The antibiotic crisis: New hope on the horizon
The UK is leading the way in the fight against antibiotic resistance, discovers
The Covid pandemic focused the world’s attention on health like never before as doctors and scientists worked together to fight the killer virus.
But there is another global health issue now causing concern – the antibiotic crisis, or antimicrobial resistance (AMR).
Its impact on serious infections such as sepsis and hospital-acquired pneumonia has always made headlines.
But the growing awareness that antibiotics are vital for every operation – and even to treat a simple infected cut – has made the threat of AMR very real and very frightening.
Penicillin transformed healthcare when it was first used in the 1940s.
It was used to treat soldiers during the Second World War, curing battlefield wound infections and pneumonia, before becoming widely available in this country. It’s hard to imagine now what healthcare was like before antibiotics, when every open wound had the potential to be deadly.
Antibiotics now underpin practically every medical procedure, with each ground-breaking advance in treatment relying on antibiotics to treat possible infections. But this has come at a cost.
People often expect that everything can be treated by antibiotics, with patients demanding them from GPs for sore throats, coughs and colds.
But even as far back as the 1950s, there were concerns overuse would make infections resistant to antibiotics.
The more antibiotics are used to treat trivial conditions, the more likely they are to become ineffective for treating more serious conditions.
This has led to the emergence of superbugs – strains of bacteria that have developed resistance to many different types of antibiotics.
And this is AMR, when bacteria, viruses, fungi and parasites change over time so they no longer respond to medicines, making infections harder to treat and increasing the risk of disease spreading, severe illness and death.
As well as affecting people,
AMR can potentially impact healthcare, veterinary, and agriculture industries, which makes it one of the world’s most urgent public health problems.
And bacteria don’t have to be resistant to every antibiotic to be dangerous. AMR infections that require second and third-line treatments can harm patients by causing serious side effects, such as organ failure, as well as prolonging care and recovery.
Joint replacements, organ transplants, cancer therapy and the treatment of chronic diseases such as diabetes, asthma and rheumatoid arthritis are constantly advancing. Yet they are also dependent on antibiotics to fight infections.
If antibiotics lose their effectiveness, the worst-case scenario is that these treatments carry huge risks and, in some cases, people would die from relatively minor conditions.
More than 1.2 million people – and
There were concerns in 1950s that overuse would make infections resistant
potenntially millions more – died in 2019 as a direct result of antibiotic-resistant bacterial infections and this is estimated to increase to 10 million deaths each year by 2050.
Few new classes of antibiotic have been discovered since the 1980s.
There are few replacement or alternative products in development and even fewer that target the more resistant infections.
There’s also a tendency to believe all we need to do is develop more antibiotics but the reality is more complex. Even someone who can boast of never having needed an antibiotic will still have ingested them in many other ways.
Unused antibiotics and waste containing antibiotics, which have been flushed down drains or toilets, can enter the environment, while antibiotics used in farming enter both crops and livestock. The good news is that the UK is the first country in the world to introduce an innovative way of funding research into antibiotics.
Traditionally, when pharmaceutical firms develop effective medication, their eventual financial rewards lie in that drug being put into circulation.
Now, the aim with antibiotics is to develop new ones, but put them on the shelf in the hope they’re never needed, or only used for patients with serious infections that have evolved so much that antibiotics and other current treatments are no longer effective.
At its simplest, what this means is that we could now have antibiotics A, B and C still working against most infections, while new antibiotics D, E and F are developed and ready for use in the worst-case scenario.
The problem is that the high cost and low returns associated with research and development of new antimicrobials makes it unsustainable if pharmaceutical firms find themselves without revenue. Many small biotech firms have failed because of lack of interest and money to fund their antibiotic products. However NHS England, NICE, the Government and UK pharmaceutical companies have now collaborated to launch a world-first pilot scheme, which means pharmaceutical firms will receive a fixed yearly fee – capped at a level that represents value to taxpayers – to help develop antibiotics.
There are currently two contracts in place to pay pharmaceutical companies for access to new antibiotics.
Around 1,700 patients per year with severe bacterial infections will be eligible for the drugs, called cefiderocol and ceftazidime–avibactam, manufactured by Shionogi and Pfizer respectively. This new style of agreement with the pharmaceutical firms will ensure doctors can give patients new antibiotics when they are needed, but preserve their effectiveness for future years.
“This is very good news for patients. NHS England, industry, NICE and the Government are moving quickly to develop this into a long-term solution following the pilot,” says Tim Mepham, AMR lead at the Association of the British Pharmaceutical Industry.
“The UK is the first country in the world to think differently about how we pay for antibiotics and put this initiative into practice. It resulted from joint working and strong collaboration between the pharmaceutical industry, the Department of Health, NHS and NICE to get this together.
“There’s a lot of global interest in this agreement, with many countries watching closely, and there’s a similar approach in the States with the Pasteur
Act currently with Congress.”
Another area of continuing interest and investment in solving the AMR crisis lies in the exploration of marine natural products. According to the National Geographic Society, 80 per cent of the ocean remains a mystery yet to be explored. So there could still be a great deal to discover to help in this battle against AMR, especially when it comes to discovering new antibiotics, rather than developing next-generation variants of existing classes of antibiotics.
There are two labs in the UK now involved in the exploration of marine natural products, led by Dr Katherine Duncan, University of Strathclyde, and Professor Marcel Jaspars, University of Aberdeen.
Dr Duncan also references the importance of a global approach.
“In order to discover new antibiotics, it’s vital we have a greater understanding of microorganisms, the chemistry they produce and what environmental influences impact this,” she says.
“Under-explored regions have been shown to be an exciting area for bio-discovery, everywhere from the deep sea to Scottish islands – there is a lot to uncover.”
Covid inspired unprecedented levels of research and hopefully the same approach will be taken with the AMR health crisis, as it has the potential to touch everyone’s lives and health.
The UK is setting the standard on how collaboration and innovation can tackle this issue in a way that benefits all involved, and hopefully prevents the worst predictions coming true.
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The aim is to develop new antibiotics but shelve them for future use