Abstract
The challenge of antimicrobial resistance is broadly appreciated by the clinical and scientific communities. To assess progress in the development of medical countermeasures to combat bacterial infections, we deployed information gleaned from clinical trials conducted from 2000 to 2021. Whereas private sector interest in cancer grew dramatically over this period, activity to combat bacterial infections remained stagnant. The comparative ambivalence to antimicrobial resistance is reflected in the number of investigative drugs under clinical investigation, their stage of development and most troublingly, a declining number of organizations that are actively involved in the development of new products to treat bacterial infections. This drop reflects the exits of many companies that had previously developed antibacterial agents.
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References
Spellberg B, Guidos R, Gilbert D, et al. The Epidemic of Antibiotic-Resistant Infections: A Call to Action for the Medical Community from the Infectious Diseases Society of America. Clin Infect Dis. 2008;46(2):155–64. https://doi.org/10.2307/40306870.
Zavišić G, Popović M, Stojkov S, et al. Antibiotic Resistance and Probiotics: Knowledge Gaps, Market Overview and Preliminary Screening. Antibiotics (Basel). 2023;12(8). https://doi.org/10.3390/antibiotics12081281.
Kursa O, Tomczyk G, Sieczkowska A, Sawicka-Durkalec A. Prevalence, Identification and Antibiotic Resistance of. Pathogens. 2023;12(8). https://doi.org/10.3390/pathogens12080992.
Diggins F. The true history of the discovery of penicillin by Alexander Fleming. Br J Biomed Sci. 1999;56(2):83–93.
Fleming A. The discovery of penicillin. Br Med Bull. 1944;2(1):4–5.
Harris H. Howard Florey and the development of penicillin. Notes Rec R Soc. 1999;53(2):243–52.
Abraham EP, Chain E. An enzyme from bacteria able to destroy penicillin. 1940. Rev Infect Dis. 1988;10(4):677–8.
Spellberg B, Taylor-Blake B. On the exoneration of Dr. William H. Stewart: debunking an urban legend. Infect Dis Poverty. 2013;2(1):3. https://doi.org/10.1186/2049-9957-2-3.
Chahine EB, Dougherty JA, Thornby KA, Guirguis EH. Antibiotic Approvals in the Last Decade: Are We Keeping Up With Resistance? Ann Pharmacother. 2022;56(4):441–62. https://doi.org/10.1177/10600280211031390.
Fox R. The post-antibiotic era beckons. J R Soc Med. 1996;89(11):602.
Dheman N, Mahoney N, Cox EM, Farley JJ, Amini T, Lanthier ML. An Analysis of Antibacterial Drug Development Trends in the United States, 1980–2019. Clin Infect Dis. 2021;73(11):e4444–50. https://doi.org/10.1093/cid/ciaa859.
Kinch MS, Merkel J, Umlauf S. Trends in pharmaceutical targeting of clinical indications: 1930–2013. Drug Discov Today. 2014;19(11):1682–5. https://doi.org/10.1016/j.drudis.2014.05.021.
Kinch MS, Patridge E, Plummer M, Hoyer D. An analysis of FDA-approved drugs for infectious disease: antibacterial agents. Drug Discov Today. 2014;19(9):1283–7. https://doi.org/10.1016/j.drudis.2014.07.005.
Plackett B. Why big pharma has abandoned antibiotics. Nature. 2020;586:S50–2.
Congress U. PART 11—Clinical trials registration and results information submission. National Archives, 2023 https://www.ecfr.gov/current/title-42/chapter-I/subchapter-A/part-11 Accessed 27 Aug 2023
Katz DG, Dutcher GA, Toigo TA, Bates R, Temple F, Cadden CG. The AIDS Clinical Trials Information Service (ACTIS): a decade of providing clinical trials information. Public Health Rep. 2002;117(2):123.
Jackson J. FDAMA 1997 Section114: another look. Value Health. 2009;12(2):191–2. https://doi.org/10.1111/j.1524-4733.2008.00432.x.
FDA. Food and Drug Administration Amendments Act (FDAAA) of 2007. https://www.fda.gov/regulatory-information/selected-amendments-fdc-act/food-and-drug-administration-amendments-act-fdaaa-2007. Accessed 25 Mar 2024.
Griesenauer RH, Schillebeeckx C, Kinch MS. CDEK: Clinical Drug Experience Knowledgebase. Database (Oxford). 2019;2019. https://doi.org/10.1093/database/baz087.
Medicine NLo. Welcome to Medical Subject Headings. National Institutes of Health. 2022. https://www.nlm.nih.gov/mesh/meshhome.html Accessed 20 Jan 2022.
Mitra-Majumdar M, Powers JH, Brown BL, Kesselheim AS. Evidence at time of regulatory approval and cost of new antibiotics in 2016–19: cohort study of FDA approved drugs. BMJ Med. 2022;1(1):e000227. https://doi.org/10.1136/bmjmed-2022-000227.
Munos B. Lessons from 60 years of pharmaceutical innovation. https://doi.org/10.1038/nrd2961. Nat Rev Drug Discov. 12//print 2009;8(12):959–968. http://www.nature.com/nrd/journal/v8/n12/suppinfo/nrd2961_S1.html. Accessed 25 Mar 2024
Kinch M. The Price of Health. New York: Pegasus Books; 2021.
Subbiah V. The next generation of evidence-based medicine. Nat Med. 2023;29(1):49–58. https://doi.org/10.1038/s41591-022-02160-z.
Sun D, Gao W, Hu H, Zhou S. Why 90% of clinical drug development fails and how to improve it? Acta Pharm Sin B. 2022;12(7):3049–62. https://doi.org/10.1016/j.apsb.2022.02.002.
Outterson K, Powers JH, Seoane-Vazquez E, Rodriguez-Monguio R, Kesselheim AS. Approval and withdrawal of new antibiotics and other antiinfectives in the US, 1980–2009. J Law Med Ethics. 2013;41(3):688–96.
Collaborators A-X. System-wide approaches to antimicrobial therapy and antimicrobial resistance in the UK: the AMR-X framework. Lancet Microbe. 2024. https://doi.org/10.1016/S2666-5247(24)00003-X.
Darrow JJ, Kesselheim AS. Incentivizing Antibiotic Development: Why Isn’t the Generating Antibiotic Incentives Now (GAIN) Act Working? Open Forum Infect Dis. 2020;7(1):ofaa001. https://doi.org/10.1093/ofid/ofaa001.
Dutescu IA, Hillier SA. Encouraging the Development of New Antibiotics: Are Financial Incentives the Right Way Forward? A Systematic Review and Case Study. Infect Drug Resist. 2021;14:415–34. https://doi.org/10.2147/IDR.S287792.
Watson R. Europe to draft plan to encourage development of new antibiotics. BMJ. 2009;339:b5309. https://doi.org/10.1136/bmj.b5309.
Laxminarayan R, Powers JH. Antibacterial R&D incentives. Nat Rev Drug Discov. 2011;10(10):727–8. https://doi.org/10.1038/nrd3560.
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This work was supported by the Laura and John Arnold Foundation.
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Teaser: Antibiotics revolutionized modern medicine and society. Despite widespread concern, the disassembly of our ability to develop new antibiotics may be reaching a dangerous point.
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Kinch, M.S., Kraft, Z. & Schwartz, T. Antibiotic Development: Lessons from the Past and Future Opportunities. Pharm Res (2024). https://doi.org/10.1007/s11095-024-03694-2
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DOI: https://doi.org/10.1007/s11095-024-03694-2