Researchers discuss drug resistance in reddit ‘AMA’

On Tuesday, June 28, Harvard Chan School faculty Sarah Fortune, professor of immunology and infectious diseases, and Eric Rubin, Irene Heinz Given Professor of Immunology and Infectious Diseases, discussed the growing threat of antibiotic resistance during a reddit “Ask Me Anything (AMA).” Recently, a “superbug” that is resistant to colistin—the antibiotic of last resort—was found in a U.S. patient with a urinary tract infection. See some of the answers from Fortune and Rubin below, and read the full AMA here.

What can we (the general population) do to slow (or stop) the progression of this antibiotic resistance?

Fortune: The emergence of antibiotic resistance is a large, evolutionary scale problem. However, as individuals, we each have a role to play in limiting the further emergence of antibiotic resistances. First, a lot of antibiotic resistance appears to be driven by the agricultural use of antibiotics as growth enhancers. Thus, we can be savvy consumers and support and be willing to absorb the costs of the efforts to get antibiotics out of the meat industry. Second, we need to be advocates for active solutions to the lack of pharmaceutical interest in antibiotic development. And finally, yes, take antibiotics only when you need them (not for viral infections) and according to instructions.

Rubin: A slightly different take on a great question. It’s certainly true that the indiscriminate use of antibiotics by doctors, the agricultural industry and individuals contribute to the rise of drug resistance. The contribution of an individual is probably pretty small, though, by changing their own bacterial flora, they can put themselves at risk. But remember, antibiotics are great drugs—they have made many diseases that killed millions of people relatively trivial illnesses. So, if you need to take them, you absolutely should. Solving antibiotic resistance is going to take more society-wide interventions.

What should the role of government be in research and development of new antibiotics?

Fortune: As this thread of questions suggests, in recent years, many major pharmaceutical companies have left the antibiotic space because they monetary incentives haven’t justified the risk or investments. Patients don’t take antibiotics for a long time. We have traditionally expected our antibiotics to be cheap; indeed, there were often significant efforts to limit the use of more expensive antibiotics because of cost. Both carrot and stick proposals have been put forth to push pharma back into antibiotic development. I favor the carrot—aligning economic incentives with the value that the successful development of new antibiotics will have for society. One way to do this might be some variant of the FDA priority review voucher program currently in place to spur drug development for neglected diseases.

Rubin: To join in an already very vigorous discussion, one of the problems with antibiotics is that most of them can cure a disease—which is to say we’re a victim of our own success. That’s not true for treatments of chronic illnesses like diabetes or high blood pressure. Drug makers know that people with these diseases are going to take drugs forever, not for a few days until they’re better. With rare exceptions (like HIV drugs) antibiotics will never have as big a market as many other drugs. Thus, we need some other incentives for drug makers to invest. There are some creative solutions out there, some of which include government incentives (that, for example, can be used to get more rapid review of other non-antibiotics). There’s no question, though, that we do need to think about this as a society.

I’ve heard that we’ve got about 10 years until bacteria will no longer resistant to penicillin. Is there any validity to this?

Rubin: You’re asking a question similar to what others are asking – is the sky falling? Or has it already fallen?

Antibiotics have been miracle drugs. Lots of diseases that killed our grandparents and even parents are almost never seen in a place like the US. HIV has been transformed from a death sentence to what is generally a chronic illness. So antibiotics (and antivirals) have made a huge difference. But how much does antibiotic resistance affect the average person? Many of the highly antibiotic resistant bacterial strains are relatively exotic – they are only found in hospitals and only infect people who have many other medical problems. But a lot of the genes that result in resistance can be transmitted to other strains, some that are more likely to cause disease outside of the hospital. That is already the case with staph infections, which are almost all resistant to multiple antibiotics. And it is becoming increasingly true for other bacterial infections as well.

The sky hasn’t fallen yet and we still have antibiotics for the vast majority of infections. But we know that increasing resistance is inevitable. How long it will take to wipe out many of our most useful drugs is less clear.