Several factors contribute to the urgency of the antibiotic resistance crisis in the United States. “Discovering the next generation of antibiotics is exceedingly challenging,” says Brad Spellberg, MD. Pharmaceutical companies are hesitant to develop antibiotics because they tend to be a poor financial investment. The London School of Economics recently estimated that a new antibiotic would have an average net value of -$50 million at discovery. Further complicating the issue is the overtly hostile regulatory environment, particularly for antibiotics.
According to Dr. Spellberg, who co-authored a paper on how to combat antibiotic resistance that was published in Medscape Infectious Diseases, the U.S. needs a national prospective surveillance system to track where antibiotic resistance to specific pathogens is occurring geographically and the frequency of these cases. “The lack of this data is a significant detriment to policy efforts aimed at fighting resistance,” Dr. Spellberg adds. “We also need a publicly available, national data collection system to monitor variation in antibiotic use across healthcare systems and geography.”
Antibiotic stewardship has been recommended to combat antibiotic resistance, but Dr. Spellberg says the cornerstone of this strategy lies in stressing the importance to physicians and patients to not overuse these drugs. “Simply telling people to not overuse antibiotics is ineffective,” he says. “We need technologies that support stewardship and economic policies that promote appropriate use of these drugs.”
Rapid diagnostic testing has emerged as a technology to inform providers about what antibiotic to use, if any, for patients. “It’s difficult to determine which patients have bacterial or viral infections,” says Dr. Spellberg. “Rapid diagnostics have the potential to eliminate that knowledge gap.” He adds that the technology has improved to the point where—within about 5 years—rapid tests may be able to screen for dozens of infections at once.
Another potential solution is to ascertain information on how providers are administering antibiotics. These data can then be used in pay-for-performance metrics. “Financial penalties or bonuses for reimbursement can then be levied based on how appropriately or inappropriately healthcare systems and providers use antibiotics,” Dr. Spellberg says.
To deal with the antibiotic resistance crisis effectively, clinicians should strive to change the way antibiotics are developed, used, and protected, according to Dr. Spellberg. “Antibiotics need to be used carefully and judiciously,” he says. “Efforts should be made to use these agents for the shortest course possible. Physicians should be at the forefront of this effort and press for regulatory and legislative solutions that preserve the antibiotics we have and rekindle pipelines so that new ones become available.”
Bartlett J, Spellberg B, Gilbert D. Eight ways to deal with antibiotic resistance. Medscape Infect Dis. 2013 Aug 7. [Epub only]. Available at http://www.medscape.com/viewarticle/808814.
Bartlett J, Gilbert D Spellberg B. Seven ways to preserve the miracle of antibiotics. Clin Infect Dis. 2013;56:1445-1450.
FDA. 2010 summary report on antimicrobials sold or distributed for use in food producing animals. 2011. Available at http://www.fda.gov/downloads/ForIndustry/UserFees/AnimalDrugUserFeeActADUFA/UCM277657.pdf.
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