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Anti-microbial resistance and changing the future

By Phil Ambery

It’s good to see the problem of anti-microbial resistance revisited by Professor Farrar — a timely reminder to us all of the potential dangers ahead. Memories are short, few will remember the days of the early 1990s, when anti-HIV therapies were limited, as were the lives of patients with AIDS. Others will assume that the days of death by “consumption” have long since passed.

Unfortunately the reality is somewhat different.

Treatment of HIV is an arms race, as viral load begins to rise in patients treated with multi-drug anti-retroviral regimes, treating physicians keep up, switching drugs to keep ahead of the virus. It’s clear that the treatment of HIV has been transformed for the better, although it’s inevitable that viral evolution will continue to drive resistance to new agents.

About 450,000 people developed multi-drug resistant tuberculosis (TB) in the world in 2012. More than half of these cases were in India, China and the Russian Federation. Around 10% of these are thought to have even more resistant strains of TB, known as XDR-TB. Whilst these countries seem, quite rightly, almost on the other side of the world, they are only a few hours away by plane.

At home, cases of MRSA, PVL-MRSA, and Clostridium difficile are rarely out of the news. Flesh-eating bugs, dying of diarrhoea, reports of dirty hospitals all sell the papers we love to read.

There’s a clear need to plan for the future and change the way we facilitate the development of new anti-microbials. Professor Farrar is absolutely right that it needed to happen yesterday. With a lead time of 10 years or more from target identification (identifying a new chink in the armour of a bacterium or virus) to getting the drug on the market for patients, we’re already behind in the arms race

bacteria petri dish

Thankfully, intervention is happening at multiple points in the development process: discovery of new targets, innovative clinical trial development, the regulatory process, and improved access to new medicines.

The UK government itself has developed a five-year anti-microbial resistance strategy, intended to deliver significant advancement by 2018. Measures include patient and professional education, optimising prescribing practice, and innovation in new drugs, treatments and diagnostics.

The EU commission is part way through a five-year action plan, commenced in 2011, against the rising threats from anti-microbial resistance. In partnership with the pharmaceutical industry, the commission has funded an innovative medicines initiative (IMI) entitled “New Drugs for Bad Bugs,” specifically targeted at anti-microbial resistance.

Regulatory agencies are playing a crucial role in facilitating the development of new antibiotics. The European regulatory agency is establishing a task force on antibiotic development in conjunction with the United States, and developing of new guidelines on the evaluation of medicinal products indicated for treatment of bacterial infections, and importantly, how use of antibiotics in animals may affect resistance patterns in humans.

Support for appropriate use of antibiotics in the developing world is also gathering pace. The Resources for the Future organisation, supported by the Gates foundation, is working with five emerging economies, China, India, South Africa, Kenya, and Vietnam to develop strategies to minimise the impact of antibiotic resistance.

Much like Charles Dickens’ ghost of Christmas future from A Christmas Carol, Professor Farrar’s vision may yet come to pass. But just like Scrooge, we have an opportunity to change. The potential seeds of change are already sown. With a more productive research environment in European Union and United States, support from governments and regulatory agencies, and ongoing initiatives to encourage appropriate use of antibiotics in the developing world, there is hope of changing the future.

Phil Ambery is a medical doctor working in the pharmaceutical industry and co-editor of the Oxford Handbook of Pharmaceutical Medicine, a textbook on all aspects of the drug development process. Views expressed in this blog are his own and do not necessarily represent those of any of the organisations which he is affiliated with.

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Image credit: Bacteria growing in a blood plate petri dish on white background. © hisartwork via iStockphoto.

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