Superbugs and Antibiotic Drug Development

There is a new type of antibiotic resistance, and it comes from an unexpected source. Health professionals and laypeople alike have been warned about the overuse of antibiotic medications and subsequent development of resistant bacterial strains. While the problem originated with the clinical introduction of penicillin in 1942, much of the early supply was used for the troops fighting World War II. The mass production methods developed after the war decreased the cost of this medication and led to an exponential increase in its use. As we now understand, a similar scenario played out with other antibiotics, resulting in an increasing number of resistant organisms — the so-called superbugs.

Global concern over antibiotic resistance led to renewed efforts to use these drugs only in appropriate situations. The rise of superbugs also underscores the need to develop new antibiotics. A recent article in The Economist explored what’s involved in producing these new medications. While a number of new antibiotics have been developed, due to their increased cost and limited availability, they are primarily used for the small percentage of individuals who develop resistance to all other known antibiotics.

However, limited use of these new drugs has led to decreased monetary returns and even bankruptcies for a number of smaller firms doing research in this field. Part of the problem is that smaller companies lack the marketing dollars needed to introduce new medications to physicians. In addition, hospitals tend to avoid these new antibiotics because they often cost thousands of dollars per patient. This problem has been exacerbated by the fact Medicare bundles antibiotic payments with hospitalization costs, not as a separate reimbursement for a particular treatment, as seen in individuals undergoing therapy for cancer.

PROVIDERS AND PATIENTS MUST CONTINUE TO STRIKE A DELICATE BALANCE BETWEEN OVERUSE AND UNDERUSE

As a result, a number of the major pharmaceutical companies have abandoned their search for new antibiotics in favor of more lucrative drugs. Presently, the only majors doing research in the area are GlaxoSmithKline, Pfizer and Merck.

It has been speculated that some of these orphan medications will eventually be prescribed more frequently as additional bacterial strains develop resistance to more widely used antibiotics. Their use is also occasionally helpful in early treatment of infection before the results of antibiotic specificity tests are complete. This polymedication often includes some of the newer types of antibiotics. It can be assumed that as more and more bacteria become resistant, these newer antibiotics will become more profitable and therefore stimulate the market. In the meantime, providers and patients must continue to strike a delicate balance between overuse and underuse of these medications.

Thomas G. Wilson Jr., DDS

Editor in Chief
twilson@belmontpublications.com

From Decisions in Dentistry. November/December 2019;5(10):8.