If you think you’ve heard the worst about drug-resistant bacteria, consider this: According to the Infectious Disease Society of America (IDSA), just one such drug-resistant bug, a strain of Staphylococcus aureus (MRSA), kills more Americans every year than emphysema, HIV/AIDS, Parkinson’s disease and homicide combined.
And consider this: In March 2013, the U.S. Centres for Disease Control and Prevention warned of a 400-per-cent increase in another drug resistant bacteria — carbapenem-resistant Enterobacteriaceae (CRE) — which kills up to 50 per cent of the people it infects and which the CDC therefore labelled as a “nightmare” bacteria.
And finally, consider this, which is most worrying of all: While the population and virulence of drug-resistant pathogens have been exploding, our effort to combat such pathogens has been imploding. That, in effect, is the message of a new report from the IDSA and published in the journal Clinical Infectious Diseases.
Although combating drug-resistant bacteria requires a multi-pronged approach, the IDSA has for nearly a decade been calling attention to the development, or lack thereof, of new antibiotics. This led to the 2010 launch of its 10 x ’20 Initiative, which called for the development of 10 new antibiotics for drug-resistant pathogens by 2020.
However, in its new report, the IDSA notes that thus far only one new drug has been developed. In fact, the U.S. Food and Drug Administration approved only two new systemic antibacterial agents between 2008 and 2012 — a far cry from the 16 it approved between 1983 and 1987.
This reduction in antibiotic production is in large part the result of a corresponding reduction in antibiotic research and development among pharmaceutical companies. And the reason for this reduction is simple: While drugs for chronic diseases such as high cholesterol, diabetes and cancer are administered for long periods of time, and in many cases, for a patient’s lifetime, antibiotics are typically taken for short courses.
Consequently, antibiotics provide only a fraction of the financial rewards of other drugs, and hence their development has been de-emphasized by most pharmaceutical companies. Indeed, according to the IDSA report, only four large multinational companies remain in antibiotic R&D — and one of these, AstraZeneca, has already signalled its intention to reduce further investments in antibiotics.
Hence, if we are to reinvigorate development of antibiotics, and in particular those that can combat drug-resistant pathogens, it’s imperative that governments around the world provide incentives for antibiotic R&D. Among other things, this could include R&D tax credits and grants and contracts, along with public-private partnerships that provide supplemental means of supporting antibiotic research.
But while the development of new antibiotics is essential, a multi-pronged approach must look to other measures as well.
Consequently, the IDSA recommends “improved infection prevention and “antibiotic stewardship,” which includes measures that health care facilities, providers and even patients can take to preserve the life-saving power of antibiotics by limiting their inappropriate use.
So yes, we must ensure that pharmaceutical companies develop new and better antibiotics and that our governments provide incentives for them to do so. But just as surely, we must do our part by using the antibiotics we have in a judicious and responsible way.
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