problems surmount as time goes on, and even modern medicine cannot seem to keep up with bacterial resistance. For example, the two newest drugs that have cured vancomycin-resistant infections have provoked resistant strains within a year of their release. Streptococcus pneumoniae tops the list of diseases to worry about, and are perhaps the most common cause of lobar pneumonia as well as being common causative agents of meningitis, sinusitis, and other infections. And although it is still susceptible to several antibiotics, it is a widespread killer in countries with meager medical care.

The Killers Within is already a highly praised book. The research is timely and meticulous. I believe that doctors, pharmacists, nurses, epidemiologists, and other healthcare practitioners will find this book as scientifically useful as the public will find it provocative. The book reads quickly, like a suspense novel in which the good guys (the medical community) must defeat the bad guys (the bacteria) with the right weapons (new miracle drugs) before the world is in real jeopardy. Unfortunately, the authors cannot predict how the saga will end.

– Daniel T. Wagner, Pharm.D., R.Ph., M.B.A.


Wildwood, Pennsylvania