Opinion: Staring into the abyss

The price to overcome the problem of antibiotic resistance will be high

Hilary Ayshford
Managing Editor

Dire warnings have been issued recently over the growing threat of drug-resistant bacteria and the lack of new antibiotics with which to treat them. Figures from the UK Health Protection Agency’s Antimicrobial Resistance Reference Laboratory show that in 2003 three samples tested positive for antibiotic resistance; last year the figure was 800. Every year deaths from MRSA far outnumber those from HIV/AIDS, yet the resources devoted to discovering treatments for the latter far outweigh the efforts put into seeking out novel antibiotics.

With increasing pressure on R&D budgets, it is little wonder that antibiotics are low on the pharma companies’ priority list. Antibiotics have come to be seen as cheap, routine treatments that are overprescribed and have low levels of patient compliance – ironically contributing significantly to their decline in efficacy.

Furthermore, any new antibiotic is likely to be held in reserve as a treatment of last resort, making the market and any potential return on investment self-limiting. It could also have a relatively short lifecycle: it will only last until bacteria develop immunity to it.

What is needed is a complete rethink regarding antibiotics R&D. Financial incentives, simplified approval procedures, funding to bridge the translational gap, sharing of research and extended market exclusivity would all be helpful, but perhaps something even more radical is needed.

Drug-resistant infections are as potentially life-threatening as cancer, and novel antibiotics should be subject to the same regulatory requirements as oncology treatments. The threat is now high enough that it should be matched by an appropriate level of acceptable risk. Healthcare providers may also have to adjust their attitude to antibiotics and be prepared to pay similar prices to those currently commanded by advanced cytotoxic drugs.

It is a problem in urgent need of a solution, and governments, healthcare providers and patients must be prepared to pay the price.

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