Global challenge: 10 new antibiotics by 2020

The Infectious Diseases Society of America (IDSA) has issued a statement challenging global leaders to develop 10 new antimicrobial drugs by 2020.

The time has come for a global commitment to develop new antibacterial drugs. Current data document the impending disaster due to the confluence of decreasing investment in antibacterial drug research and development concomitant with the documented rapid increase in the level of resistance to currently licensed drugs. Despite the good faith efforts of many individuals, professional societies, and governmental agencies, the looming crisis has only worsened over the past decade. …

Drug-resistant infections and related morbidity and mortality are on the rise in the United States and around the world. The World Health Organization has identified antimicrobial resistance as 1 of the 3 greatest threats to human health. … [T]here are few candidate drugs in the pipeline that offer benefits over existing drugs and few drugs moving forward that will treat infections due to the so-called “ESKAPE” pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species), which currently cause the majority of US hospital infections and effectively “escape” the effects of approved antibacterial drugs.

Life after the Age of Antibiotics

The consequences of failing to act are disastrous:

The antibiotic pipeline problem may change the practice of medicine as we know it. Advanced interventions currently taken for granted–for example, surgery, cancer treatment, transplantation, and care of premature babies–could become impossible as antibiotic options become fewer.

Surgery, especially extensive, time-consuming procedures such as open heart surgery, would greatly expose patients to bacteria for which there would be no antibiotics. Cancer treatment, transplants, and premature birth all involve weakened immune systems, which leave patients especially vulnerable to infection and require effective antibiotics to survive.
Antibiotics have been around for a mere 70 years. It would be a tragedy if the antibiotic age, which has made such a tremendous difference in the practice of medicine, should come to an end.

As a global society, we have a moral obligation to ensure, in perpetuity, that the treasure of antibiotics is never lost and that no infant, child, or adult dies unnecessarily of a bacterial infection caused by the lack of effective and safe antibiotic therapies.

As Brad Spellberg writes in Rising Plague:

[I]f we do nothing, we run the risk that some day, historians will look back with nostalgia upon a golden “antibiotic era,” when doctors could treat infections with miracle drugs. In that bleak future, medicine would descend into a “postantibiotic era,” and infectious diseases would once again reign supreme.

Pharmaceutical companies are not developing new antibiotics to counter those bacteria that are now resistant to all antimicrobials. This is the “pipeline” problem. Spellberg’s book contains an excellent explanation of why this is happening and what we might be able to do about it.

President Obama’s action and President Kennedy’s example

The IDSA statement mentions the agreement between President Obama and Swedish Prime Minister Fredrik Reinfeldt (on behalf of the European Union) to establish a transatlantic task force focusing on the lack of new antibacterial drugs. It goes on to compare the international commitment to develop new drugs to President Kennedy’s pledge to send humans to the moon.

In 1961, John F. Kennedy declared that it was possible for humans to walk on the moon. … [N]aysayers will discount our 10×`20 initiative as too radical, politically impossible, and unacceptable to industry, academe, government, international colleagues, and others. Objections are inevitable but easily nullified by recognition of the magnitude of the problem and the moral and ethical commitment of the leadership of all stakeholders to make it happen. Without a moral commitment to create and maintain the necessary infrastructure, the inventory of safe and effective antibiotics will inevitably shrink as bacteria become ever more resistant to the current inventory of antibacterial drugs. It need not happen if we all work together to make the 10×’20 commitment a priority. As President Kennedy forecasted, we can walk on the moon within 10 years if we collectively commit to the goal.

Source: Clinical Infectious Diseases

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