How to Solve the Problem of Antibiotic Resistance

SA Forum

nterviews for the WEF by Katia Moskvitch.

Antibiotics have saved millions of lives—but their misuse and overuse is making them less effective as bacteria develop . Despite scientists’ warnings, antibiotic prescriptions in many countries continue to soar.

Venki Ramakrishnan, a Nobel Prize-winning chemist based at the Laboratory of Molecular Biology at the University of Cambridge, tells us about the importance of gaining a better understanding of the use and misuse of these wonder drugs.

[]

The world seems to be running out of antibiotics. In middle of the 20th century more than 20 new classes of antibiotics were marketed; since the 1960s only two new classes have reached the market. Why is that the case?

But then it became a law of diminishing returns for the number of new compounds that could be effective. Being able to kill bacteria is not enough; you have to be able to make an antibiotic cheaply, and it has to be safe. So the number of really new compounds diminished and a lot of drug companies were modifying known antibiotics, trying to make them better and more effective.

There have been recent reports of a breakthrough—a new antibiotic that “kills pathogens without detectable resistance.” What do you think of this advance?

The other issue is resistance. In the paper they claim that this antibiotic, because of the way it acts, is unlikely to lead to resistance. But people have said this about many different things before, and eventually resistance seems to develop. I would be a little cautious to say that no resistance will ever develop to anything, because natural selection is very powerful and has a way of defeating even the most powerful tools. Still, it seems very promising.

Researchers are now waging a war against antibiotic-resistant bacteria. What exactly is being done?

But there’s a larger problem—the problem of resistance is also due to an abuse of antibiotics. Many people will go to a doctor and demand an antibiotic when they have a cold or a flu, for which these antibacterial compounds are useless. In many countries it is possible to buy antibiotics over the counter. Often, if people are poor, they will not take the full dose—all of that leads to resistance.

In countries like India people will give you antibiotics prophylactically, as a way to prevent infection. This should only be done in very extreme cases because it’s again spreading resistance.

So is the problem limited mostly to the developing world?

We need better diagnostics, to allow us to very quickly diagnose a bacterium that is causing a particular disease, to then treat it specifically with a narrow spectrum of antibiotics. And finally, there’s a whole issue of better public hygiene.

People now move all over the world, so if resistance emerges in one place it can very quickly spread to other places. So it needs a concerted attack—it is a broad social problem.

Are you confident we can win this war against resistant bacteria?

I would prefer that governments in a worldwide agreement establish certain guidelines for antibiotics use—for public health, for hygiene, for use of antibiotics in the animal industry; and also will promote science—get better diagnostics, better understanding of how bacteria cause disease and for the development of new antibiotics.

What would a world without antibiotics look like?

Are there any alternatives to antibiotics?

—naturally occurring viruses that attack specific bacteria—have sometimes been mentioned as possible tools. Although they were discovered in the early 20th century, their clinical use has so far been limited to some efforts in Russia, [the Republic of] Georgia and Poland. This is partly because they are large biological agents, and delivering the phage to the appropriate target is not as straightforward as administering a small-molecule antibiotic. Phages and bacteria can also mutate, rendering them ineffective. However, it is possible that future research may pave the way for greater use of phages to treat bacterial infections.

Are governments and the public beginning to understand the problem with resistant bacteria and do something about it?

It’s a multipronged approach. Measures like public health and hygiene will take a long time.

Do you think the production of drugs should be funded by governments or by private companies, as it is mostly the case today?

If it’s a good antibiotic, the patient will be cured in a week or two—whereas ideally if you want to make a lot of money from a drug, it should be something the patient has to take all of their life. So antibiotics by their nature are not going to be the same class of moneymaker.

So I think that governments really need to get involved in the development of new antibiotics. They have to think of this as something generally good for society, the same reason that governments fund education, roads, police, defense and so on. This is one case where governments need to act.

Related articles:

Chomsky: We Are All – Fill in the Blank.

This entry passed through the Full-Text RSS service - if this is your content and you're reading it on someone else's site, please read the FAQ at http://ift.tt/jcXqJW.