Treating resistant infections¶

An antibiotic can be unavailable because a supplier has run short. It can also become less useful because bacteria have become resistant. The first problem calls for another delivery. The second calls for another treatment, and developing one takes time.

A thin pipeline¶

New antibiotics arrive slowly. Since July 2017, 13 have been authorised, and only 2 belong to a new chemical class (WHO). The WHO finds the preclinical pipeline “active and innovative, with many non-traditional approaches”: phages, antibodies and agents that disarm bacteria or restore the gut flora. Belgium already treats patients with personalised phages. A consortium of the Queen Astrid Military Hospital, KU Leuven and Sciensano analysed its first 100 cases, treated between 2008 and 2022 in 35 hospitals in 12 countries. Patients improved in 77.2% of the infections treated, and the bacteria were eradicated in 61.3%. Eradication was 70% less probable without antibiotics alongside the phages (Pirnay et al.). Antisense antibiotics are earlier still. They are short synthetic strands that pair with the message of one bacterial gene and block it, leaving the rest of the gut alone. In Würzburg, the Helmholtz Institute for RNA-based Infection Research names delivery into the bacterium and “the lack of venture capital investment” as the obstacles (Vogel et al.). The first registered trial in patients, at Fudan University in Shanghai, tests antisense eye drops against resistant bacterial keratitis (ClinicalTrials.gov).

Getting treatment¶

A new treatment reaches some patients long before others. The Belgian phages “were offered free of charge”, and the defence ministry’s research institute, the hospital, Sciensano and KU Leuven bore most of the costs. The authors call the licensing requirements for biological medicines “an insurmountable barrier in terms of timelines and cost” for a phage centre (Pirnay et al.). New antibiotics are approved once for the whole EU, but manufacturers launch them in large markets first. In a review of 31 antibacterials approved worldwide over a decade, Iceland had none, and Malta and Latvia had one each (Zasheva et al.).

The pharmaceutical supply problem sits upstream of these decisions: an unavailable narrow-spectrum antibiotic may mean a broader one is prescribed instead.