Combating antibiotic resistance will require scientists, drug developers and other stakeholders to reorient their strategy to the problem by addressing stubborn and complex barriers to effective use of existing medicines and the creation of new ones, a Weill Cornell researcher writes in the New England Journal of Medicine.
Dr. Carl Nathan's perspective, published Oct. 1 with co-author Dr. Otto Cars, proposes a global "antimicrobial oversight agency" that would tackle some of the "daunting challenges" associated with antibiotic resistance, which has weakened the medicines’ ability to treat life-threatening illnesses and endangers both individual and collective wellbeing around the world.
The agency would be tasked with monitoring the spread of resistance, mitigating some of the reasons for it, and encouraging companies to resume developing new antibiotics. Rewarding innovative companies proportionally to the quality-adjusted life-years their drugs save, rather than through sales of new antibiotics at high prices, would encourage antibiotic development, promote access to antibiotics by those in need, and remove the incentive for counterfeiting and dilution, which are prevalent in many countries and promote the spread of antibiotic resistance worldwide, the authors write. Overcoming resistance will also require prescribers to have access to — and to use — diagnostic tests that would identify infections that the medicines would effectively treat. (Antibiotics are often prescribed for viral infections that don't respond to the drugs.) And antibiotic stewardship programs would help curb over-use. Other conservation measures Drs. Nathan and Cars describe include discontinuing the use of antibiotics for growth promotion in food animals, reducing over-the-counter sales of the drugs, and ending the practice, prevalent in some countries, of prescribers profiting directly from antibiotic sales.
The NEJM commentary comes two weeks after President Obama charged the National Security Council with developing a national action plan to address antimicrobial resistance.
While everyone is affected, "Physicians may care about this problem most passionately, for they must tell more and more families that there is no hope," write Dr. Nathan, chair of Weill Cornell's Department of Microbiology and Immunology, and Dr. Cars, a professor of infectious diseases at Uppsala University in Sweden. "Doctors can act not just individually and medically, but also collectively and civically" to ensure that plans such as those that President Obama has called for are funded and enacted, they write.