Issues in the fight against antibiotic resistance
I apologize for the slow pace of updates this semester; it has been hectic, and scouring the news for alerts of general microbiological interest to post here has taken a backseat to grading for the past few weeks. However, I came across a review article from the latest issue of Trends In Microbiology that is timely with regards to our current class discussion about antibiotics and their place in modern medicine.
I have painted a less than rosy picture many times in this forum about the future of medicine, primarily as a result of the diminishing utility of antibiotics. The premise is this: the more antibiotics are used to treat infectious disease, the less they are ultimately effective as a result of the acquisition of antibiotic resistance. Indeed, the observation that genes conferring antibiotic resistance to today’s antibiotics have been found in thousands of years old samples of bacteria in permafrost suggests that acquisition of resistance is not a matter of “if it happens,” but rather “when it happens” to antibiotics that haven’t even been developed yet.
In our viewing of the Frontline episode “Hunting the Nightmare Bacteria” in class the other day, one of the most alarming points come out to me was the highlighting of the problem of who is supposed to deal with with looming catastrophe. The majority of the large pharmaceutical companies have pulled out of the antibiotic business due to a simple financial decision–it costs a tremendous amount of money to bring new drugs to market, and by their nature antibiotics give a very poor return on investment. At the same time, it was also clear that there is no national consensus to determine the scope of the problem or what the most appropriate response should be.
The review article takes the following stance; public health officials must be proactive in recognizing the severity of the issue, and governments need to take the lead in prioritizing antibiotic discovery in both academic and industrial settings. Public-Private partnerships (PPPs) have been established in small scale between not-for-profit charities, small biotech companies, and large pharmaceutical firms, however the lack of financial return has limited their effectiveness to date. The model however is valid, and if adopted large scale the financial burden of bringing these critical drugs to market can be distributed broadly between the academic, governmental, and industrial players. Such a model in the current political climate in the United States is difficult, but not impossible to propose. These organizations have successfully come into being in Europe which has traditionally had a more open interaction between government and industry, however the passing in the US of the Prescription Drug User Fee Act (PDUFA V) provides financial incentives for novel antibiotic development in this country. Hopefully, these incentives will allow medicine to stay ahead of antibiotic resistance at least for a little while!