New Antibiotics and New Resistance
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Abstract:
Antibiotics were treated as miracle drugs when they first became
available half a century ago. But their popularity rapidly led to
overuse. Over the last decade, it has become well-known that
antibiotics are losing their effectiveness as bacteria evolve
resistance against them and new drugs only rarely reach the market.
Bacteria can acquire drug resistance in a multitude of ways, so
getting around the resistance problem is not a straightforward
matter. Pharmaceutical companies have just recently revived efforts
to develop new antibiotics. But preventing a future in which
bacteria are once again widespread killers requires more than one
approach-among them, the rational use of antibiotics in health care
and agriculture, improved techniques for developing new drugs and
new perspectives on how to live with the infectious creatures that
share the planet with us.
Bacterial infections have been a scourge on humankind for millennia.
Plague, tuberculosis, wound infections and typhoid fever have caused
historical as well as personal tragedies. No wonder, then, that
antibiotics were greeted as miracle drugs. For a few decades the
success of antibiotic therapies was remarkable, but enthusiasm for
them led to abuses. Observers disregarded the early emergence of
resistant bacteria; a number of new antibiotics were still being
discovered, suggesting that effective drugs would always be
available. With infections deemed under control, pharmaceutical
companies lost interest in developing new antibiotics.
After decades of complacency and just 50 years after the first
clinical use of an antibiotic, penicillin, the public health threat
posed by antibiotic resistance finally gained widespread attention.
Resistance made the cover of Time and Newsweek in
the early 1990s; now, most people know that antibiotics can fail.
Over nearly 20 years, from the early 1980s to the late 1990s, not a
single truly new antibiotic was introduced into clinical use. Even
now, barely a trickle has reached the market since 1999. Meanwhile,
resistance keeps evolving, and drugs are rapidly losing their
efficacy, resulting in increased treatment costs, loss of labor time
and, of course worst of all, lost lives. My colleagues and I
reviewed how bacteria evolve so quickly towards resistance some
years ago ("Antibiotic Resistance," July-August 1995).
Here I will discuss new discoveries on the biology of resistance, as
well as efforts to either restrain or circumvent resistant
organisms. In the struggle against antibiotic resistance, science is
providing useful tools, and physicians are slowly realizing that
antibiotics are simultaneously powerful and dangerous drugs.
Ultimately, though, we will all need to change the way we deal with
bacteria in the coming "post-antibiotic era." ...