"Antibiotics were one of the most significant discoveries of the 20th century. Klller diseases such as tuberculosis, meningitis, scarlet fever and pneumonia could suddenly be treated and cured," said Dr. Gro Harlem Bruntland, director general of the World Health Organization (WHO; Geneva, Switzerland). "Unless we act to protect these medical miracles, we could be headed for a post-antibiotic age in which many medical and surgical advances could be undermined by the risk of incurable infection."

Over the past five years, in excess of $17 billion has been spent by the pharmaceutical industry on research and development of medicines to treat infectious diseases. Unless drug resistance is tackled quickly, much of that investment could be lost. As a result of three years of work with national and international partners, WHO is launching a new, comprehensive strategy to contain the spread of drug resistance.

"This strategy is designed to promote the wiser use of drugs so that resistance in minimized and effective treatments can continue to be used for generations to come," said Dr. David Heymann, WHO executive director for communicable diseases.

WHO's global strategy recommends a series of actions, including obligatory prescriptions for all antibiotics use for disease control in animals and the phasing out of antibiotics as growth promoters in the farming industry. Currently, 50% of all antibiotic production is used in agriculture, mostly to promote livestock and poultry growth. Drug-resistant microbes in animals can be transferred to humans.

"There is indisputable evidence of resistance to medicines used to treat meningitis, sexually transmitted diseases like gonorrhea, infections acquired in hospitals and even to the new classes of antiretroviral drugs used to treat HIV," Heymann said. Additionally, in several countries tuberculosis strains have become resistant to at least two of the most effective drugs used against the disease, and in many areas, commonly used antimalarial drugs have become virtually useless because of acquired resistance of the malaria parasite.

Leading international microbiologists met recently in Hamburg, Germany, to review the latest results of the Mystic surveillance program, which collects data from hospitals around the world that use broad-spectrum antibiotics. The program compares the susceptibility of bacterial isolates in specialist and general hospital patients and correlates the information with resistance trends.

Delegates found that the study provided firm evidence that certain antibiotics, especially carbapenems, continue to be effective. "In some participating hospitals, resistance to antibiotics such as the penicillins, cephalosporins, aminogylcosides and fluoroquinolones has increased dramatically," noted Dr. Ronald Jones, Mystic summit meeting chairman and team leader. "Mystic has a pivotal role to play in global surveillance, and we need to continually share information and be prepared to modify and improve the program to help hospitals change their prescribing practices to minimize resistance," he said.

"[Drug resistance] is a problem faced in both rich and poor communities, in industrialized as well as developing countries," Heymann said. "It has different roots in different societies – overuse of drugs in many developed countries and underuse in poorer nations – but the net result and the imminent danger are the same."

Pain management developments

Effective pain relief over a longer period of time is claimed by Willi Rusch (Kernen, Germany) with the PainBuster Soaker pain management system for alleviating moderate-to-severe pain following surgery. The system provides continuous infusion of a local anesthetic agent into the site of the wound with the special Soaker catheter, which is designed to provide even distribution of the anesthetic agent over a wide area.

Soring Medizintechnik (Quickborn, Germany) uses a different approach with ultrasound-assisted wound treatment for chronic wounds. The Soneco 180 uses an anesthesizing wound treatment solution containing heparin in the ultrasound-assisted treatment, which results in non-lesional wound debridement, reduction of bacterial growth with a bacterial effect, and alleviation of pain.

The Perfusor Compact S syringe pump from Braun Melsungen (Melsungen, Germany) has been developed to provide the very low infusion rates for analgesics and other therapies for pediatric and neonatal use. Calculation of the infusion rate, based on volume and time pre-selection, is automatic, with rates of between 0.01 ml/hour and 200 ml/hour possible. The pump provides enhanced delivery characteristics at infusion rates less than 1 ml/hr.

Medical gas industry changes

Air Products (Allentown, Pennsylvania) has acquired the Home Care Organization unit of Messer Griesheim (Krefeld, Germany) for an undisclosed price. The unit provides medical gases on a home delivery basis to 30,000 patients in Germany.

Praxair (Danbury, Connecticut) has simultaneously bought the Messer Griesheim Canadian subsidiary, Respircare (Ottawa, Ontario), which has 14 locations across Ontario providing medical gases on a home care basis.

Air Liquide (Paris) has bought from Associated Respiratory Holdings the balance of 30% of the shares of VitalAire Canada to become sole owner. VitalAire provides medical gases to hospitals throughout Canada, with revenues of $70 million in 2000.

Linde (Wiesbaden, Germany) has reported European Community clearance for its INOmax inhaled nitric oxide gas as a pharmaceutical for use with neonates and patients with respiratory difficulties. This is a significant milestone for Linde, which is pressing hard to increase its market share in European medical gases. Last year, the company reported INOmax sales of $405 million out of total worldwide revenues of $3.4 billion. Linde subsidiary INO Therapeutics obtained FDA clearance for INOmax at the end of 1999.

Robotic palpation at a distance

Philippe Arbeille of the University Hospital Trousseau (Tours, France) and his group have developed a remotely controlled robotic system that enables a physician to examine by palpation and ultrasound a patient some distance away.

In collaboration with the University of Orleans (Orleans, France), and France Telecom, the French national telephone service, they have designed a system that is in clinical trials. Not only can an echographic examination of a pregnant patient be made at a distance, but also diagnosis of nephritic colitis, phlembitis, acute appendicitis and certain cardiac valvular insufficiencies. "In all these cases, echography with palpation is the simplest and most effective diagnostic mode," Arbeille said.

This form of tele-echography makes possible urgent diagnosis or distance consultation with specialists for each of these pathologies. Smaller and more isolated hospitals are particularly interested in this system, Arbeille said. At Tours, the research team has developed the "slave" robot that will operate next to the patient, reproducing the movements of the specialist physician. The robot is equipped with pneumatic rubber "muscles" so that the ultrasound probe is correctly positioned on the patient's stomach.

"Often, surgical robots are industrial models modified by researchers," said Jocelyne Troccaz, group leader at Tours. Such robots are capable of producing considerable force and therefore pose problems in medical use. That is why the Tours group has developed a miniature robot weighing less than five pounds so as to reduce risks as much as possible.

The robotic vision laboratory at the University of Orleans has developed the "master" station controlled by the consulting physician, who can use either a virtual reality visor or work in front of a normal screen.