New An­tibi­otics Ur­gently Needed to Com­bat Re­sis­tant Bac­te­ria

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The United Na­tions World Health Or­gan­i­sa­tion has just pub­lished its first ever list of an­tibi­otic-re­sis­tant “pri­or­ity pathogens” – a cat­a­logue of 12 fam­i­lies of bac­te­ria that pose the great­est threat to hu­man health.

The list was drawn up in a bid to guide and pro­mote re­search and de­vel­op­ment (R&D) of new an­tibi­otics, as part of the World Health Or­ga­ni­za­tion (WHO) ef­forts to ad­dress grow­ing global re­sis­tance to an­timi­cro­bial medicines.

Es­pe­cially threat­en­ing is gram-neg­a­tive bac­te­ria that are re­sis­tant to mul­ti­ple an­tibi­otics. These bac­te­ria have built-in abil­i­ties to find new ways to re­sist treat­ment and can pass along ge­netic ma­te­rial that al­lows other bac­te­ria to be­come drug-re­sis­tant as well, WHO re­ported on Feb. 27.

“This list is a new tool to en­sure R&D re­sponds to ur­gent pub­lic health needs,” says Dr Marie-paule Kieny, WHO’S As­sis­tant Di­rec­tor-gen­eral for Health Sys­tems and In­no­va­tion. “An­tibi­otic re­sis­tance is grow­ing, and we are fast run­ning out of treat­ment op­tions. If we leave it to mar­ket forces alone, the new an­tibi­otics we most ur­gently need are not go­ing to be de­vel­oped in time.”

New re­sis­tance mech­a­nisms are emerg­ing and spread­ing glob­ally, threat­en­ing our abil­ity to treat com­mon in­fec­tious dis­eases, re­sult­ing in pro­longed ill­ness, dis­abil­ity, and death.

With­out ef­fec­tive an­timi­cro­bials for pre­ven­tion and treat­ment of in­fec­tions, med­i­cal pro­ce­dures such as or­gan trans­plan­ta­tion, can­cer chemo­ther­apy, di­a­betes man­age­ment and ma­jor surgery (for ex­am­ple, cae­sarean sec­tions or hip re­place­ments) be­come very high risk.

Three Cat­e­gories Ac­cord­ing to Ur­gency of Need

The WHO list is di­vided into three cat­e­gories ac­cord­ing to the ur­gency of need for new an­tibi­otics: crit­i­cal, high and medium pri­or­ity.

The most crit­i­cal group of all in­cludes mul­tidrug re­sis­tant bac­te­ria that pose a par­tic­u­lar threat in hos­pi­tals, nurs­ing homes, and among pa­tients whose care re­quires de­vices such as ven­ti­la­tors and blood catheters.

They in­clude Acine­to­bac­ter, Pseu­domonas and var­i­ous En­ter­obac­te­ri­aceae (in­clud­ing Kleb­siella, E. coli, Ser­ra­tia, and Pro­teus). They can cause se­vere and of­ten deadly in­fec­tions such as blood­stream in­fec­tions and pneu­mo­nia.

These bac­te­ria have be­come re­sis­tant to a large num­ber of an­tibi­otics, in­clud­ing car­bapen­ems and third gen­er­a­tion cephalosporins – the best avail­able an­tibi­otics for treat­ing multi-drug re­sis­tant bac­te­ria.

The sec­ond and third tiers in the list – the high and medium pri­or­ity cat­e­gories – con­tain other in­creas­ingly drug-re­sis­tant bac­te­ria that cause more com­mon dis­eases such as gon­or­rhoea and food poi­son­ing caused by sal­mo­nella.

Tu­ber­cu­lo­sis – whose re­sis­tance to tra­di­tional treat­ment has been grow­ing in re­cent years – was not in­cluded in the list be­cause it is tar­geted by other, ded­i­cated pro­grammes, says the UN spe­cialised body.

“Other bac­te­ria that were not in­cluded, such as strep­to­coc­cus A and B and ch­lamy­dia, have low lev­els of re­sis­tance to ex­ist­ing treat­ments and do not cur­rently pose a sig­nif­i­cant pub­lic health threat.”

WHO ex­plained that the cri­te­ria for se­lect­ing pathogens on the list were: how deadly the in­fec­tions they cause are; whether their treat­ment re­quires long hospi­tal stays; how fre­quently they are re­sis­tant to ex­ist­ing an­tibi­otics when peo­ple in com­mu­ni­ties catch them; how eas­ily they spread be­tween an­i­mals, from an­i­mals to hu­mans, and from per­son to per­son; whether they can be pre­vented (e.g. through good hy­giene and vac­ci­na­tion); how many treat­ment op­tions re­main; and whether new an­tibi­otics to treat them are al­ready in the R&D pipe­line.

“New an­tibi­otics tar­get­ing this pri­or­ity list of pathogens will help to re­duce deaths due to re­sis­tant in­fec­tions around the world,” warned Prof Evelina Tac­conelli, Head of the Divi­sion of In­fec­tious Dis­eases at the Univer­sity of Tübin­gen and a ma­jor con­trib­u­tor to the de­vel­op­ment of the list. “Wait­ing any longer will cause fur­ther pub­lic health prob­lems and dra­mat­i­cally im­pact on pa­tient care.”

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