As antibiotic resistance continues to increase, the options to treat diseases become more limited. In 1990, there were 20 major pharmaceutical companies with large antibiotic Research and Development programs. Today, there are just two and a handful of smaller ones. In this segment of Antibiotics: The Broken Promise, our Katie Gibas tells us why Antibiotic development has dwindled to almost a standstill in recent years and what that means for the future of medicine.
After the introduction of antibiotics in the 1940s, companies ramped up production of these infection fighting drugs.
“We were always sort of one step ahead and when they could catch up with resistance, we would come out with the next thing. And that’s the part of the equation that’s changed,” said Dr. Brad Spellberg, a Professor of Medicine at Harbour-UCLA.
Fewer and fewer new antibiotics are hitting the market. According to the Infectious Disease Society of America, 16 new antibiotics were approved between 1983 and 1987. Only two have hit the market since 2008.
"It's an enormous investment to make a drug, both time and money. And the hurdles are many. First to find the compound that is a novel compound that is something that is unique and makes your drug special and therefore, marketable, that's tough. And then to put it through all the human use testing that has to go on, the post market testing, you're talking about drug development in decades and in hundreds of millions of dollars," said Dr. Mark Polhemus, an infectious disease specialist at Upstate University Hospital.
And with that kind of capital project, drug companies want to maximize their return on investment.
"If you can get a medicine that lowers your cholesterol and have a person take it every day for 40 or 50 years, or a heart medicine, that's a much better return on your investment than trying to get someone to be one of a number of options and then taken only for 10 days," said Polhemus.
All the while, resistance just keeps increasing.
"If a person is sick from one of these resistant drugs, and you're already down to the second line therapy, some of them, we don't have third line and fourth line therapies that we can move to. So if we fail those second line therapies, we're in trouble," said Polhemus.
Plus, fewer options means more of a commitment from patients.
"Those options are incredibly expensive. We don't necessarily have the oral options, the pill options. Some of those are just in IV," said Polhemus.
Dr. John Epling, the Chair of Family Medicine at Upstate University Hospital added, “We don’t want to get to a point where we have to treat people intravenously right out of the gate for something that would otherwise be treated orally.”
Resistance is becoming a major concern for the future of medicine.
"It’s already too late. Many, many patients have already died of infections that are resistant to everything. And of course, tens of thousands die of resistant infections we may only have one of two drugs left to treat. It’s not like we’re going to be ahead of the game if we solve this issue. We’re already behind. The microbes are already ahead," said Spellberg.
Dr. Helen Jacoby, the Medical Director of Infectious Disease at St. Joseph's Hospital added, "Pretty much every bacteria we have is becoming more resistant to antibiotics. Resistance is developing faster than new antibiotics are being developed. And the antibiotic era isn't even 100 years old yet. So the question is, over the very long-term what will happen?"
Experts say it’s going to take a huge culture shift and reinvestment in antibiotic research and development to turn things around. Something they say needs to happen now, before it’s too late.