Antibiotic-resistant infections cost the healthcare system more than $20 billion annually and result in more than 8 million additional days in the hospital. Overcoming the crisis will require comprehensive, multipronged strategies that are aimed at reducing the emergence and spread of antimicrobial-resistant organisms.
Few New Antibiotics on the Horizon
Many pharmaceutical companies have had less interest in developing new antibiotics because they aren’t as profitable as drugs used to treat chronic conditions or lifestyle issues. Additional barriers include uncertainties about requirements for FDA approval and the scientific and technical challenges that are inherent in identifying new classes of antibiotics. Once a successful new antibiotic clears hurdles and enters the market, the profitability of the drug is limited by effective antimicrobial stewardship programs and by the ability of microbes to rapidly adapt to antibiotics. Since 2008, only two new antibiotics have been approved by the FDA.
“As much as 50% of antibiotic use in humans is either unnecessary or inappropriate.”
The Infectious Diseases Society of America set forth the 10 x ‘20 Initiative to spur the development of 10 new antibiotics by 2020, a goal that includes new incentives for drug research and development, among other strategies. Unfortunately, little progress has been made in achieving this goal. Accordingly, legislators need to support new incentives for industry, and regulators need to consider the important clinical and public health benefits that antibiotics provide as they develop new guidelines and update existing guidance for the design of clinical trials.
Education on Antibiotic Use is Critical
As much as 50% of antibiotic use in humans is either unnecessary or inappropriate. Efforts to increase education of the healthcare community about the most appropriate use of antibiotics are essential. To limit the emergence and spread of antibiotic resistance, effective antibiotic stewardship programs are needed in conjunction with comprehensive infection prevention and control efforts. Clinicians must be engaged in and supportive of these efforts to promote judicious antimicrobial use. It’s also critical to support efforts to strengthen surveillance programs, prevention and control efforts, and research capabilities to better understand, track, and limit antimicrobial resistance.
Calls to Action to Reduce Antibiotic Resistance
Advancing the development of rapid point-of-care diagnostic tests is a critical part of the solution. Such tests could lead to better treatment decisions and reduce drug development costs. The Strategies to Address Antimicrobial Resistance Act and the Generating Antibiotic Incentives Now Act are two legislative initiatives that are designed to strengthen surveillance and control efforts and to stimulate the development of antibiotics and diagnostic tests for antimicrobial resistance with incentives. More of these efforts are needed to truly make an impact.
Healthcare professionals play a critical role in addressing antibiotic resistance, from prescribing antimicrobial agents appropriately to raising awareness of the problem among their patients and political leaders. Increasing the promotion of proper immunization practices can also be helpful. If clinicians fail to act, deaths and morbidity from antimicrobial resistance will continue to increase and further tax the available drugs we have at our disposal. Taking the extra steps to ensure that resources are available to combat antibiotic resistance is paramount to protect future generations.
Readings & Resources (click to view)
Roberts RR, Hota B, Ahmad I, et al. Hospital and societal costs of antimicrobial-resistant infections in a Chicago teaching hospital: implications for antibiotic stewardship. Clin Infect Dis. 2009;49:1175-1184.
Spellberg B, Guidos RJ, Gilbert DN, et al; Infectious Diseases Society of America. The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America. Clin Infect Dis. 2008;46:155-164.
Gilbert DN, Guidos RJ, Boucher HW, et al; Infectious Diseases Society of America. The 10 x ’20 Initiative: pursuing a global commitment to develop 10 new antibacterial drugs by 2020. Clin Infect Dis. 2010;50:1081-1083.
Dellit TH, Owens RC, McGowan JE Jr, et al; Infectious Diseases Society of America; Society for Healthcare Epidemiology of America. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44:159-177.
Sanchez Garcia M, De la Torre MA, Morales G, et al. Clinical outbreak of linezolid-resistant Staphylococcus aureus in an intensive care unit. JAMA. 2010;303:2260-2264.