[Ip-health] Nature editorial: A three-step plan for antibiotics

Thiru Balasubramaniam thiru at keionline.org
Wed May 28 04:22:56 PDT 2014



A three-step plan for antibiotics

If the threat of antibiotic resistance is to be managed, existing drugs
must be marshalled more effectively and new medicines must get to market
27 May 2014
If the first step towards solving a problem is to acknowledge its
existence, then some important progress has been made on the thorny issue
of antibiotic resistance. Last July, *Nature *noted approvingly a “notable
rise in awareness among policy-makers and the public” on the issue and
credited the advocacy of scientists for the surge (see *Nature **499,* 379;
2013 <http://www.nature.com/uidfinder/10.1038/499379b>). That rise has
continued, but with increased public and political awareness comes a
greater demand for action. Much of that heavy expectation will fall on
scientists. So, after the advocacy, how can the antibiotic-resistance
threat be countered?
The first step, and one that must be pursued with urgency, is better
stewardship of existing antibiotics. This demands fresh research and
discoveries, but significant gains are also possible if officials and
policy-makers can crank up the funds and willpower to match their rhetoric.
Doctors and others who routinely overprescribe antibiotics for everything
from sore throats to bronchitis need clear and explicit instructions from
the top to stop. Medical schools that do not drum into their trainees the
importance of prudence must start to do so.
Over-the-counter sales of antibiotics must be banned. The countries that
allow it are squandering a precious resource as surely as if they were
tipping oil down the toilet. Regional regulations that limit the use of
antibiotics to speed up the growth of livestock should extend worldwide.
Public education — both to restrict the waste of antibiotics and to build
support for measures to restrict unnecessary use — is vital. These are
low-hanging fruit and they must be picked with all possible urgency. They
need top-down political action, and that means governments. Cross-party
consensus should be explicitly hammered out and publicized — there is no
equivalent of Big Oil or Big Tobacco in this debate to delay and obfuscate.


The second step, and this is the one in which scientists have the biggest
role, is to find ways to maximize the impact of our existing stocks.
Researchers in the public and private sectors must re-examine all compound
libraries for drugs that could couple with rapid diagnostic tests to offer
new, narrow-spectrum therapies. Other compounds could be used in
combination to reverse resistance to existing medicines and so extend their
useful life — similar cocktails of drugs have been successful in treating
HIV, after all.

Research can improve diagnosis too, to both speed up treatment of patients
and minimize the waste of ineffective drugs. As a Comment article on page
557 <http://www.nature.com/uidfinder/10.1038/509557a> points out, genome
sequencing of infectious bacteria can rapidly identify resistance genes. So
samples from an infected patient — analysed in clinical microbiology labs
as close to point of care as possible — could steer drug treatment, at
least in the developed world. Mass spectrometry was introduced for clinical
use in this way a few years ago, it notes, and is now commonly used to
identify pathogens from signature microbial peptides. Such a rapid
front-line diagnostic kit to improve antibiotic use is one of the six major
challenges identified by the UK government in its new Longitude Prize,
intended to boost innovation.

The third step must be to boost the number of antibiotic drugs that are
reaching the market. Between 1983 and 1992, the US Food and Drug
Administration approved 30 new antibiotics; between 2003 to 2012, it
approved just seven.

Reversing this trend is less about research and more about restructuring
the financial incentives for firms to do that work. In 2012, for instance,
the United States passed the Generating Antibiotic Incentives Now Act,
which gives companies an extra five years of exclusive use for new
antibiotics that they develop.

Others, including the World Health Organization (WHO), are considering more
radical changes to the drug-development model itself. Last week, WHO
members met to discuss a draft global action plan on antimicrobial
resistance that floated “new business models” driven by public need rather
than market forces. Such action would demand global consensus on the
problem, and a Comment piece on page
555<http://www.nature.com/uidfinder/10.1038/509555a> argues
that the globe needs a new body to help to achieve that and to drive action
— an intergovernmental panel on antimicrobial resistance.

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