The associate director of the Centers for Disease Control (CDC) has announced the end of the use of antibiotics. Dr. Arjun Srinivasan says that antibacterial resistance, resulting from the overuse of antibiotics in both humans and livestock, has rendered the former “miracle drugs” useless against “superbugs.”
According to a report in the Daily Mail, Srinivasan has discussed the growing problem of antibacterial resistance throughout a series of interviews since the summer.
“For a long time, there have been newspaper stories and covers of magazines that talked about ‘The end of antibiotics, question mark?'” Srinivasan said in a PBS interview. “Well, now I would say you can change the title to “The end of antibiotics, period.”
In a Frontline report entitled “Hunting the Nightmare Bacteria,” which aired Tuesday, Srinivasan said that both humans and livestock have been so overmedicated that bacteria are now resistant to antibiotics.
“We’re in the post-antibiotic era,” he said. “There are patients for whom we have no therapy, and we are literally in a position of having a patient in a bed who has an infection, something that five years ago even we could have treated, but now we can’t.”
As an example, Srinivasan cited the recent case of three Tampa Bay Buccaneers players who reportedly contracted potentially dangerous MRSA infections which, until recently, were mostly found in hospitals.
About a decade ago, however, Srinivasan said he began seeing outbreaks of different types of MRSA infections in schools and gyms.
“In hospitals, when you see MRSA infections, you oftentimes see that in patients who have a catheter in their blood, and that creates an opportunity for MRSA to get into their bloodstream,” he said. “In the community, it was causing a very different type of infection. It was causing a lot of very, very serious and painful infections of the skin, which was completely different from what we would see in health care.”
Since bacteria have developed resistance to conventional antibiotics, doctors have been returning to some older, but more dangerous, cures such as colistin.
“It’s very toxic,” said Srinivasan. “We don’t like to use it. It damages the kidneys. But we’re forced to use it in a lot of instances.”
The first antibiotic, penicillin, was discovered in 1928 by Scottish Professor Alexander Fleming. The discovery led to the successful treatment of millions of people suffering from illnesses that were once thought to be deadly. In addition, procedures such as organ transplants and chemotherapy, which weaken the immune system, creating greater susceptibility to infection, became possible due to its use. Penicillin-related antibiotics such as ampicillin, amoxicillin, and benzylpenicillin are widely in use today to treat various infections.
The CDC director said that people have allowed bacterial resistance through rampant overuse and misuse of antibiotics.
“These drugs are miracle drugs, these antibiotics that we have, but we haven’t taken good care of them over the 50 years that we’ve had them,” he said.
Concerns about antimicrobial resistance led the World Health Organization (WHO) to warn that a health emergency of global proportions could result without the antibiotics needed to combat multi-drug resistance bacteria that are spreading around the world.
“Antibiotic resistance is one of the foremost issues that will affect healthcare worldwide, including Australia, in the coming decades,” said Thomas Gottlieb, president of the Australasian Society for infectious Diseases, and advisor to pharmaceutical companies Novartis, Pfizer, AstraZeneca and Janssen-Cilag.
Srinivasan said pharmaceutical companies are at least partially to blame for this problem because they have neglected the development of new and more sophisticated antibiotics that could keep up with bacterial resistance because “there’s not much money to be made” in this field.
In the Frontline report, journalist David Hoffman discussed the lack of economic incentive for pharmaceutical companies to develop new antibiotics:
[In the ’50s and ’60s] I think there was something like 150 classes of new antibiotics. And although there were warnings then that if we misused them that resistance would grow, you could just see in the marketplace new ones coming on every couple of years. … I think we got very, very complacent. … In the ’80s and particularly in the ’90s we went around the bend a little bit because the science didn’t continue to produce new antibiotics at that rate, and the economics of drug development changed rather remarkably. …
We’re bombarded with advertisements that there are drugs now to treat chronic diseases … that you would take for the rest of your life. And you can imagine, if you’re in drug development, if you create and invent one of these drugs that can tackle a chronic disease that people will take forever, the return on investment for the drug companies to develop those big blockbuster drugs … that became irresistible.
But think about antibiotics. If they’re taken properly, you take them only for a short course, a couple of weeks maybe, and then you stop and you forget it, you get better. … So the economics of making antibiotics wasn’t going to make these big profits for the drug companies. And slowly, but with increasing frequency, they begun [sic] to pull out of research on antibiotics.
Shila Kaur, a health consultant with Third World Network, writes that besides low return on investment, however, big pharmaceutical companies also complain of another obstacle: the “lack of regulatory clarity from the U.S. Food and Drug Administration (FDA), which has reportedly made it increasingly difficult for antibiotic development to overcome all the necessary regulatory hurdles.
Critics of Big Pharma, however, observe that fast-tracking regulatory approval procedures might compromise drug safety while it also makes antibiotic development more profitable for big drug companies at the expense of smaller ones, the latter of which actually have the ability to research superbugs and new antibiotics while they earn profits due to lower overhead costs.
“There are only a handful of companies like us out there,” said Steve Gilman, chief scientific officer and executive vice president of Cubist, a bio-pharmaceutical company based in Lexington, Massachusetts. “We’re focusing exclusively on the superbugs of today and other types of anti-resistant bacteria,” he told CNBC.
“Our guidance for R&D [research and development] for 2013 is between $400 and $420 million, with the bulk of that focused on antibiotics,” he added.
“Our overhead is much less than a larger firm,” Gilman said about Cubist, a publicly-traded company which reported net revenue in 2012 of $926.4 million, up 23 percent from 2011. “We’ve been able to find a steady stream of revenues that keeps growing. We’re happy to pursue a $500 million market, where the bigger firms won’t.”
“I don’t think the bigger pharmaceutical firms are going to change their mind about getting back into antibiotic research anytime soon,” Gilman said. “It’s up to us (smaller firms) to get this solved.”