We Can’t Rely on Development of New Drugs Alone to Combat Antimicrobial Resistance

By the bioMérieux Connection Editors

Antimicrobial resistance (AMR) presents a global health crisis, as every day we encounter more infections that cannot be cured with existing antimicrobials. At the same time, the majority of major drug companies have been scaling back or cutting antibiotic research due to development challenges. New antimicrobials may help improve patient treatment options and outcomes, especially against resistant infections, but the fight against AMR cannot rely on drug development alone. AMR is an inevitable process that occurs in response to the use of antimicrobial agents.

Many pharmaceutical companies have been leaving the antibiotic business as a result of difficult scientific obstacles and challenging business incentives. Successful antimicrobials have to preserve their efficacy as long as possible by delaying the emergence of drug resistance while sparing the body’s normal microbiota. New antimicrobials can cost anywhere from $1-3 billion to bring to the market and that can prove too difficult a business model to maintain for some companies. Between 1962 and 2000, no new major classes of antibiotics were approved to treat common and deadly gram-negative infections.

Microbes have continued to develop new types of resistance against even our most powerful drugs, since the discovery of penicillin over 90 years ago. According to the authors of Challenges for the Development of New Antimicrobials— Rethinking the Approaches, “Bacteria predate humans by billions of years and have evolved a complex series of coping mechanisms that enable them to survive under harsh conditions and in the presence of numerous toxic metabolites.” They note that the inevitability of resistance is well accepted by researchers, and they also offer recommendations to manage AMR through identification and surveillance.

How can we help preserve the efficacy of our antimicrobials?

Identification and surveillance can help maintain the effectiveness of our antimicrobials. As our diagnostic tools become more advanced, we can more accurately identify the cause of infections. Diagnostic tools can improve the speed and accuracy of a patient’s diagnosis, improving appropriate antibiotic selection and reducing unnecessary antibiotic use.

Diagnostic tools can also identify when resistance spreads and support public health tracking to identify threats and infection trends. By combining efficient diagnostics with data from resistance surveillance, we can more accurately treat infections with the correct antimicrobials, from the beginning.

Arjun Srinivasan, the author of Antibiotic Stewardship: Why We Must, How We Can, notes that stewardship is important not only to society but to individual patients. He discusses a study that showed patients treated under an antibiotic stewardship program are three times more likely to receive appropriate antibiotic therapy according to guidelines than those who aren’t. In addition, diagnostic stewardship is critical in improving patient care and combating AMR. Ordering the wrong tests, ordering tests at the wrong time, or interpreting tests incorrectly harms patients. It can result in delayed diagnosis or wrong diagnosis that can impact lives.

Health professionals can be stewards and do their part to help to preserve the efficacy of antimicrobials by doing following:

  • Follow infection prevention and control recommendations
  • Ensure your patients receive recommended vaccines
  • Stay informed on current outbreaks
  • Educate patients on ways to prevent spread of infections
  • Improve antibiotic prescribing
  • Ensure you are notified by the lab immediately when antibiotic-resistant bacteria are identified in your patients

While antibiotic development has slowed, AMR has not. We must work to preserve the efficacy of our antimicrobials through diagnostics and stewardship.

Opinions expressed in this article are not necessarily those of bioMérieux, Inc.

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