The End of Antibiotics

More Americans die each year from antibiotic-resistant bacteria than AIDS, and there are no new drugs coming

November 7, 2013
November 7, 2013

“We’re in the post-antibiotic era,” Dr. Arjun Srinivasan, the deputy director of the US Centers for Disease Control, tells PBS. His agency just reported that at least 23,000 Americans die each year from antibiotic-resistant infections, more than the 15,000 who die from AIDS, notes health researcher Bill Gardener. And we’re running out of options.

Since penicillin became the first widely-used drug to fight infections in the 1940s, the success of antibiotics in killing germs has had evolutionary consequences: Germs that are genetically predisposed to survive these drugs have grown more numerous, some even transmitting resistance to other germs. This has resulted in an arms race between nature and pharmaceutical researchers trying to develop new medicines to target germs like Clostridium difficle, one of three strains the CDC has identified as urgent threats:

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The problem is that today, we’re losing this arms race. The number of new antibiotics entering the market has fallen in recent years, as this chart from the CDC shows, and many of the newest antibiotics aren’t as effective as their ancestors.Screen Shot 2013-11-07 at 12.56.04 PM Which is really bad, and not just because people can pick up infections. A lot of sophisticated modern medicine depends on temporarily reducing the strength of a patient’s immune system—think of chemotherapy treatments for cancer, organ transplants, skin grafts, and kidney dialysis. Antibiotics make it possible to protect these patients while their body can’t do it themselves, but absent germ-killing drugs, more of these approaches may simply become ineffective.

So where are the pharmaceutical companies? Largely pulling out of antibiotic research, which they view as less profitable than blockbuster drugs for cancer or lifestyle drugs targeting the aging baby-boomer population. Pharmaceutical research spending has shrunk overall in the last three years, and many companies, including Pfizer, Roche, Bristol-Myers Squibb and Eli Lilly, just don’t bother with antibiotics that could kill enterobacteriaceae, another urgent threat:

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Much basic drug research has fallen to the government, but budget negotiations in Washington aren’t likely to fund an effective response. Both the CDC and the National Institute of Health, which makes grants to medical researchers, face further spending cuts as lawmakers contemplate reducing the budget of their parent, the Department of Health and Human Services, as much as 18.6% from last year’s already-shrunk spending:

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For the NIH, that means fewer grants to lab researchers, including those working on antibiotics. At the CDC, those cuts make it harder for public health officials to track and isolate the resistant germs and set best practices for treatment to help avoid over-prescription. This has had some success: MRSA, the poster-child for scary bacteria resistance, is still a major killer but the number of infections have shrunk thanks to initiatives to improve care during intravenous hospital procedures. Similar efforts could help reduce antibiotic-resistant gonorrhea, one of the most awful things we can think of:

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The US government is taking some action to solve this problem, giving a special grant of $40 million to one company, GlaxoSmithKline, that still maintains a robust antibiotic research program, and allowing companies that produce them five extra years of protection from generic competition. The US Food and Drug Administration, which determines whether medicine is safe for public consumption, is also planning to loosen rules around antibiotic approval so new drugs can make it to market faster, which has some worried that ugly side effects could be missed or even ignored. But with the antibiotic pipeline running dry, there may be few other options.

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