7 ms·

In its apparent desire to blame Congress for the end of antibiotics, this article misses a big reason companies aren't developing new antibiotics anymore: they

In its apparent desire to blame Congress for the end of antibiotics, this article misses a big reason companies aren't developing new antibiotics anymore: they just don't work like they used to. Every new generation of antibiotic is effective for a shorter period than the previous.

JumpCrisscross 10y ago
Do you have a source for this alleged temporal decay of efficacy?
- asdfasdfa11112 10y ago
  If you are serious with your question, instead of just trying to jockey for hacker forum dominance, a very quick google search will answer your question. It is possible that I misunderstood your Q, and your tone, and if so, I apologize. I searched google.com for "increased antibiotic resistance over time" and found two sources that seem pretty legit. One is the World Health Organization, the other is the US National Library of Medicine. Both articles appear to address the question I believe you raised. [0] http://www.who.int/mediacentre/factsheets/fs194/en/ http://www.who.int/mediacentre/factsheets/fs194/en/ [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/
  - JumpCrisscross 10y ago
    Thank you! My key question was less around increasing numbers of antibiotic-resistant pathogens and more toward the claim that antibiotics released today produce resistant strains faster than ones produced say fifty years ago. The timeline in your second link should help me piece that together...
melling 10y ago
They should be blaming doctors and people for using them incorrectly. Doctors used to give them to people because they had a cold, for example. People insisted on being given some sort of medicine. In India, you can still buy antibiotics over the counter. http://www.npr.org/sections/goatsandsoda/2015/09/17/441146398/why-india-is-a-hotbed-of-antibiotic-resistance-and-sweden-is-not http://www.npr.org/sections/goatsandsoda/2015/09/17/44114639...
- douche 10y ago
  Unfortunately, that does work in most cases. I'm curious what the success rates would be if all zithromax (?) prescriptions were replaced with sugar pills. I've gotten that drug many times for what may or may not have been strep or bronchitis.
  - Fomite 10y ago
    There is actually a company doing this. They were handing out samples at IDWeek. It's called the "ZeePack" or something of the sort (a play on the the azithromycin/zithromax 'Z-Pak') and is essentially vitamins and herbal supplements you can give to cold patients so they feel like they have been given something.
  - rscho 10y ago
    The "success" rate would still be very high, as most people would surmount the infection. However, the "failure" rate (people dying) would be much higher as well... I am sure you can see that would be an ethical and practical problem. Where would you put the "safety" cutoff of not giving zithromax?
    - douche 10y ago
      Really, what are the rates on people dying from tier 1 infections like that
      - rscho 10y ago
        https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4829a1.htm https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4829a1.htm That kind of rates. In the 1918 influenza pandemics for example, many people died of a bacterial pneumonia following the flu infection. So you see, the impact of "1-tier" infections is very real without antibiotics. EDIT: by all means, downvoters, make your point explicit!
  - fuzzfactor 10y ago
    Perhaps healthier hearts? http://www.fda.gov/Drugs/DrugSafety/ucm341822.htm http://www.fda.gov/Drugs/DrugSafety/ucm341822.htm Seems like one of the primary features of this antibiotic was to have a chemical that was new at the time, so patent protection could be enjoyed from that point forward. Different features can have different priorities at different times, sometimes there's nothing "engineering" can do about it, it's a marketing thing. Wherever cardiac health might fall on the priorities list, it's probably not way up there for this compound. disclaimer: haven't worked for a drug producer since I was first out of college
Fomite 10y ago
This will come as a surprise to Merck, which recently bought Cubist to boost their antibiotics research arm, and which is actively funding research in that area. Or GSK, which has partnered with a bunch of European universities to develop new antibiotics against gram negatives.
- thephyber 10y ago
  I don't think it will "come as a surprise" to any major public pharma company. They are all in the business of managing risk: * that a drug test will fail trials * that they will be beat to market by a competing drug * that a contamination in their products will cause damage to patients * that R&D costs will not be recovered before the patent expires * keeping R&D costs low enough to be competitive, but high enough to have a pipeline of future products IIRC, general antibiotics have never lasted more than 18 months before we found a bacteria that became resistant to them. Pharma companies know this more than the rest of us. They are betting/hedging on getting to market first with a multi-drug resistant (MDR) bug killer. Everyone on Earth will need a new antibiotic as the current MDR bugs become more widespread. And the more widespread the current MDR bugs are, the more valuable a fresh antibiotic would be (it would be an effective monopoly).
  - refurb 10y ago
    general antibiotics have never lasted more than 18 months before we found a bacteria that became resistant to them But this doesn't mean the drug won't be used. Drug resistance rates are often in the single percent of patients. You can have resistance out there, but still have a huge market.
  - Fomite 10y ago
    18 months is the time until any resistance is found, but that doesn't mean we hang up the antibiotic. We do susceptibility testing, we use higher doses, we use combination therapy, etc. Resistance is a continuum, not a binary state.
  - greeneggs 10y ago
    > IIRC, general antibiotics have never lasted more than 18 months before we found a bacteria that became resistant to them. This does not seem to be correct. With the most recently introduced antibiotics—Levoflaxacin, Linezolid and Ceftaroline—resistance has developed very rapidly. But that didn't used to be the case; old antibiotics lasted much longer before resistance developed. [1] I am not sure why this is---are these newer antibiotics more fragile (i.e., easier to resist), or are they being misused more broadly? If it is the latter reason, then perhaps we should stop developing new antibiotics until better usage practices are enforced. It is stupid to spend a lot of money developing antibiotics, only to throw it away by misusing them. [1] http://www.nature.com/nature/journal/v509/n7498_supp/fig_tab/509S2a_G2.html http://www.nature.com/nature/journal/v509/n7498_supp/fig_tab...
refurb 10y ago
Another big reason is the lack of financial incentives for companies. A lot of new antibiotics are for very small populations (you'll only use a new antibiotics for the rare cases of drug resistance). As a result, drug companies are looking at spending $100M to make a new drug, when they'd be lucky to make their money back on it.
Swannie 10y ago
Sadly I read this as a thinly veiled attempt to argue for Congress to fund anti-bioitic research. Why? Well the article practically spells out the why: pharma is not incentivised to bring new anti-biotics to market, but they can create lots of "new" ones that are similar to the old ones. Why not change the model, and create a system where pharma companies can churn out "new and innovative" anti-biotics, for a nice guaranteed government payout. "Win win" for pharma, politicians, and who knows - maybe farmers and people? Cynical? Extremely. An element of truth in my view? Almost certainly. The way I view it - we have too many different options available on the market. We should look to remove a decent % of them from circulation in as many countries as possible, to allow any resistant strains to lose their resistance. Yes, this would impact pharma companies, but their could be a rotational system with extensions to patents as required to keep them happy.

JumpCrisscross 10y ago

Do you have a source for this alleged temporal decay of efficacy?

asdfasdfa11112 10y ago
If you are serious with your question, instead of just trying to jockey for hacker forum dominance, a very quick google search will answer your question. It is possible that I misunderstood your Q, and your tone, and if so, I apologize. I searched google.com for "increased antibiotic resistance over time" and found two sources that seem pretty legit. One is the World Health Organization, the other is the US National Library of Medicine. Both articles appear to address the question I believe you raised. [0] http://www.who.int/mediacentre/factsheets/fs194/en/ http://www.who.int/mediacentre/factsheets/fs194/en/ [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/
- JumpCrisscross 10y ago
  Thank you! My key question was less around increasing numbers of antibiotic-resistant pathogens and more toward the claim that antibiotics released today produce resistant strains faster than ones produced say fifty years ago. The timeline in your second link should help me piece that together...

melling 10y ago

They should be blaming doctors and people for using them incorrectly. Doctors used to give them to people because they had a cold, for example. People insisted on being given some sort of medicine. In India, you can still buy antibiotics over the counter. http://www.npr.org/sections/goatsandsoda/2015/09/17/441146398/why-india-is-a-hotbed-of-antibiotic-resistance-and-sweden-is-not http://www.npr.org/sections/goatsandsoda/2015/09/17/44114639...

douche 10y ago
Unfortunately, that does work in most cases. I'm curious what the success rates would be if all zithromax (?) prescriptions were replaced with sugar pills. I've gotten that drug many times for what may or may not have been strep or bronchitis.
- Fomite 10y ago
  There is actually a company doing this. They were handing out samples at IDWeek. It's called the "ZeePack" or something of the sort (a play on the the azithromycin/zithromax 'Z-Pak') and is essentially vitamins and herbal supplements you can give to cold patients so they feel like they have been given something.
- rscho 10y ago
  The "success" rate would still be very high, as most people would surmount the infection. However, the "failure" rate (people dying) would be much higher as well... I am sure you can see that would be an ethical and practical problem. Where would you put the "safety" cutoff of not giving zithromax?
  - douche 10y ago
    Really, what are the rates on people dying from tier 1 infections like that
    - rscho 10y ago
      https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4829a1.htm https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4829a1.htm That kind of rates. In the 1918 influenza pandemics for example, many people died of a bacterial pneumonia following the flu infection. So you see, the impact of "1-tier" infections is very real without antibiotics. EDIT: by all means, downvoters, make your point explicit!
- fuzzfactor 10y ago
  Perhaps healthier hearts? http://www.fda.gov/Drugs/DrugSafety/ucm341822.htm http://www.fda.gov/Drugs/DrugSafety/ucm341822.htm Seems like one of the primary features of this antibiotic was to have a chemical that was new at the time, so patent protection could be enjoyed from that point forward. Different features can have different priorities at different times, sometimes there's nothing "engineering" can do about it, it's a marketing thing. Wherever cardiac health might fall on the priorities list, it's probably not way up there for this compound. disclaimer: haven't worked for a drug producer since I was first out of college

Fomite 10y ago

This will come as a surprise to Merck, which recently bought Cubist to boost their antibiotics research arm, and which is actively funding research in that area. Or GSK, which has partnered with a bunch of European universities to develop new antibiotics against gram negatives.

thephyber 10y ago
I don't think it will "come as a surprise" to any major public pharma company. They are all in the business of managing risk: * that a drug test will fail trials * that they will be beat to market by a competing drug * that a contamination in their products will cause damage to patients * that R&D costs will not be recovered before the patent expires * keeping R&D costs low enough to be competitive, but high enough to have a pipeline of future products IIRC, general antibiotics have never lasted more than 18 months before we found a bacteria that became resistant to them. Pharma companies know this more than the rest of us. They are betting/hedging on getting to market first with a multi-drug resistant (MDR) bug killer. Everyone on Earth will need a new antibiotic as the current MDR bugs become more widespread. And the more widespread the current MDR bugs are, the more valuable a fresh antibiotic would be (it would be an effective monopoly).
- refurb 10y ago
  general antibiotics have never lasted more than 18 months before we found a bacteria that became resistant to them But this doesn't mean the drug won't be used. Drug resistance rates are often in the single percent of patients. You can have resistance out there, but still have a huge market.
- Fomite 10y ago
  18 months is the time until any resistance is found, but that doesn't mean we hang up the antibiotic. We do susceptibility testing, we use higher doses, we use combination therapy, etc. Resistance is a continuum, not a binary state.
- greeneggs 10y ago
  > IIRC, general antibiotics have never lasted more than 18 months before we found a bacteria that became resistant to them. This does not seem to be correct. With the most recently introduced antibiotics—Levoflaxacin, Linezolid and Ceftaroline—resistance has developed very rapidly. But that didn't used to be the case; old antibiotics lasted much longer before resistance developed. [1] I am not sure why this is---are these newer antibiotics more fragile (i.e., easier to resist), or are they being misused more broadly? If it is the latter reason, then perhaps we should stop developing new antibiotics until better usage practices are enforced. It is stupid to spend a lot of money developing antibiotics, only to throw it away by misusing them. [1] http://www.nature.com/nature/journal/v509/n7498_supp/fig_tab/509S2a_G2.html http://www.nature.com/nature/journal/v509/n7498_supp/fig_tab...

refurb 10y ago

Another big reason is the lack of financial incentives for companies. A lot of new antibiotics are for very small populations (you'll only use a new antibiotics for the rare cases of drug resistance). As a result, drug companies are looking at spending $100M to make a new drug, when they'd be lucky to make their money back on it.

Swannie 10y ago

Sadly I read this as a thinly veiled attempt to argue for Congress to fund anti-bioitic research. Why? Well the article practically spells out the why: pharma is not incentivised to bring new anti-biotics to market, but they can create lots of "new" ones that are similar to the old ones. Why not change the model, and create a system where pharma companies can churn out "new and innovative" anti-biotics, for a nice guaranteed government payout. "Win win" for pharma, politicians, and who knows - maybe farmers and people? Cynical? Extremely. An element of truth in my view? Almost certainly. The way I view it - we have too many different options available on the market. We should look to remove a decent % of them from circulation in as many countries as possible, to allow any resistant strains to lose their resistance. Yes, this would impact pharma companies, but their could be a rotational system with extensions to patents as required to keep them happy.