The demise of antibacterial drug discovery, combined with increasing resistance, is pushing the world towards the unthinkable scenario of untreatable infections. In a paper published Online First in The Lancet Infectious Diseases, Professor Laura Piddock, School of Immunity and Infection at the University of Birmingham, UK, and President of the British Society for Antimicrobial Chemotherapy (BSAC), stresses the urgency of the situation and the actions needed to turn it around. The paper is timed to coincide with European Antibiotics Awareness Day on Friday November 18.
The public has become so accustomed to the ease of access to antibiotics that there is no sense of urgency about either the lack of new drugs, or the essential job existing antibiotics have in extending life. A wide range of medical procedures, including many on the immune-weakened elderly, depend on use of antibiotics to keep away opportunistic infections. Even relatively simple procedures, such as transrectal prostate biopsy, commonly used in prostate cancer detection, are being complicated by antibiotic resistant infections. Professor Piddock says: "When patients are denied treatment with a new cancer drug because of its expense, there is public outrage despite the possibility of extending life by only a few weeks. Antibiotics are not perceived as essential to health or the practice of medicine, despite such agents saving lives so that individuals can live for many years after infection."
2 years ago, WHO announced antibiotic resistance as one of the three biggest threats to health. Yet politicians, the public, and the media have been slow to appreciate the urgency of the situation. On Thursday, November 17, the EU launches the Commission's 5-year Action Plan on Antimicrobial Resistance (AMR). Organisations such as The Infectious Diseases Society of America, ReACT (Action against Antibiotic Resistance), and the BSAC have also been active with various campaigns, but there remains as yet no globally joined up movement to push antibiotics to the top of health agendas. BSAC's Antibiotic Action campaign hopes to change this (see below).
The problem is particularly acute for treatment of Gram-negative bacterial infections such as those caused by Acinetobacter baumanii, Pseudomonas aeruginos, and multi-drug resistant Escherichia coli. Industry interest in antimicrobial drug development has dwindled due to a number of factors: mergers of pharmaceuticial companies, lack of profit in such drugs since they are usually short-course treatments and resistance can develop quickly, and the onerous regulatory barriers that must be overcome for a drug to be approved. A serious problem is the nature of drug trials in this field, which recruit people who are infected but not necessarily with the bacteria the drug is aimed to kill, thus this would affect efficacy results. However, Professor Piddock points out this drawback can be overcome by using point-of-care tests to identify the exact bacteria causing the infection, and eliminating that person from the study if it is not the bacteria being targeted. This approach would reduce the number of people required for a trial (currently prohibitively high) and also make sure participants in the study get the drug targeted to their infection.
To overcome the barriers to new antibiotic discovery and development the profile of this issue needs to be raised. To achieve this goal, the British Society of Antimicrobial Chemotherapy launched Antibiotic Action. This campaign has already obtained worldwide support including from the Infectious Diseases Society of America, ReACT, charities, and not-for-profit agencies for whom the treatment of patients that they represent is reliant on effective antibiotics. Professor Piddock says: "As absence of new antibiotics affects everyone, shifting this issue out of the medical arena and into the public eye is paramount, which will stimulate governments to act. To do this, Antibiotic Action is using the latest communication methods including Twitter;this approach will assist as many individuals as possible to sign one of two on-line petitions, one for UK citizens and another for those from outside the UK." (antibiotic-action.com/petition/)
Professor Piddock says that just as the GAVI Alliance and the Bill and Melinda Gates Foundation have successfully delivered vital vaccines worldwide, a similar model could be used to encourage new antimicrobial development. She concludes: "Antibiotic Action will seek to unite and extend its activities with partner organisations worldwide so that this global alliance is established. However, until a global alliance for antibiotic drug discovery and development is formed, pharmaceutical companies need to recognise that many expensive medicines in their portfolio and in development might by useless if patients succumb to fatal infections. Therefore, their return on investment for products to treat cancer or chronic diseases depends, in part, on effective treatment of infections. This fact alone should be an incentive for pharmaceutical companies to continue or re-enter antibiotic development."
The Crisis of No New Antibiotics: No Action Today, No Cure Tomorrow
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