The growing threat of antibiotic resistance
Thursday, August 14, 2014
A number of diseases once easily treatable have become resistant to antibiotics currently on the market, and that number continues to grow. Healthcare spending due to this antibiotic resistance costs $20 billion per year. Tom Frieden, director of the Centers for Disease Control and Prevention (CDC), has warned that antibiotic resistance is such a serious problem that it could be the "next pandemic."
Obviously, the growth of antibiotic-resistant pathogens means that more and more cases emerge where standard treatments no longer work, infections become more difficult to control, and the risk of spreading infections to others is increased — especially when hospital stays are prolonged.
Recently, both the CDC and the World Health Organization (WHO) have sounded an alarm about carbapenem-resistant Enterobacteriaceae (CRE), a class of antibiotic-resistant bacteria even more problematic than MRSA. The WHO labeled CRE "one of the three greatest threats to human health."
In fact, cases of this highly-resistant class of microorganisms have found their way into community hospitals in the Southeast. In a retrospective five-year study, a cluster of 305 different patients in 25 community-based hospitals were identified.
So why are these drug-resistant microorganisms spreading? There are several reasons.
Many pharmaceutical companies over time have abandoned or are trying to abandon their R&D efforts in the development of new antibiotics. Examples of these include Roche, Pfizer and more recently AstraZeneca — even though the latter company currently has an ongoing study for ceftazidime-avibactam for hospital-acquired pneumonia. While Roche has recently gotten back into this arena, the other Big Pharma companies remain in the background.
Other reasons include the overprescribing of antibiotics — causing some bacteria to mutate — and the indiscriminate use of antibiotics on livestock that are important to treat humans.
However, the news is not all bad. The Infectious Disease News recently highlighted five new antibiotics currently in the pipeline — all from small companies. While the larger companies apparently do not see antibiotics as a wise investment, small companies look upon this market as not only a profitable one, but one in which they are proud to be doing research.
Here are a few notable examples:
- Cubist: ceftolozane for urinary tract and intra-abdominal infections and tedizolid for acute skin and skin structures infections)
- The Medicine Group: oritavancin for skin infections including MRSA, which was approved by the FDA earlier this month
- Basilea: ceftobiprole for hospital-acquired pneumonia
- Otsuka: delamanid for tuberculosis
Researchers are exploring new routes for fighting resistant infections. A study in Hamburg, Germany, used bacteriophages to treat Clostridium difficile (C. diff). C. diff is particularly difficult to treat because it is resistant to most standard treatments. The hope is that this will open the door to engineering specific bacteriophages to kill the ever increasing number of resistant organisms.
Studies in a laboratory setting are also being done, which entails looking at common drugs already on the market for other uses to treat more difficult infections. A study published in mBio, the online open-access journal of the American Society for Microbiology, demonstrates a new way to identify nonantibiotic drugs that could eventually be used in bacterial infections. For example, the drugs being studied include compounds like loperamide (Imodium) and clemastine (Tavist).
The government can also play a major role here by granting money for more basic research on bacterial drug resistance. The total 2014 NIH budget for infectious diseases is $5 billion spread across all infectious disease areas from HIV/AIDS to bio-defense work. Maybe it is time for the NIH to give antibiotic resistance research the priority it deserves.
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