The Real Threat of Antimicrobial Resistance
As the pool of companies developing new antibiotics continues to shrink, the threat of antimicrobial resistance intensifies. Greater investment is needed, with millions of lives potentially depending on it.
This is an antibiotic.
It represents one of the breakthrough medical discoveries of the 20th century. Used to treat bacterial infections, antibiotic substances are naturally occurring yet can also be chemically synthesized.
One class of antibiotics is called carbapenems, which are often used to treat serious infections in hospitals. There are a plethora of infectious diseases—pneumonia, bloodstream infections, urinary tract infections, and more—that can impact anyone, but are more serious for those who are weakened, such as the elderly and newborn, or are already sick. That’s why antibiotic use in hospitals, and the use of carbapenems in particular, is so vital.
Unfortunately, because of the speed with which bacteria and other microbes evolve to become resistant to antibiotics, the WHO has found that carbapenem antibiotics are ineffective in treating half of pneumonia cases in some countries.
How do antibiotics lose their effectiveness?
As with other living organisms, bacteria and microbes follow an evolutionary process over time. When a pressure or threat such as an antibiotic is introduced into a microbial population, some bacteria are able to survive and reproduce. This is because they possess genetic variations that make them resistant to the effects of the antibiotic, while those bacteria without these genetic variations prove susceptible to the antibiotic and die off. Whereas complex organisms like primates require hundreds or thousands of years to evolve advantageously, microorganisms like bacteria can literally evolve overnight.
AMR endangers effective treatment for the following:
- E. coli
- Staph infections
- Fungal infections
What has driven the speed of antimicrobial resistance?
Though AMR is a natural process, it has been expedited by human practices related the administration of antibiotics. When antibiotics are taken by people with viral infections (such as common colds and coughs), the virus itself isn’t affected, but the body’s natural bacteria are able to develop resistance to that kind of antibiotic.
To resolve this problem, both physicians and patients must use antibiotics responsibly. For physicians this means prescribing antibiotics only to treat bacterial infections, and for patients this means taking the full regimen of prescribed antibiotics.
There is more work to be done, though.
The entire health care industry knows it. In 2016, more than 100 companies and groups signed the Davos Declaration, which called for “collective action to create a sustainable and predictable market for antibiotics, vaccines, and diagnostics.”
The industry also recognizes that public education is an important tenet of battling AMR. Across multiple continents, a number of leading figures in industry and education have launched Massive Open Online Courses (MOOCs) on antimicrobial stewardship, the purpose of which is to educate everyone from practicing physicians to clinical pharmacists about the proper use of antibiotics. The pharmaceutical industry and government agencies also sponsor detailed, online databases that, over time, collect information about the prevalence of different bacterial infections, bacterial resistance rates, antibiotic efficacy, and other issues related to AMR. This information is made available to health care providers and professionals, whether they’re conducting research or creating treatment plans for ill patients.
We must start thinking ahead.
Vaccines are one important aspect of combating AMR, since they have the potential to prevent some bacterial infections from ever occurring in a human host, eliminating or reducing the need to use antibiotics. For example, one study by the CDC surveying the pneumococcal bacteria present in child populations showed that vaccine administration resulted in a marked decrease in drug resistance over time—a 93 percent decrease, in fact, of isolates that were resistant to single antibiotics. National immunization initiatives and a dedicated pipeline for new vaccines could help address the health and economic impact of AMR.
But vaccines don’t render antibiotics unnecessary. A report from the World Health Organization in September 2017 listed only eight antibiotics and biologics in development that are classified as “innovative” and adding value to our current range of antibiotic treatments. The pharmaceutical industry has encouraged a new regulatory framework that would incentivize and more efficiently fund the research, development, and release of new forms of antibiotics.
New antibiotics require billions of dollars from discovery to launch, a staggering cost that illuminates the desperate need for research funding in antibiotic innovation. That cost—and the relatively low profit generated by antibiotic sales—discourages pharmaceutical companies from focusing on this vital health care need. In the 1990s there were 14 companies performing research and development; by 2013, that number had dwindled to four. Further there has not been a new class of antibiotics discovered since 1984, and the current pipeline of drugs is not sufficient to meet the public health needs. Therefore, additional government incentives are needed to significantly increase sustainable investment across all stages of research and development.
Along with ongoing vaccination campaigns and public education about antibiotic misuse, it is imperative that continued, strengthened innovation in antibiotics remain a priority for government and industry alike.
Millions of lives could depend on it.