Novel Programs and Discoveries Aim to Combat Antibiotic Resistance.

Abstract

Withincreasing concerns over the continued development of bacterial resistance to antibiotic drugs, researchers and public health officials are conductingandsupportingnew initiatives to develop novel antibiotics and to discover the mechanisms involved with resistance in bacteria that cause urinary tract infections, pneumonia, bloodstream infections, and others. The need for these efforts will only continue to grow: antibiotic-resistant organisms are associated with approximately 23 000 deaths and 2 million infections in theUnited States each year (http://1 .usa.gov/1nDmtkJ). What’s more, an estimated 700 000 deaths per year worldwide are attributable to antimicrobial resistance (AMR), and experts estimate that 10 million people will die worldwide each year by 2050 due to increasing AMR, with some of the highest potential burdens in Asia and Africa (http://bit.ly/1yCt7re). Drug discovery efforts are not keeping pace; between 1983 and 1987, 16 new systemic antibacterial agents were approved by the US Food and Drug Administration (FDA), but this number has been decreasing steadily ever since, with only 2 new agents having been approved between 2008 and 2012 (Boucher HW et al. Clin Infect Dis. 2013;56[12]:1685-1694). The perception that the commercial potential of antibiotics is much lower than that of drugs used to treat conditions such as cancer, heart disease, or mental illness has historically stalled investments and advances in novel antibiotic development (Hwang TJ et al. Sci Transl Med. 2015; 7[276]:276fs9). However, the annual effect of antibiotic-resistant infections on the US economymay be as high as $20 billion in excess direct health care costs and as much as $35 billion in lost productivity fromhospitalizations and sick days (http://1 .usa.gov/1nDmtkJ). “Much of the true innovation in antibiotic development right now is based in academic medical centers and small pharmaceutical and biotech companies,” said Aaron Kesselheim, MD, JD, MPH, an associate professor of medicine at Harvard Medical School and the division of pharmacoepidemiology and pharmacoeconomics at Brigham and Women’s Hospital, in Boston. “We need to support this work with greater public investment and other tailored incentives that focus on antibiotics of high clinical need, but we also need systems in place to ensure rational use of the products once approved, or else we’ll never break the cycle we’re in now.”