The world is moving towards the unthinkable scenario of untreatable infections as fewer antibacterial drugs are discovered and more and more people are becoming resistant to existing drugs, researchers from University of Birmingham, England, reported in The Lancet Infectious Diseases. The article coincides with the European Antibiotics Awareness Day, and warns about the urgency of the situation and the actions needed to turn it around.

People have become so used to antibiotics being readily available that there is no sense of urgency regarding the lack of new drugs, or in existing antibiotic’s essential tasks to prolong life.

A wide spectrum of medical procedures, including many elderly people whose immune system has weakened, rely on antibiotics to fend off opportunistic infections. Even fairly simple procedures, for example, transrectal prostate biopsies that are typically used to detect prostate cancer, become problematic because of antibiotic resistant infections.

Author Professor Laura Piddock explains:

“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.”

According to an announcement made by the WHO (World Health Organization) 2 years ago, antibiotic resistance is one of the three biggest health threats, yet politicians, the public, and the media have been slow to understand the urgency of the situation.

The EU (European Union) launched the Commission’s 5-year Action Plan on Antimicrobial Resistance (AMR) on Thursday, November 17, which is supported by organizations including The Infectious Diseases Society of America, ReACT (Action against Antibiotic Resistance), and the BSAC which have also been active with various campaigns.

However, so far there is no global collaboration in existence to push the antibiotic issue to the top of the health agendas, although the BSAC’s Antibiotic Action campaign anticipates changing this (see below).

The current concern applies in particular to treatment of Gram-negative bacterial infections, like those caused by Acinetobacter baumanii, Pseudomonas aeruginos, and multi-drug resistant Escherichia coli.

Various factors have contributed to a dramatic decrease in industries losing interest in pursuing antimicrobial drug development, including pharmaceutical company mergers, small profit margins of these drugs, as they usually consist of short-term treatments with the ability to develop resistance quickly, as well as the burden of regulatory barriers that have to be overcome to achieve a drug’s approval.

Put simply: The pharmaceutical industry finds that after spending a lot of money developing a new drug, they are then faced with many regulatory barriers, only to find that when their new medication is finally approved, it is not effective for long because the bacterium rapidly develops resistance to it.

One serious problem is the approach of drug trials for antibiotics. Researchers recruit people with infections who are not necessarily infected with the bacteria that the drug is designed to kill, which in turn affects efficacy results.

According to Professor Piddock, this problem could be eliminated by using point-of-care tests to identify the precise bacteria causing the infection and excluding that particular individual from the study if they do not have the bacterium which is being targeted. The number of people required for a trial is currently prohibitively high, yet an approach like this would reduce the number of people needed for each trial, and also ensure that those participating receive the drug that is specifically targeted to their infection.

The profile of this issue must be raised in order to overcome the barriers to new antibiotic discovery and development. In response to this, the British Society of Antimicrobial Chemotherapy has launched Antibiotic Action, a campaign that has already obtained worldwide support, from the Infectious Diseases Society of America, ReACT, charities, and not-for-profit agencies amongst others.

All these initiatives represent patients who depend on effective antibiotic treatment.

Professor Piddock states:

“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.” ( )

Piddock adds that in the same fashion that the GAVI Alliance and the Bill and Melinda Gates Foundation have successfully delivered vital vaccines worldwide, a similar model could be implemented to encourage new antimicrobial development.

She says in a concluding statement:

“Antibiotic Action will seek to unite and extend its activities with partner organizations 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 recognize 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.”

Written by Christian Nordqvist