WHO: Not Enough Antibiotics in Pipeline to Curb Superbugs

September 19, 2017

Not enough new antibiotics are in the research and development pipeline to meet the challenge of burgeoning antibiotic resistance, especially with tuberculosis (TB), the World Health Organization (WHO) warned in a new report released today.

Although several dozen antibiotics are now in that pipeline, most are modifications of existing antibiotic classes and few "are likely to cover a broader range of resistant pathogens," the report stated.

"There is an urgent need for more investment in research and development for antibiotic resistant infections, including TB," said WHO Director-General Tedros Adhanom Ghebreyesus, in a news release. "Otherwise we will be forced back to a time when people feared common infections and risked their lives from minor surgery."

The United States has tried to do its part to fill the pipeline. During the Obama administration, the US Food and Drug Administration fast-tracked the approval process for new antibiotics. And the 21st Century Cures Act, passed by Congress last December, makes it even easier for antibiotics to reach the market, in part by allowing smaller clinical trials.

New treatments for TB should be a priority, WHO said in its report. Only two new antibiotics have gone on the market in the last 70 years for treating multidrug-resistant TB, which kills about 250,000 people worldwide each year. Seven more antibiotics for TB are in the wings, but WHO said that's not enough, given that treating this infection requires at least three antibiotics.

In all, WHO identified a total of 51 antibiotics, including combinations of them, as well as 11 biological agents to battle an array of bacterial pathogens,  including Clostridium difficile and three carbapenem-resistant bugs classified as critical priority — Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterobacteriaceae. These three belong to the gram-negative class of bacteria that cry out for new treatments, WHO said. Strains of gram-negative bacteria are appearing that can't be treated with any antibiotics on the market.

The report lamented how almost all new agents under development for gram-negative bacteria are tweaks of existing antibiotics, and they attack only specific pathogens, or a limited subset of resistant strains. WHO also noted that very few oral antibiotics for gram-negative pathogens are being developed, which is a serious shortcoming.

"Oral drugs are required in countries with high resistance rates in community-treated infections such as urinary-tract infections," the report stated. "This is especially important for low and middle income countries but is not addressed by the current pipeline."

Like other public health authorities, WHO said that it will take more than a replenished arsenal to avoid the medical disasters of antibiotic resistance. Clinicians also must prudently prescribe these drugs. Stewardship extends to their use in animals.

The WHO report is available on the agency's website.

Follow Robert Lowes on Twitter @LowesRobert


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