How should we address antibiotic resistance?
Antibiotic resistance can be addressed by looking at behavioral changes and scientific solutions. In this video, HealthMaker Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, explains how.
Transcript
The overwhelming proportion of visits when someone comes in with a sore throat or a sinusitis
don't need antibiotics. We're overusing inappropriately antibiotics. [INSTRUMENTAL MUSIC PLAYING]
Antibiotic resistance and how we address it can be looked at from two vantage points.
One is a behavioral thing of what we do as societal behavior, physician behavior,
agricultural behavior, and the other is a scientific approach of developing better antibiotics
by developing a pipeline of antibiotics that can replace those to which microbes become resistant.
And these are two things that come in parallel. For example, we know that inappropriate use of antibiotics in humans is something
that is a clear selective pressure for the development of antibiotic resistance.
We know that good infection control in a hospital, good point-of-care diagnostics
go a long way to preventing the evolution and the propagation of resistance, hospital outbreaks, nursing home
outbreaks. If you do some statistical analyses, the overwhelming proportion of visits
when someone comes in with a sore throat or a sinusitis don't need antibiotics. The majority get antibiotics.
So, right away, just in normal clinical practice in an office, we're overusing inappropriately antibiotics.
Now, if we had a point-of-care diagnostic, and by "point of care," I mean to tell almost instantaneously
whether you're dealing with a viral or a bacterial infection, and if you're dealing with a viral infection, you don't want to give somebody antibiotics.
Those are the kind of things that discovery can work on. The other thing that we're doing here at NIH is partnering with
pharmaceutical companies to de-risk for them getting
involved in the development of new antibiotics, and by "de-risking" means, if you look at the process from
a concept development, preclinical, early trials, advanced trials, and then FDA approval manufacturing,
it's a long spectrum. If a drug company does it on their own, they have to make an investment of several hundred million
to close to between one half and 3/4 of $1,000,000,000 to get a new product.
Now, if it's a product that a vast majority of the population will ultimately use, an antihypertensive,
a lipid-lowering agent, people use it for the rest of their lives, the profit margin on this, it's a blockbuster. But antibiotics are very often not blockbusters,
or they have a blockbuster half-life that's very short, because, sooner or later, they'll be resistant, people won't use it,
people use antibiotics 10 days to two weeks at a time, not everybody uses them, they use them once or twice a year.
So what we try to do is make an investment to take some of the responsibility for the early concept, the pre-clinical, the resource
research that we do, the making available of animal models, the toxicology studies to help the companies out,
so we meet them halfway, or a third of the way, so that they don't have to take the risk of a major investment.
And we're getting involved with these types of partnerships now with them, hopefully, to get more companies involved
in trying to make that pipeline more robust for new antibiotics.
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