We need to develop new antibiotics

Progressing of antibiotic resistance in bacteria erodes our therapeutic resources. Some infections are caused by bacteria that have only one or no therapeutic options. New antibacterial agents should be developed, but economic considerations conspire against investing in this market.

Antibiotics are used, at most, two weeks for serious infections, and there is a tendency of lesser time use. Infection control wants exactly that: to control new antibiotic use to delay resistance, so the market for those new drugs is restricted. Compare antibiotics with statins, antihypertensives, chronic pain medication and anti-acid:, these drugs are used for long time, without restrictions (although, there should be some restrictions, but this is another story) and this almost over the counter use is where money is.

The development of new antibiotics needs studies comparing new drugs with other antibiotics, and they should be “no inferior” at least, to be approved by the Food and Drugs Administration. The recruitment of enough patients with the right bacterial infection and comparable disease severity is difficult. Recruiting infections by agents resistant to determinate drugs are even harder: if you study includes few pariticpants and probable bias, the scientific relevance of the study will be affected.  Only in vitro studies are insufficient: a number of problems were discovered only after clinical use. Some examples, daptomycin, proved to be  not a good option for lung infections. Further studies demonstrated that this drug was bound by lung surfactant. Doripenem was good for intra-abdominal infections, i was worse with comparator theraphy in ventilator-associated pneumonia. A single dose of delafloxacin was good for skin infections, but failed frequently for gonorrhea. And the list of examples goes on and on.

One solution might be to turn new antibiotics financially interesting to Big Pharma, but nothing can be so attractive than monoclonal antibodies pricewise

Cox E, Nambiar S . Baden L. Needed: antimicrobial development. N Engl J Med. 2018;380(8): 783-85. http://doi.org/ 10.1056/NEJMe1901525.

We need to develop new antibiotics