Data from across the world have shown an overall decline in the antibiotic pipeline and continually rising resistance to all first-line and last-resort antibiotics. The gaps in our knowledge of existing prevalence and mechanisms of antibiotic resistance (ABR) are all too well known. Several decades of antibiotic abuse in humans, animals, and agricultural practices have created health emergency situations and huge socio-economic impact. This paper discusses key findings of the studies conducted by several national and international collaborative organizations on the current state of affairs in ABR. Alongside, a brief overview of the antibacterial agents' discovery in recent years approved by the US FDA is discussed.
Antibiotic drug resistance; Antibacterial drug resistance; Antimicrobial drugs
Citation: Arpana Sagwal Chaudhary A Review Of Global Initiatives To Fight Antibiotic Resistance And Recent Antibiotics' Discovery doi:10.1016/j.apsb.2016.06.004.
Received: 5 May 2016, Revised: 20 May 2016, Accepted: 2 June 2016, Available online: 15 July 2016
Copyright: © 2016 Chinese Pharmaceutical Association and Institute of Materia Medica, Chinese Academy of Medical Sciences. Production and hosting byElsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
The currently available estimates of ABR burden in each country point to an evident conclusion that it is in the self interest of each country to prolong antibiotic effectiveness within their territories. The pipeline of new antibacterial agents is especially discouraging and it has been so for the last few decades. Several reasons are attributed to this grim scenario of drug discovery for new antibiotics. The major one however is the lacking interest of pharma companies. Finding it hard to recoup drug discovery costs from antibiotics which develop resistance within a decade or so, pharmaceutical companies preferably choose to invest in safer types of drugs, such as antidepressants, statins, and anti-inflammatory medications, which can bring steady flow of revenue, even when off-patent. Although, academic laboratories appear to continue their research efforts in looking for new drug leads, their efforts are inadvertently quashed by their inability to collaborate with the pharma companies for conducting high level pre-clinical research, and also their failure to transfer/license such technologies beyond academic laboratories. Such setbacks cost dearly to the new antibiotic discovery, because academic labs lack the resources and funding to carry out top gear research on their own. This symbiotic relationship of academic labs and pharma industry needs to be lessened by increasing the amount of federal funding to the universities. It so appears that the government has begun efforts to lure pharmaceutical companies back into the antibiotic research by facilitating fast-track FDA approvals, providing extended drug-patent exclusivity of five years, which is evidenced by the Generating Antibiotic Incentives Now (GAIN) Act, a new law brought about in 2012 by the US government; although, the results of it remain to be seen in coming years.
For now, the future of antibiotic discovery is uncertain, and therefore we need to lessen our anticipation of a robust antibacterial drug pipeline and with that our hopes for a drastic upsurge in ABR drug discovery trends in near future. In fact, preventive measures can go a long way in tackling ABR effectively and appear to be a reasonable solution to the problem until some radical innovation transforms the antibacterial drug pipeline towards betterment.
All countries, especially the developing ones, in the context of antibiotics, need to institute methods for the appropriate choice of drug treatment—a complex problem involving prescribers, dispensers, and consumers. The most necessary component, the diagnostic aspect of drug prescription, is often ignored in many countries. It is important that bacterial culture and susceptibility testing before antibacterial prescription are mandated. Drug quality plays an important role too and needs serious enforcement measures. This is a particularly common problem with generic drug makers in developing countries. Sub-optimal amounts of drug invariably lead to drug resistance; therefore quality control measures of drug labels are important. At the same time, educational interventions at the patient level play a critical role. Most importantly, controlling the spread of resistant organisms using proper quarantine measures will have a tremendous additive effect on the prevention of ABR dissemination. For example, in case of outbreaks, countries must be ready with pre-specialized task forces to prevent the introduction and transmission of infective agents, especially amongst mobile population. The “search and destroy” policy involving patient pre-screening, isolating, quarantining, staff member screening, has been proven effective in many countries. Similar approaches should be tailored specific to the needs of each region and outbreak type, and must be pre-instituted and ready-at-use at the eleventh hour. It is also important to realize that each country faces its unique challenges in ABR and therefore needs to proactively review their own precise problems and find solution applicable within their boundaries.