How can we solve the antibiotic resistance crisis? - Gerry Wright

Summary

Antibiotics are crucial for modern medicine, yet we face the threat of antibiotic resistance due to overuse and lack of new discoveries. Originating with penicillin, the issue has escalated as bacteria evolve to resist our drugs. The pharmaceutical industry's shift to more profitable, long-term medications has left antibiotics behind. Solutions include controlling antibiotic use, developing new ones, and exploring alternatives like phages and vaccines. However, inadequate funding and the challenge of profitability hinder progress in combating resistance.

Takeaways

• 💊 Antibiotics are essential for modern medicine, treating infections and supporting procedures like surgery and organ transplants.
• 🛡️ The risk of losing the effectiveness of antibiotics due to bacterial resistance poses a significant threat to healthcare.
• 🔬 Alexander Fleming discovered penicillin in 1928 and warned about the potential for bacterial resistance in his Nobel Prize acceptance speech.
• 📉 Pharmaceutical companies once found new antibiotics to counter resistance but have since reduced efforts due to lower profitability.
• 🌱 The discovery of new antibiotics has slowed, with no new chemical classes found since the mid-1980s.
• 🌿 Agriculture is a major consumer of antibiotics, contributing to resistance through overuse and the potential for human infection via the food chain.
• 🔬 Nature offers a promising source for new antibiotic compounds, with organisms like microbes and fungi having evolved to compete against bacteria.
• 🛡️ Combining antibiotics with molecules that inhibit resistance can help overcome bacterial resistance mechanisms.
• 🦠 Phages, viruses that attack bacteria, are a novel approach to fighting bacterial infections without affecting humans.
• 💉 Developing vaccines for common infections can prevent diseases and reduce the need for antibiotic use.
• 💸 Funding is a significant challenge in antibiotic development, with profitability concerns leading to reduced investment by pharmaceutical companies.
• 🏛️ Alternative funding models, such as subscription-based purchasing by healthcare providers, are being explored to incentivize antibiotic development.

Q & A

What is the role of antibiotics in modern medicine?

Antibiotics are essential in modern medicine for treating infectious diseases and for safely facilitating procedures such as surgery, chemotherapy, and organ transplants. Without them, routine medical procedures could lead to life-threatening infections.

Why are we at risk of losing the effectiveness of antibiotics?

The risk of losing the effectiveness of antibiotics is due to the development of bacterial resistance to all currently available antibiotics and the cessation of discovering new ones.

Who discovered the first widely used antibiotic and when?

Alexander Fleming discovered the first widely used antibiotic, penicillin, in 1928.

What warning did Alexander Fleming give in his 1945 Nobel Prize acceptance speech?

Fleming warned that bacterial resistance had the potential to ruin the miracle of antibiotics.

How did the pharmaceutical industry initially respond to bacterial resistance in the 1940s and 50s?

In the 1940s and 50s, pharmaceutical companies countered the problem of resistance by discovering many new antibiotics, which was a highly successful and profitable enterprise at first.

What changed in the discovery of new antibiotics over time?

Over time, newly discovered antibiotics became less profitable as they were often only effective for a narrow spectrum of infections, compared to the first ones which were broadly applicable.

Why did the overprescription of antibiotics initially occur?

Antibiotics were heavily overprescribed in the early days, including for viral infections they had no effect on, due to a lack of understanding of their specific use and potential for resistance.

What shift in pharmaceutical company focus contributed to the decrease in new antibiotic development?

Companies shifted focus to developing drugs for chronic conditions like blood pressure and cholesterol medications, which are taken indefinitely and are more profitable than antibiotics.

Why are bacteria becoming resistant to many antibiotics?

Bacteria continue to acquire resistance and pass it along by sharing genetic information between individual bacteria and even across species.

What are some strategies to combat antibiotic resistance and find new ways to fight bacterial infections?

Strategies include controlling the use of existing antibiotics, creating new ones, combating resistance to new and existing drugs, and finding alternative treatments such as phages and vaccines.

What is the largest consumer of antibiotics and how does this contribute to resistance?

Agriculture is the largest consumer of antibiotics, using them to treat infections and promote the growth of food animals. This increases bacteria's exposure to antibiotics, giving them more opportunities to develop resistance.

What is one innovative approach to packaging antibiotics to combat resistance?

One approach is to package antibiotics with molecules that inhibit resistance, such as molecules that block the proteins bacteria use to degrade the drug.

How can vaccines contribute to the fight against bacterial infections?

Vaccines can help prevent diseases in the first place, reducing the need for antibiotic use and thereby helping to control the spread of antibiotic resistance.

What is the biggest challenge in developing new antibiotics and alternative treatments?

The biggest challenge is funding, as antibiotics and new therapeutic techniques are often unprofitable, leading to a lack of investment in their development.

What is one potential solution proposed to incentivize the development of new antibiotics?

Shifting profits away from the volume of antibiotics sold, such as the United Kingdom's model of healthcare providers purchasing antibiotic subscriptions, could incentivize development.