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Federal authorities have spent much of this week looking for people who may have been exposed to a man suffering from a dangerous form of tuberculosis. It's described as drug-resistant TB, which means what it says - that strain of tuberculosis does not respond to many antibiotics.

We wanted to find out how common it's become for strains of disease to become drug-resistant, so we brought in Dr. Anthony Fauci. He's director of the National Institute of Allergy and Infectious Diseases.

Welcome to the program.

Dr. ANTHONY FAUCI (Director, National Institute of Allergy and Infectious Diseases): Good to be here.

INSKEEP: Drug-resistant TB is a phrase that people have heard a lot on recent days. Are there other diseases out there that you would describe the same way?

Dr. FAUCI: Oh, plenty. Drug-resistant TB is one of many, many examples of microbes that develop a resistance to the standard antimicrobials that are generally used successfully against them. And in fact, it has really put a damper on the extraordinary advances that have been made over decades and decades of antimicrobial agents, antibiotics, antivirals, because sooner or later microbes have the capability of being able to evolve towards protecting themselves from what we, the human species, do to blunt them.

INSKEEP: So what are some other diseases out there that people maybe didn't worry much about 10 or 20 years ago that now have strains that can kill you?

Dr. FAUCI: Well, I think staphylococcus is the prime example of that.

INSKEEP: Staph infection. That's how people refer to it.

Dr. FAUCI: Yeah, typical staph infection. Some of them are more severe than others, but within a few years of the introduction of the penicillins back in the '50s, these staphylococci developed a resistance. And then a new generation of drugs, methacillin, was developed, and they were very well treated with methacillin. And then very soon thereafter methacillin-resistant staphylococcus came in. Over a period of time, when you use antibiotics, you can actually make the resistance phenomenon come sooner rather than later.

INSKEEP: How's that happen? You kill off the weak ones, and the strong ones survive?

Dr. FAUCI: Microbes, as they replicate, are continually able to mutate and divert themselves around. So if you go with an antibiotic that's successfully treating a microbe, there will always be a small fraction of the microbe that under most circumstances wouldn't be a problem, but when you get rid of all the sensitive microbes with the antibiotic, then those other strains that were generally minor the strains start to take over. The problem is, they are resistant to the antibiotic. And then they become the predominant microbe in a particular infection.

INSKEEP: Are we accelerating this process by the way that we use antibiotics?

Dr. FAUCI: Unfortunately, yes. There is a considerable amount of what we call inappropriate use of antibiotics. People come into a doctor's office, they don't have a bacterial infection, they have a viral infection, but they want an antibiotic, thinking it's going to make them better more quickly. If you inappropriately treat somebody with antibiotics, you will select for the less benign component of that.

INSKEEP: You will get rid of the ones you don't have to worry about...

Dr. FAUCI: Exactly.

INSKEEP: ...and the ones that you do have to worry about have more room to grow.

Dr. FAUCI: Precisely.

INSKEEP: Is the pharmaceutical industry coming up with new antibiotics as rapidly as the old ones become less useful?

Dr. FAUCI: Unfortunately, the answer to that is no. There is not that much of an incentive for pharmaceutical companies to make new antibiotics, because, first of all, antibiotics generally are not used on a daily basis year-round. Pharmaceutical companies like to get a new blockbuster drug that somebody like you and I will use every day.

INSKEEP: The purple pill to help you with that condition which - yeah.

Dr. FAUCI: Well, lipid-lowering agents, blood pressure agents, new types of Viagra and things like that - the things that people use over a long period of time. Antibiotics are effective, but it is not a long-term, major investment usually. Occasionally you got a brand new blockbuster antibiotic, but that is more unlikely than it is likely.

INSKEEP: Can you anticipate a time when we might have to accept much higher rates of infectious disease and death, perhaps like we had a century ago?

Dr. FAUCI: No. I think that is the thing that looms there. It's a threat. I will not submit that we have to accept one day that that's what's going to happen. I have confidence that the research community will keep up. But it's not going to happen automatically. It's going to be kind of an agreement between the fundamental research community and the developmental community and the pharmaceutical organizations. If we get asleep at the switch, then it'll happen. But we should not allow that to happen.

INSKEEP: Dr. Anthony Fauci, thanks for coming by.

Dr. FAUCI: It's great to be here.

INSKEEP: Anthony Fauci is head of the National Institute of Allergy and Infectious Diseases. That's part of the National Institutes of Health. And you can read more about how TB becomes drug-resistant by going to npr.org.

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