If we don't invest in research into antibiotics and antimicrobials, we risk moving into a "post-antibiotics era", where patients suffering from infections cannot be treated adequately.
Antimicrobial Resistance - a major health threat and cost factor in health care
Ever since antibiotics were used commonly to treat infectious diseases, bacteria developed resistance to those antibiotics. Accelerated by the overuse of antibiotics in the 20th century, multiple drug resistant bacteria have emerged in all parts of the world. These include MDR-TB and XDR-TB (multiple and extremely drug resistant tuberculosis, respectively), and pathogens of the so-called ESKAPE class, namely VRE (vancomycin-resistant Enterococcus), MRSA (methicillin-resistant Staphylococcus aureus) and MDR Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Escherichia coli.
Infections with these drug-resistant bacteria pose an enormous threat to human health and lead to massive cost for health care. Although hard to estimate, the WHO reports that “the yearly cost to the US health system alone has been estimated at US $21 to $34 billion dollars, accompanied by more than 8 million additional days in hospital”. (Source: WHO Antimicrobial Resistance: Global Report on Surveillance 2014.)
As long as novel antibiotics were developed, infections could fortunately still be treated. However, pharmaceutical companies have largely withdrawn from the field of antibiotics, primarily due to the very poor successes of their antibiotic screening efforts. This has resulted in the so-called discovery void: hardly any novel compounds have been introduced over the past 25 years.
An "apocalyptic scenario" where people will succumb to untreatable infections or admitted to the hospital for intravenous treatment of simple infections for which oral antibiotics are not available anymore, should be avoided at all cost. This calls for novel, preferably small spectrum antibiotics with less side effects on the normal microbiota. Preferred additional properties are stability, possibilities for chemical or genetic derivatization and low resistance.
In recent years, there has been a revival in antibiotic research, inspired by advances in science.
For example, genome sequencing efforts have revealed that filamentous microorganisms contain many more gene clusters for natural products than originally anticipated. Also, the opportunities posed by synthetic biology have stimulated efforts in making new-to-nature antimicrobial compounds. Currently, attempts are made to exploit these yet untapped sources of antimicrobials.
National Science Agenda (NWA)
In the Dutch national science agenda (nationale wetenschapsagenda, NWA), antibiotics is a prominent theme. The numerous questions on this subject are clustered in the following "cluster questions":
- Clusterquestion 005: What is the role of micro-organisms in ecosystems and how can we use them for heath and environment?
- Clusterquestion 097: How do we control micro-organisms in health, farming and the environment?
- Clusterquestion 099: How can we, with a greater understanding of life, identify new targets for molecular therapies, antibiotics and antivirals?
All these questions are grouped in the route "Health care research, prevention and treatment" ("exemplarische route" #3).