Warning over antibiotic use

Bacteria may build up resistance to all antibiotics

Hospitals may be neutralising their last defence against superbugs by routinely using a powerful antibiotic, say researchers.

Vancomycin can prevent wound infection after surgery.

However, instead of using it sparingly, some hospitals are using the drug as routine.

Experts fear this overuse increases the risk that drug resistant superbugs will be created for which medicine has no answer.

Vancomycin usage is like firing your last remaining bullet

Dr David Jenkins, Leicester Royal Infirmary

If a life-threatening microbe like MRSA became fully resistant to vancomycin it would prove virtually untreatable.

MRSA (methicillin resistant staphylococcus aureus) is a major problem in hospitals. Already vancomycin is one of the few antibiotics that remains an effective treatment.

Dr David Jenkins, a clinical microbiologist at Leicester Royal Infirmary, said: "It's a potential problem. A lot of microbiologists are concerned that vancomycin usage is like firing your last remaining bullet.

"It is active against a wide range of bacteria, and until now has been regarded as one antibiotic you can rely on.

"But in the last three years or so there have been a growing number of reports world-wide of particular strains of bacteria that are becoming less sensitive to vancomycin."

Dr Jenkins said it was unclear how many hospitals routinely used vancomycin. He said it was probable that many did.

Exeter case

New Scientist magazine highlights the case of the Royal Devon and Exeter Hospital, where doctors were said to have given vancomycin to every patient operated on following a bad outbreak of infection last year.

Antibiotics are used to prevent infection following surgery

Terry Riordan, one of the Exeter team that took the decision, was quoted by New Scientist saying there was only a "small theoretical risk of resistance".

He said patients at the hospital were given single doses of the antibiotic, and vancomycin resistance was only likely to arise from prolonged courses.

However Dr Jenkins disagreed that there was any safe dose limit.

Consultant epidemiologist Richard Mayon-White, from Oxfordshire Health Authority, also questioned whether resistance could be avoided by giving single doses.

"Using it in more people increases the likelihood of giving the antibiotic to somebody who is carrying an organism poised to become vancomycin resistant.

"If you are giving it to large numbers of patients, the single doses add up," he told New Scientist.

Dr Jenkins said one of the biggest risks was that of a relatively harmless bug transferring its resistance to a highly dangerous one.

It had already been demonstrated in the laboratory that genes from vancomycin resistant Enterococcus bacteria - a non-life threatening organism - can be transferred to MRSA, making it impervious to the antibiotic.

Dr Brian Duerden, medical director of the Public Health Laboratory Service in London, said he sympathised with surgeons who wanted to use the most effective method possible to protect their patients from infection.

He said: "The downside of using vancomycin is the chance of breeding resistance over a long period of time."

He said it was important to monitor patients for emerging resistance and to look for alternative drugs equally good as vancomycin.