We are losing the war against bacteria. The antibiotic colistin is a last line defense against bacterial infections…but that last line has been officially penetrated. In late 2015 in China, microbiologists found bacteria with a gene (mcr-1 gene) that gave the bacteria resistance to colistin and could be transferred from one bacterium to another via something called plasmids. Since then, bacteria with this gene has appeared in Europe, Canada,…and now the United States. According to a just published article in the journal Antimicrobial Agents and Chemotherapy, last month, the urine of a 49-year old woman in Pennsylvania contained Escherichia coli bacteria with the mcr-1 gene.
Colistin is one of the last antibiotics effective against carbapenem-resistant enterobacteriaceae (CRE), a superbug or superbacteria that is steadily spreading throughout health care facilities around the country and can kill up to half of the people it infects. People have dubbed CRE the “phantom menace” because of the substantial threat that CRE poses. Our computational modeling study published in the American Journal of Epidemiology shows how quickly CRE can spread throughout healthcare facilities in a region, unless more aggressive measures are taken. For example, in Orange County, California, within a decade, CRE could go from being relatively uncommon to very common in all health care facilities.
This is scary stuff, like finding a vampire who is no longer affected by sunlight. Many people are not old enough to remember the days before antibiotics were available. Before Alexander Fleming discovered penicillin in 1928, bacterial infections were among the leading causes of premature death. Even “simple” infections – such as skin, urinary tract, and upper respiratory infections — could quickly lead to severe disablement or death. Antibiotics in many ways transformed society, helping extend life expectancy which in turn led to more productivity and ultimately many of the other advances that have occurred over the past eight decades. Think about how prevalent antibiotics are these days. Physicians routinely prescribe them for a variety of infections. Surgeons and dentists administer them after procedures. Farmers place large amounts of antibiotics in animal feed.
But soon after antibiotics arrived, so did antibiotic-resistant bacteria. Bacteria are like email spam, once you find a way to defend against them, they soon evolve to get around your defenses. So, you have to save your ammunition and keep developing new weapons.
The trouble is that new antibiotic development is not keeping pace with the emergence of new antibiotic-resistant bacterial strains. A report from The Pew Charitable Trusts on the antibiotic development pipeline found the following:
- Too few antibiotics are under development: Only 37 new antibiotics are in clinical development with 11 in phase 1 clinical trials, 13 in phase 2, and 13 in phase 3. On average, only one in five drugs that begin clinical development make it through to the market.
- The big pharmaceutical companies are not developing as many antibiotics: According to The Pew Charitable Trusts, “of the 34 or so companies with antibiotics in clinical development, only five rank among the top 50 pharmaceutical companies by sales.” Novartis has no antibiotics in clinical development. Over 80 percent of antibiotics in clinical development are being handled by small companies. About half of the companies developing antibiotics currently have no products on the market.
As more and more capital flows into industries such as social media, proportionately less seems to be going into drug discovery and development in general…and even less into antibiotic development. So basically, we are losing the battle against bacteria and not developing enough new weapons. Finding the colistin-resistant bacteria in the U.S. should be a wake up call. We have to realize the very real threat of antibiotic-resistant bacteria and the real possibility that we may run out of antibiotics that work. With the clear need for new antibiotics, there should be more investment in antibiotic development. Part of this may be changing any perceptions that antibiotics do not represent good investment and business opportunities. Part of this may be finding ways to decrease barriers to investing in antibiotic development. Ultimately, the question is why is so much time, effort, and capital flowing into finding the next “killer app” for the smart phone but not possibly the most important “killer app”: new antibiotics?
This article was written by Bruce Y. Lee from Forbes and was legally licensed through the NewsCred publisher network.
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