Summer 2018
Drug Discovery World
Antibiotics & Antimicrobial Resistance (AMR) - A Global Perspective
Professor Anthony Coates and Dr Yanmin Hu
Summer 2018

Antibiotic resistance is at a crossroad. In the world today, deaths in low income countries from Antimicrobial Resistance (AMR) are predicted to rise dramatically by 2050.

We know how to stop this disaster, and some steps are being taken in the right direction. Will these steps be enough? Antibiotics for Critical Priority bacterial Pathogens are in the clinical trials stage, but, overall, the pipeline is described by the WHO as inadequate. Combinations of antibiotics and rejuvenation of old antibiotics are appearing in development and have potential alongside new chemical entities and new classes. The AMR report, chaired by Jim O’Neill, has recommended what we need to do.

The actions in response to this report are, at best, patchy. Universal access to new antibiotics by both the rich and the poor may be feasible, but universal stewardship will be a difficult problem to solve. Long-term solutions, particularly for antibiotic development by the pharmaceutical industry are proposed here.

It is predicted that 10 million people will die each year from Antimicrobial Resistance (AMR O’Neil report 2016) if the present welldescribed inertia continues. These deaths will be predominantly in low income countries. A limited number of brave, mostly small antibiotic companies are developing new antibiotics against Critical Priority Pathogens (WHO 2017) which are Carbapenem-resistant Gram-negative bacteria. But, this alone is not enough. These new antibiotics need to become available to the poor in low income countries. Furthermore, all countries need to use antibiotics in a responsible way (for example, not via the internet or ‘over the counter’) – so-called Stewardship, which will reduce the emergence of resistance.

New fast, cheap diagnostic tests will help this process when they become available in all countries. Since systemic antibiotics give rise to resistant bacterial mutants in the large intestine, AMR will continue to spread unless the use of antibiotics is substantially reduced, or some other solution is found. This review will discuss the WHO list of Antibacterials in Clinical Trials (2017) and will then address the difficult issues of universal access, universal stewardship and long-term antibiotic development by the pharmaceutical industry....

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