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mosquito repellent. Regardless of the repellent chosen, Here’s the WHO list of superbugs:
it is vital for patients to follow all instructions/precau-
tions in the product labeling to ensure safe and effective Priority 1: CRITICAL
use.” 2016;36(12):1272–1280. 1. Carbapenem-resistant Acinetobacter baumannii
2. Carbapenem-resistant Pseudomonas aeruginosa
3. Carbapenem-resistant, ESBL-producing
n n n Enterobacteriaceae

WHO Superbug List: Priority 2: HIGH
Enemy No. 1 Is Bug That Plagues Soldiers 1. Vancomycin-resistant Enterococcus faecium
2. Methicillin-resistant, vancomycin-intermediate and
As reported by Maggie Fox (http://www.nbcnews.com resistant Staphylococcus aureus
/health/health-news/who-s-superbug-list-enemy-no 3. Clarithromycin-resistant Helicobacter pylori
-1-bug-plagues-soldiers-n726311), “Drug-resistant germs 4. Fluoroquinolone-resistant Campylobacter and
that caused horrible wound infections among soldiers in Salmonellae
the Vietnam conflict and bloodstream infections among 5. Cephalosporin- and fluoroquinolone-resistant
military patients in Iraq and Afghanistan top a new list Neisseria gonorrhoeae
of superbug enemies put out by the World Health Or-
ganization. It’s the first-ever priority list written up by Priority 3: MEDIUM
WHO, which wants to push drug companies and gov- 1. Penicillin-resistant Streptococcus pneumoniae
ernments to put money and effort into developing new 2. Ampicillin-resistant Haemophilus influenzae
and better antibiotics. 3. Fluoroquinolone-resistant Shigella

“At the top of the list are carbapenem-resistant Acineto-
bacter baumannii and two other bacteria that resist the n n n
effects of carbapenem antibiotics—the big guns in the
medical arsenal. They are not common among healthy Bad Medicine, or sometimes the only thing worse
people but are extremely resistant to drugs and lethal to than being excluded from a clinical trial is being
infected patients. included
Freakonomics Radio, an American public radio pro-
“‘Certainly Acinetobacter are something that we have gram that discusses socioeconomic issues for a general
seen in our returning military service people,’ said Dr audience, is hosted by journalist Stephen Dubner, with
Helen Boucher of the Infectious Diseases Society of economist Steven Levitt as a regular guest and presented
America.” as a weekly podcast.

Dr Rupa Kanapathipillai of Doctors Without Borders In a three-part series, Stephen J. Dubner looks at the
said drug-resistant infections are a big problem in devel- mistakes produced by centuries of trial-and-error and
oping countries and especially in areas of conflict. asks whether the new era of evidence-based medicine is
the solution. The following is an excerpt from the sec-
“We see—with alarming regularity—the critical-listed ond podcast.
bacterial infections in people we treat in the field, in-
cluding babies and children, burn victims and conflict VINAY PRASAD [oncologist and an assistant professor
and trauma injuries,” said Kanapathipillai. “It’s getting of medicine at Oregon Health and Science University]:
harder to treat people for drug-resistant infections in the So much of the research agenda, even the randomized-
resource-limited settings in which we work. With the trial research agenda, is driven by the biopharmaceutical
priority pathogen list, we need to urgently see new an- industry. And that’s not necessarily a bad thing. I think
tibiotics developed that are affordable, appropriate and there’s many good things about that, that really drives
accessible to fill a depleted drug pipeline.” many, many trials; it drives a lot of good products. It

152 Journal of Special Operations Medicine Volume 17, Edition 1/Spring 2017