Before the discovery of antibiotics in the 1940s, little could be done for patients with bacterial infections. People either recovered on their own or died.

The problems of the past are returning gradually, courtesy of the new "superbugs," bacteria untreatable by most antibiotics. These bugs are the hardy few survivors among those who have been hit with antibiotics. The survivors multiply as only bacteria can do, and they grow more resistant over time.

A 12-year-old Ramona boy, Carlos Don IV, died recently from such an infection. His story is more than a family tragedy; it's an example of how difficult it is to tell the difference between an ordinary illness and something much more deadly.

Mystery illness

Carlos was an active, energetic child at Hanson Lane Elementary School. A winner of state motorcycle races, he wanted to be a professional football player. So getting some fun in the outdoors at Camp Cuyamaca, which he attended in mid-January, was totally in keeping for him.

But after Carlos returned home on Jan. 19, he fell ill, becoming short of breath. At first, it appeared as if he had a cold or the flu; there had been an outbreak of some illness among half the students at the camp. This was later found to be a flu outbreak.

However, this didn't explain Carlos' symptoms, which were far worse than those of his campmates. Over the next few days, it became clear that he was not getting well on his own. In addition to having trouble catching his breath, Carlos' heart began beating rapidly.

Carlos was rushed to an urgent care clinic, given antibiotics and taken home. He began to hallucinate, said Carlos Don Sr., his grandfather, who is acting as spokesman for the family.

Carlos was hospitalized at Rady Children's Hospital, where he was put on oxygen. It didn't help. By Jan. 25, doctors had figured out that he had contracted a notorious superbug known as methicillin-resistant staphylococcus aureus, or MRSA.

The question was, where?

MRSA is well-known inside hospitals, where it has been a known danger for years. One patient who contracts it can leave it behind to infect other patients, who by definition are usually not in good health. Medical experts have found that this superbug usually doesn't harm healthy people. Staphylococcus aureus is a common resident inside the nose, as is the antibiotic-resistant variety known as MRSA.

In most cases, MRSA infections can be traced to exposure in a hospital or other health care facility. But not in Carlos' case. He had what is known as "community-acquired MRSA," shorthand for saying its origin was unclear.

What became clear, said Carlos Don Sr., was that Carlos' immune system had been knocked down by the flu, making the lining of his respiratory tract more vulnerable to infection. Lesions left from the flu let the bacteria infect his lungs, causing pneumonia. And once established in the lungs, the bacteria coursed throughout his body.

Carlos was placed in a medically induced coma in an attempt to slow the infection. His legs became infected, killing tissue from the toes and spreading to the feet and up the calves. Doctors feared the legs would have to be amputated.

That fear was overtaken by events: Carlos died on Feb. 4.

What happened to Carlos was a combination of a lack of ability to quickly determine the cause of his illness and just plain bad luck, said Carlos Don Sr.

"We're just upset that they didn't have the right technology to isolate this sooner, or (have) the medicine," he said. "If we see some good come out of this, then it wasn't in vain."

Prevention as protection

It's still possible in some cases to knock down MRSA before it gets a firm foothold if the right antibiotics are given quickly. But doctors are reluctant to give antibiotics without a proper diagnosis. Overuse of antibiotics is what has helped speed the development of antibiotic-resistant bacteria. Also, some antibiotics have toxic side effects, so they're not used except in an emergency.

Improved antibiotics that can tame these superbugs are a long way off. A number of pharmaceutical and biotechnology companies are researching new drugs, but it takes years to find potential drugs and test them in cell cultures and animals before they reach human clinical trials.

And even then, it takes years to get marketing approval, if the drugs work. Most drugs fail clinical trials.

Public health officials say the best way to deal with the superbugs is by being diligent about good hygiene. Frequent hand-washing helps, as does being careful not to share personal items. Dishes should be washed in hot soapy water and dirty clothes laundered promptly.

Bacteria are normally present on the human body, including the "staph" species that can cause MRSA. Most of the time, staph is harmless. But when the skin barrier is broken, such as through a cut, staph can enter the body to cause an infection. Staph germs can also show their presence by causing a skin boil.

Staph infections differ in their ferocity from minor nuisances to life-threatening, depending on how virulent the particular strain is. Hand-washing and other hygienic measures help ensure that dangerous strains of staph or other bacteria don't get passed around.

If you've got a skin infection, especially a persistent one, see your doctor. Cover up the infection with a bandage or other dressing, and dispose of used dressings properly so the germs don't spread. More information about MRSA is available from the U.S. Centers for Disease Control and Prevention: http://www.cdc.gov/ncidod/aip/research/mrsa.html.

Urgent push

Many medical experts think antibiotic resistance is encouraged by the common practice of giving antibiotics to livestock to help them grow faster. Many bacteria that commonly inhabit animals can also infect humans. There is no ironclad proof that this happens, but the experts say it is a reasonable possibility, and as such warrants precautions.

The process never stops. As better antibiotics kill bacteria, the few that do survive become even harder to kill the next time around, and stronger antibiotics are needed.

The public should demand that the federal government put more of a priority on developing new antibiotics to kill the superbugs, said Victor Nizet, an associate professor of pediatrics in the infectious diseases division of UC San Diego School of Medicine.

"We'd like the pharmaceutical industry to be able to handle this on their own, but you can't wait for the market to catch up," Nizet said.

Contact staff writer Bradley J. Fikes at (760) 739-6641 or bfikes@nctimes.com.

Prevention is the key

Medical professionals stress that prevention is the best way to handle superbugs: Wash your hands frequently, don't share personal items and see a doctor if you get an infection, especially if it doesn't appear to be healing in a few days. And if you're prescribed antibiotics, take them all and don't stop just because you feel better. Start-and-stop antibiotic use contributes to antibiotic resistance.