NZ deaths lead to new drug - 40 years later

An American doctor who answered a call for help over a medical mystery 40 years ago says he is pleased to see his research come full circle. File photo / Thinkstock

An American doctor who answered a call for help over a medical mystery 40 years ago says he is pleased to see his research come full circle and produce a drug which offers a solution to the problems which killed patients in several New Zealand hospitals in 1970.

Dr Sherwood Gorbach said he received an urgent call from a drug company after significant numbers of New Zealand patients treated with its antibiotic, lincomycin, developed severe cases of diarrhoea and bowel inflammation. Some of them died.

Dr Gorbach spent years tracking down the cause of other similar outbreaks in the United States and pursuing treatments.

"I was called by The Upjohn Company, an American pharmaceutical company located in Michigan, about the cases since they were all associated with their drug, clindamycin," he told NZPA.

Eventually Dr Gorbach and other researchers identified toxin-producing clostridia bacteria in 1978 as the likely culprits in such cases.

But their research was triggered by two noted New Zealand gastroenterologists, Alistair Scott and Gordon Nicholson, at Auckland Hospital and the Auckland Medical School, and Alan Kerr, a cardiothoracic surgeon at Green Lane Hospital.

Their paper, Lincomycin as a Cause of Pseudomembranous Colitis, detailed eight patients who acquired gut infections while being treated for other ailments. Seven had been treated with lincomycin, and three of them died.

The illness -- fever, severe abdominal cramps, and diarrhoea with blood and mucus -- was accompanied by inflammation and bleeding from the lining of the colon, which took on a characteristic appearance called "pseudomembranes".

It is now known that some bacteria normally in the gut can run amok when broad-spectrum antibiotics kill off other, harmless, bacteria competing with them. The Clostridium difficile bacteria produce toxins that cause inflammation of the colon lining, severe diarrhoea and, in the most serious cases, death. They are resistant to many antibiotics.

New Zealand had made only limited use of the Upjohn company's drug from its introduction in 1966, but it became available free of charge in April 1972.

"The increasing frequency of the condition ... parallels the increasing use of lincomycin in this community," the doctors said in The Lancet in December 1973. "It must be anticipated that the related drug clindamycin will also be associated with this disease.

"Our experience suggests the lincomycyin should be used with caution," they warned.

Clostridium difficile kills about 5 per cent of its victims and another 1 per cent of patients must have their colons removed. Many patients are elderly people in hospitals or nursing homes, but younger adults and children can also be infected.

In 2003, Dr Gorbach was asked for advice by another pharmaceutical company, Optimer, and realised that hamsters treated with fidaxomicin had remained healthy even after treatment stopped. In 2005, he joined the company, and became its chief scientific officer.

"All the other drugs, when you stop the treatment, they all die within two or three days," he told the New York Times.

"This was an opportunity for me to see a drug through that could really make a difference in people's lives," he said. "It's thrilling to be part of this and see the full circle."

This month, the USA's Food and Drug Administration approved the drug, branded as Dificid, as the first new medicine in 25 years approved to treat diarrhoea caused by C.difficile.

- NZPA