The “silent epidemic” of increasing antibiotic resistance 21 MAR 23
Not enough new antibiotics in the pipeline, the QUI review concludes, especially those microbes that are resistant to pharmaceuticals
A QAE review of the number of new antibiotics currently in the pipeline shows that only 12 new antibiotics entered the market in the five years from 2017-21. Very few (only 27) are under development in clinical trials against critical pathogens considered by WHO, such as Acinetobacter oeni and Pseudomonas aeruginosa. Of these 27, only six are considered “innovative” enough to overcome the WHO criteria for antibiotic resistance* and only two of those six target forms of drugs that are highly resistant to these microbes.
The market faces a catalog of problems and no miracle drugs are being promoted to increase resistance to antibiotics.
This update on the state of the antibiotic landscape is presented in a special online session of the European Congress of Microbiology and Infectious Diseases (ECCMID 2023, Copenhagen, April 15) and led by Dr. Valeria Gigante, WHO team leader, Division of Antimicrobial Resistance, Geneva, Switzerland. In the five years covered by this report, we have approved only 12 antibiotics, and only one, Cefiderocol, can attack all critical pathogens from WHO, explains Dr. Giant. “And there are only 27 more now in development in phase 1 to 3 clinical trials, with little innovation. Only four of the 27 have new mechanisms of action, and most of them are not new types of drugs, but the evolution of existing types.
Currently, the antibiotic, Solithroymcin, which will be treated in community-acquired pneumonia and other infections, is in the “new drug application” stage (it has undergone clinical trials and awaits marketing authorization) and seven other products They are in phase 3 trials with efficacy provided. Dr. Gigante explains that since failures are also possible in phase 3 trials, it is difficult to predict if and when a marketing license will be granted for these drugs.
According to recent estimates, nearly 5 million deaths each year are now associated with antimicrobial resistance (AMR). But the real resistance package could be bigger. In addition, AMR disproportionately affects poor people who have little access to more expensive second-line antibiotics that work when first-line drugs fail.
The latest type of antibiotic was discovered in the 1980s.
Antimicrobials are not as lucrative a prospect as other treatments for pharmaceutical companies because they are generally short-term treatments, and antibiotic stewardship programs aim to preserve or “save” any new drugs until they are desperately needed. And it’s just as likely to fail in the research and development process as any other drug in other conditions, and yet they offer a fraction of the revenue compared to, say, cancer and cardiology drugs. Due to these and other factors, the research and development process of new antibiotics is challenged and underfunded. The latest class of antibiotics was discovered in the 1980s, and the first antibiotic in this class, daptomycin, hit the market in 2003.
Antimicrobial resistance arises from excessive and inappropriate use, such as people not completing their course of antibiotics or because they are prescribed the wrong antibiotic or, in some countries, antibiotics that are widely used without a medical prescription. The universal trend of antibiotic use shows the inappropriate time it takes to develop resistance to new antibiotics: for antibiotics released between 1930 and 1950, the average time to develop resistance was 11 years; for antibiotics released between 1970 and 2000 it was only 2 to 3 years.
This silent pandemic of antibiotic resistance is growing around the world. Experts often warn of a “missionary mission” in which medical practices, for example antibiotic prophylaxis in the treatment of cancer or other diseases, are no longer effective and countless numbers of people could die from infections that were previously simple and treatable.
