How Should We Address Antibiotic Resistance?

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Antibiotic resistance and how we address it can be looked at from two vantage points. One is, a beheavioral thing of what we do, a societal behavior, physician behavior, agricultural behavior, and the other is a scientific approach of developing better antibiotics by developing pipeline of antibiotics that can replace those to which microbes become resistance, and these are two things that come unparallel. 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 prevent in the evolution, and the propagation of resistance, hospital outbreaks, nursing home outbreaks. I mentioned the inappropriate use on antibiotics, if you knew what you were dealing with, I mean as something very simple,

if you do some statistical analysis, 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 are 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 infectio, 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 are 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 to pre-clinical, 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 investments of several 100 millions to close to between a half and three quarters of a billion dollars to get a new product. Now, if it's a product that a vast majority of the population will ultimately use an anti-hypertensive, or lipid lowering age, and people use it for the rest of their lives, the profit margin and this hits a blockbuster, but antibiotics are very often not blockbusters, or they have a blockbuster half-life that's very short, because sooner or later there will be resistance, 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 making investments to take some of the responsibilities 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 this types of partnerships now with them, hopefully to get more companies involved in trying to make that pipeline more robust for new antibiotics.