Antibiotic Development: Where Are We Headed?
Is It Time to Ditch "Broad-Spectrum" Antibiotics?
We recently delivered our Antibiotic Selection & Prescribing Masterclass and during our research, we had a deep look into the landscape and future of antibiotics.
It was intriguing but scary at the same time. I’ve recently looked at antibiotic resistance in a previous newsletter but I was more interested in the development of new antibiotics.
The reality is, the majority of antibiotics on the market are pretty old. For example, amoxicillin was developed in 1977. Cephalosporins, the earliest of which is cefalexin was discovered in in 1945. Fan-favourite Tazocin was made in 1993.
The good ol’ saying of “old is gold” doesn’t apply as much to antibiotics. Bacteria are become smarter and we are seeing more resistant species. Take the following acronyms which you might have heard off:
Extended Spectrum Beta-Lactamase (ESBL) producing organisms - These are typically E-coli and Klebsiella which produce the ESBL enzyme, helping it to breakdown antibiotics such as penicillins and cephalosporins. Carbapenams such as meropenam is the only class of antibiotics that is effective.
MRSA (methicillin-resistant staphylococcus aureus) - These are a class of staphylococcus aureus that is resistant to the majority of penicillin antibiotics. They can also be resistant to other classes of antibiotics including macrocodes.
How Has This Effected Patient Outcomes?
The WHO reported in 2022 that approximately 30% of newborns with sepsis die due to bacterial infections resistant to first-line antibiotics. It is well accepted that antibiotic resistance is a “silent killer”, leading to a number of deaths worldwide.
Currently, antibiotics are being developed but not at the rate that is needed. There is also a need to “re-invent the wheel” as much of antibiotic development occurs within established classes. For instance, in 2017 there were 12 new antibiotics, 10 of which there was already some form resistance to.
Unfortunately, antibiotics take approximately 15 years to develop and the costs associated with it can be a huge turn off for pharmaceutical companies. Most antibiotic development is driven by smaller companies who fail to find funding for drug development. It is quite common for drug companies to suspend development for these reasons.
Despite the low rate of antibiotic development, there is some innovation occurring. Monoclonal antibiotics, bacteriophages and viruses are being programmed to target pathogenic bacteria. It is likely that these new classes of treatment will be combined with existing antibiotics to attack bacteria from different angles.
What is Our Role?
Whilst I’m not in the business of drug development, I am a clinician and do see it as my responsibility to assist this fight against multi-drug resistant bacteria. NICE have released a lot of guidance recently and there are some useful points that I’ve extracted from this:
Does the patient need antibiotics? Make use of criteria such as CENTOR to help guide your prescribing decision.
Educate your patients about antibiotic resistance to help them rationalise your management plan.
Limit antibiotic courses to 5 days. There is little/no evidence for longer courses than 5 days unless specified.
For patients on IV antibiotics, ensure that there is a scheduled review (usually within 48 hours). Try and switch to the oral equivalent as soon as clinically/practically possible.
What’s on the Pareto Calendar?
We’ve got some awesome events coming up over the next few weeks.
If you’re a student due to sit SBA exams, check out our FREE, online webinar on Core MSK. You can book here.
If you’re a professional/student looking to perfect your ECG interpretation skills, then consider booking onto our popular ECG Masterclass. This is the second time we are running this and we had some amazing reviews the first time we held this. You will also get a FREE ECG interpretation E-book which we have written ourselves. You can book here.
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