Antibiotic resistance: 4 areas of progress, 6 challenges

The golden era of antibiotics has ended. From the 1930s to the 1960s, the discovery of antibiotics proliferated, and modern medicine was changed.

However, antibiotic resistance is derailing much of the work done during that golden era, as pathogens increasingly develop resistance, argue Carl Nathan, MD, of Weill Cornell Medical College in New York and Otto Cars, MD, PhD, of Uppsala University in Sweden.

In a perspective published in the New England Journal of Medicine, the two physicians highlight the past achievements and future challenges regarding antibiotic resistance.

4 areas of progress

Recognizing the problem: Antibiotic resistance has become a focal point for many key organizations, including the Infectious Diseases Society of America, the Centers for Disease Control and Prevention, the World Health Organization and the World Economic Forum. Additionally, President Barack Obama recently issued an executive order to develop a task force and a national action plan to address resistance issues in the United States.

Partnerships: Public-private partnerships are developing experiments and initiatives for research and advancements surrounding antibiotics. Such collaborations are pooling together ideas and resources to accelerate developments and discoveries to address the problem at hand.

Returning to the issue: Many major pharmaceutical companies stopped antibiotic research due to little competition in the market. Competition is down largely because the drugs are starting to fail, according to the perspective. However, pharmaceutical companies are slowly returning to the market.

Prevention efforts: Infection prevention practices are becoming a focal point in the healthcare industry as providers are becoming more concerned about the growing inefficacy of antibiotics.

6 remaining challenges

Leadership: The authors argue an effective antibiotic stewardship program requires global leadership and resources, including collaboration between health, security and economic development sectors.

Monetary rewards: The authors suggest monetary rewards should not be linked to drug sales. "Unless monetary reward are delinked from drug sales, few companies will invest in high-risk programs to develop drugs whose use must be restricted and which will probably ultimately lose their clinical utility," they wrote. Additionally, tying profit to sales pushes cost higher, making access to drugs that much more difficult for the poor. Instead, the authors suggest developing an antimicrobial oversight agency that rewards antibiotic developers "in proportion to the estimated quality-adjusted life-years saved," which they say would keep prices more in line with the actual production and distribution costs.

Access: Poorer countries do not have equal access to drugs. The authors suggest a global fund that solicits contributions as related to countries' gross domestic products. Until that happens, though, wealthier countries might need to subsidize antibiotic use in poorer countries.

Conserve drugs by not using them on animals: If countries continue to use antibiotics to bolster animal growth, they cannot expect antibiotics remain effective. The authors suggest governments implement restraints like the European Union, which banned the use of growth-promoting antibiotics in animals.

Conserve drugs through appropriate diagnoses: Instead of prescribing antibiotics for viral infections and ailments without knowing the origin, technology can improve diagnostics to more accurately determine which prescriptions will work best.

Conserve drugs through controlled access: Antimicrobial stewardship programs are going to be key in helping reduce antibiotic resistance. The authors suggest wealthier countries have an obligation to poorer countries to help develop the infrastructure allowing clinicians to learn better prescribing practices.

More articles on antibiotic resistance:

Are viruses the new antibiotics?
Unnecessary antibiotic use leads to more than $163M in spending waste
Obama issues executive order to combat antibiotic-resistant bacteria

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