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VIRULENT MICROBES, such asEscherichia coli O157, are emerging at a frightening rate. And many disease organisms are becoming resistant tomodern antibiotics.

Some researchers warn that the antimicrobial ingredients in soaps and other household productscould contribute to the problem.

Killing bacteria is like hitting a moving target--just whenyou think you've got them, they mutate on you. Through the overuse and misuse of antibiotics, doctors and farmers haveunwittingly spawned or accelerated the development of strains of bacteria that survive conventional antibiotic attack. Tokeep drugs potent, many in the medical community preach judicious use of antibiotics and teach patients to take their fullcourse of medication. But just when the tide may be turning in the medical world, new battle lines are forming in unlikelyplaces--America's kitchens and bathrooms.

The marketing of antimicrobial soaps, hand lotions, sponges and kitchensurfaces has increased in recent years. These novel products contain bacteria-busting compounds such as zinc pyrithione,hydrogen peroxide or, most commonly in soaps, triclosan.

But such germ killers could perversely lead to more harmfulstrains in the home, according to Stuart B. Levy, a medical researcher at Tufts University. Levy decried the growing casualuse of these products at "Modern Plagues: Emerging and Re-Emerging Infectious Diseases," a symposium sponsored by theWhitehead Institute for Biomedical Research and the Massachusetts General Hospital this past May. "Antibiotics are societaldrugs," said Levy, author of The Antibiotic Paradox: How Miracle Drugs are Destroying the Miracle (Plenum Press,1992). "Any use affects what's out there."

Resistant strains of bacteria generally emerge through evolutionary selection: inany situation where antibiotics are used, cells that can survive exposure to the drugs gradually replace their more vulnerablecousins. Hospitals, where both antibiotics and germs are abundant, have long been recognized as unintentional breedinggrounds for resistant bacteria. Two hospitals in the same city may be confronted with two different sets of resistanceproblems, depending on individual patient populations and the way antibiotics are used.

Domestic antibacterials aredistinct from medical antibiotics, but they may pose a parallel danger. Levy cautions that just as every hospital develops itsown antibiotic-resistance profile, resistance within an individual home's microbial ecology could be altered by the misuse ofhome antibacterial products. The risk runs from hardier E. coli to tougher Streptococcus pyogenes andpneumococci. "I'm not saying it's a problem," he noted. "It's a potential problem."


WINNING THE RACE? The Harvard Medical School's Mary E. Wilson, predicts thatinfectious disease "will be with us for the foreseeable future."

To prevent the potentialfrom becoming a reality, Levy urges that people not use such products regularly. Rather, they should save the antibacterialsfor critical situations, such as when a patient returns from the hospital. Then, the sudden appearance of the bacteria-fightingagents can indeed wreak havoc on a local microbial population that is not yet used to dealing with them. But manufacturersusually tout their antibacterial soaps and lotions as suitable for everyday use.

A recent surge in the attention paid to theissue of antibiotic resistance attests to the medical community's recognition that the heady days of easy antibiotic and vaccinevictories are over. In 1969, U.S. Surgeon General William Stewart testified before Congress that we could "close the book oninfectious disease." The hard-won wisdom of 1997 was summed up by another symposium participant, the Harvard MedicalSchool's Mary E. Wilson, who has closed the book on Stewart's hubris. "Infectious disease," she pronounced, "will be with usfor the foreseeable future."

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