Antibiotic Resistance

A person holds several bottles of prescription medicine.

While there are a number of drugs designed to treat infections, resistant strains are emerging at a rate that is currently outpacing the development of effective new drugs.

What’s the Issue?

Many of the world’s diseases are caused by microorganisms such as bacteria, fungi, viruses, and parasites. While there are a number of drugs designed to treat these infections, resistant strains are emerging at a rate that is currently outpacing the development of effective new drugs. Methicillin-resistant Staphylococcus aureus (MRSA) alone kills more than 19,000 Americans every year—more than emphysema, HIV/AIDS, Parkinson’s disease, and homicide combined. Despite this public health need, pharmaceutical companies do not have strong economic incentives to develop new antibiotic drugs.

Unless new drugs are developed—together with measures taken to slow the emergence of new drug-resistant microbes—previously treatable infections will become major public health concerns, posing grave threats to infected individuals and increasing the risk of spreading to others. In recent years, several global and national public health organizations have highlighted the growing number of multidrug-resistant microbes as a major public health priority.

The commonly used term “antimicrobial resistance” applies to any microbe—bacteria, fungus, or virus—against which drugs have declining, limited, or zero effectiveness. This policy brief primarily focuses on the diminishing effectiveness many drugs specifically in fighting bacteria, referred to here as “antibiotic resistance.”

With so many agencies involved in the regulation and use of antibiotics, comprehensive solutions must focus on creating a coordinated plan that touches on aspects of research and development as well as enhanced infection prevention and control, and stewardship to ensure the proper use of these drugs across different settings.

This brief provides an overview of antibiotic resistance, including a summary of its current impact, the factors that contribute to its spread, and the policy recommendations put in place by federal and global public health agencies. It also reviews the debate around the regulation of antibiotic use in agriculture and examines new developments in policy and research associated with multidrug-resistant bacterial diseases and their underlying causes.

What's Next?

There are several potential directions for new antimicrobial drug research and development. Better diagnostic tools could affect the way antibiotic resistance is detected, diagnosed, and reported. More rapid tests could help to prevent overprescription of antibiotics and assist with global surveillance measures already emerging as a result of policy goals.

There are also potential developments for new drugs. Researchers at Northeastern University recently published a paper in Nature about a potential new antibiotic called teixobactin that targets polymers that build the bacterial cell wall. The drug’s pathway—examined in mice but not yet in humans—is similar to vancomycin, another antibiotic often used as a last-resort treatment for resistant strains of bacteria such as MRSA. In their paper, the researchers highlighted how the technology used for this discovery might help lead to additional drug discoveries.

While it is tempting to assume that a potential new human antibiotic means that the pharmaceutical industry’s interest in developing new antibacterial drugs will spring back into gear, it’s important to consider that the failure rate for antibiotics from early discovery stage to actual drug approval is 97 percent. In general, new antibiotics are less profitable compared to other types of drugs, as their use is tightly controlled by hospitals trying to prevent the emergence of new resistant strains, and yet drug companies are not able to compensate for slow adoption by charging more because they’d have to compete with inexpensive generic antibiotics. In 2011, for example, Pfizer, one of the few drug companies to work on developing new antibiotics, closed its research lab in Connecticut.

For health care facilities, life science researchers, federal agencies, and local health officials to meet many of the specific goals outlined in the Obama administration’s recent National Action Plan, they will require additional resources. To that end, President Obama’s fiscal year 2016 budget proposes to nearly double the amount of federal funding for combating and preventing antibiotic resistance to more than $1.2 billion. Congress, however, is unlikely to support and enact the president’s full budget request.