New drugs needed to fight global antibiotics crisis

Your editorial concerning the need to address the crisis in antimicrobial resistance was welcome (The Editorial Board, January 28). The UK government’s AMR plan shows genuine leadership and builds on the G20 commitment to combat AMR. However, I wanted to highlight some other potential solutions.

Through the second half of the last century society benefited from an antibiotic revolution. The discovery of new mechanism antibiotics allowed physicians to keep ahead of AMR. In recent decades, no new mechanism antibiotics have been introduced. We have seen improvements to existing antibiotics but old and often inappropriate antibiotics continue to be used in preference.

Ironically, this is partly a result of efforts to tackle AMR. Hospitals, under pressure to keep antibiotics in reserve, are reluctant to prescribe new drugs. Healthcare systems must promote stewardship, but new drugs are needed to support a healthy development ecosystem for antibiotics and leaving new antibiotics on the shelf is not the solution. A lack of adoption of new antibiotics fuels AMR. Reduced investment threatens the industry’s ability to respond to threats: big pharma has generally abandoned antibiotics and investors are deterred by the lack of return.

Industry needs to be creative with research and development, for example, developing clinical trials that demonstrate the societal value of new antibiotics. Governments can help maintain investment into antibiotic research in academia and smaller companies. At the market facing end, incentives that reward innovative antibiotics are required to ensure a return on the R&D investment.

A healthy funding environment will support innovation. With greater understanding of bacterial genetics, targeted antibiotics can be produced to improve patient outcomes and provide options to beat AMR. These antibiotics promote stewardship by matching the right drug to the right infection, allowing valuable broad-spectrum agents to be kept in reserve.

Dr David Roblin
Chief Operating Officer and Chief Medical Officer, Summit Therapeutics, London EC2, UK