One of my most vivid recollections from residency training is that of a patient we had in the ICU who was gravely ill from an infection. We treated her infection as we usually do in these situations – supportive care and antibiotics. What was so unusual about her case that I still remember it to this day? She had an infection with a multi-drug resistant bacteria. What does this mean? Antibiotics were virtually useless to treat her infection. Again, why do I still remember her case? Well, we treated her room almost the same way you would treat a room with a patient who had Ebola – i.e., extremely strict isolation precautions were observed as the chance of spreading her bacterial infection to ourselves or another patient was terrifying. After she passed away (as was inevitable due to her overwhelming antibiotic-resistant infection), our janitorial services had the daunting task of using bleach and other disinfectants to decontaminate the entire room, and because we needed to take extra precautions before allowing another patient into that room, a UV germicidal lamp was used to kill any additional organisms that may have escaped the cleaning process. It was a huge task to ensure patient and environmental safety in this case, and I don’t think hospitals would do well if this was a more regular occurrence (rather than something that happens only very occasionally).
I tell this story not to freak people out but rather to illustrate that multi-drug resistant organisms are a real thing, and they are just as large of a public health concern as Ebola or measles because of how deadly and untreatable they are. The World Health Organization (WHO) released a report last year detailing the rise of these “superbugs” in all regions of the world, not just the U.S. And, in all worldwide regions, there is documented resistance to even last-resort antibiotics in organisms that cause infections ranging from diarrhea to pneumonia to sepsis, which can ultimately result in major disability or death.
On Friday, the White House released the National Action Plan for Combating Antibiotic Resistant Bacteria to address many of the concerns raised in the WHO report. Although there are already many criticisms of this plan, one imperative area that the White House is addressing is the funding of novel antibiotics.
The pharmaceutical industry has lost interest in development of antibiotics – there has been only one new class of antibiotics discovered since 1987. The pipeline for new antibiotics has run dry for a number of reasons, but one of the main reasons is the way we practice medicine.
Antibiotic stewardship means that physicians don’t use newer antibiotics as first-line treatment; we only use these antibiotics if tests suggest that bacteria are resistant to older antibiotics. This means that pharmaceutical companies had very little to gain by developing novel antibiotics. In fact, they might lose money due to the fact that they would have 20 years on a patent before a medication becomes generic. If you factor in the roughly 8 years it takes to get a drug to market, this means that pharmaceutical companies have 12 years to recoup their losses and turn a profit, but with the proper practice of antibiotic stewardship, the patent on novel antibiotics is likely to expire before these medications become widely used or needed. And, as antibiotics are not intended for chronic diseases but rather for short term infections, this cuts their profit margins even further.
Whether we like it or not and despite efforts of antibiotic stewardship to try to curtail more resistant organisms from developing, we currently have no new antibiotics on the market (and limited ones in development) to treat resistant infections from the superbugs that already exist. Government funding is essential to replenishing the antibiotic pipeline and bringing these drugs to market for this emerging threat to public health.