Antibiotic development—we gave it a push, now it needs a pull

Antibiotic development—we gave it a push, now it needs a pull

Originally published on Contagion Live

After years of sounding the alarm about the dangers of limited antibiotic development, infectious diseases clinicians have been rewarded with multiple new antibiotics in the 2010s. To my shock, the Infectious Diseases Society of America’s “10x20” goal (10 new antibiotics before 2020) may actually be achieved. Changed regulatory pathways and “push” incentives that assist antibiotic development are partially responsible for the increased antibiotic throughput that we are benefitting from now.

However, the number of major pharmaceutical companies that invest in antibiotic development continues to decline, with AstraZeneca, Novartis, and Allergan recently announcing that they are leaving the anti-infective space. Allergan’s exitis particularly notable as the company markets several recently approved antibacterial agents that address critical needs. Antibiotics are a societal good that rely on private industry for production and the message that even selling approved, useful antibiotics that save patient lives is not enough to attract major drug developers to stay in the market is disheartening, to say the least.

What is going on? There are many issues, however, the main issue is that because private industry is for-profit, it gravitates toward therapeutic areas that make the most money. Antibiotics, which fulfill an acute need that most people do not have, are not one of those areas. Inexpensive generic antibiotics are currently effective for the majority of infections in the world, while branded, expensive antibiotics that fulfill a need, such as infections caused by carbapenem-resistant Enterobacteriaceae (CRE), are used in a very small number of patients. To put that in another context, 100% of the CRE market is smaller than 1% of the diabetes market. 

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