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Park J, Kim D, Son YJ, Ciufolini MA, Clovis S, Han M, Kim LH, Shin SJ, Hwang HJ. Chemical optimization and derivatization of micrococcin p2 to target multiple bacterial infections: new antibiotics from thiopeptides. World J Microbiol Biotechnol 2024; 40:307. [PMID: 39162916 DOI: 10.1007/s11274-024-04109-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 08/09/2024] [Indexed: 08/21/2024]
Abstract
Antimicrobial resistance poses a significant threat to humanity, and the development of new antibiotics is urgently needed. Our research has focused on thiopeptide antibiotics such as micrococcin P2 (MP2) and derivatives thereof as new anti-infective agents. Thiopeptides are sulfur-rich, structurally complex substances that exhibit potent activity against Gram-positive pathogens and Mycobacteria species, including clinically resistant strains. The clinical development of thiopeptides has been hampered by the lack of efficient synthetic platforms to conduct detailed structure-activity relationship studies of these natural products. The present contribution touches upon efficient synthetic routes to MP2 that laid the groundwork for clinical translation. The medicinal chemistry campaign on MP2 has been guided by computational molecular dynamic simulations and parallel investigations to improve drug-like properties, such as enhancing the aqueous solubility and optimizing antibacterial activity. Such endeavors have enabled identification of promising lead compounds, AJ-037 and AJ-206, against Mycobacterium avium complex (MAC). Extensive in vitro studies revealed that these compounds exert potent activity against MAC species, a subspecies of non-tuberculous mycobacteria (NTM) that proliferate inside macrophages. Two additional pre-clinical candidates have been identified: AJ-024, for the treatment of Clostridioides difficile infections, and AJ-147, for methicillin-resistant Staphylococcus aureus impetigo. Both compounds compare quite favorably with current first-line treatments. In particular, the ability of AJ-147 to downregulate pro-inflammatory cytokines adds a valuable dimension to its clinical use. In light of above, these new thiopeptide derivatives are well-poised for further clinical development.
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Affiliation(s)
- Jiyun Park
- Department of Microbiology, Institute for Immunology and Immunological Disease, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Dahyun Kim
- A&J Science Co., Ltd, 80 Chumbok Ro, Dong Gu, Daegu, 41061, Republic of Korea
| | - Young-Jin Son
- A&J Science Co., Ltd, 80 Chumbok Ro, Dong Gu, Daegu, 41061, Republic of Korea
| | - Marco A Ciufolini
- Department of Chemistry, University of British Columbia, 2036 Main Mall, Vancouver, BC, V6K 1Z1, Canada
| | - Shyaka Clovis
- A&J Science Co., Ltd, 80 Chumbok Ro, Dong Gu, Daegu, 41061, Republic of Korea
| | - Minwoo Han
- New Drug Development Center, Daegu Gyeongbuk Medical Innovation Foundation (K-MEDI hub), 80 Chumbok Ro, Dong Gu, Daegu, 41061, Republic of Korea
| | - Lee-Han Kim
- Department of Microbiology, Institute for Immunology and Immunological Disease, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Sung Jae Shin
- Department of Microbiology, Institute for Immunology and Immunological Disease, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.
| | - Hee-Jong Hwang
- A&J Science Co., Ltd, 80 Chumbok Ro, Dong Gu, Daegu, 41061, Republic of Korea.
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Bertagnolio S, Dobreva Z, Centner CM, Olaru ID, Donà D, Burzo S, Huttner BD, Chaillon A, Gebreselassie N, Wi T, Hasso-Agopsowicz M, Allegranzi B, Sati H, Ivanovska V, Kothari KU, Balkhy HH, Cassini A, Hamers RL, Weezenbeek KV. WHO global research priorities for antimicrobial resistance in human health. THE LANCET. MICROBE 2024:100902. [PMID: 39146948 DOI: 10.1016/s2666-5247(24)00134-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 08/17/2024]
Abstract
The WHO research agenda for antimicrobial resistance (AMR) in human health has identified 40 research priorities to be addressed by the year 2030. These priorities focus on bacterial and fungal pathogens of crucial importance in addressing AMR, including drug-resistant pathogens causing tuberculosis. These research priorities encompass the entire people-centred journey, covering prevention, diagnosis, and treatment of antimicrobial-resistant infections, in addition to addressing the overarching knowledge gaps in AMR epidemiology, burden and drivers, policies and regulations, and awareness and education. The research priorities were identified through a multistage process, starting with a comprehensive scoping review of knowledge gaps, with expert inputs gathered through a survey and open call. The priority setting involved a rigorous modified Child Health and Nutrition Research Initiative approach, ensuring global representation and applicability of the findings. The ultimate goal of this research agenda is to encourage research and investment in the generation of evidence to better understand AMR dynamics and facilitate policy translation for reducing the burden and consequences of AMR.
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Affiliation(s)
| | | | - Chad M Centner
- Antimicrobial Resistance Division, WHO, Geneva, Switzerland
| | - Ioana Diana Olaru
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; Institute of Medical Microbiology, University of Münster, Münster, Germany
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Stefano Burzo
- Antimicrobial Resistance Division, WHO, Geneva, Switzerland
| | | | | | | | - Teodora Wi
- Global HIV, Hepatitis and STI Programme, WHO, Geneva, Switzerland
| | | | | | - Hatim Sati
- Antimicrobial Resistance Division, WHO, Geneva, Switzerland
| | | | | | - Hanan H Balkhy
- Antimicrobial Resistance Division, WHO, Geneva, Switzerland
| | - Alessandro Cassini
- Public Health Department, Canton of Vaud, Lausanne, Switzerland; Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Raph L Hamers
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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3
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Michaeli DT, Michaeli T, Albers S, Boch T, Michaeli JC. Special FDA designations for drug development: orphan, fast track, accelerated approval, priority review, and breakthrough therapy. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:979-997. [PMID: 37962724 PMCID: PMC11283430 DOI: 10.1007/s10198-023-01639-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/02/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Over the past decades, US Congress enabled the US Food and Drug Administration (FDA) to facilitate and expedite drug development for serious conditions filling unmet medical needs with five special designations and review pathways: orphan, fast track, accelerated approval, priority review, and breakthrough therapy. OBJECTIVES This study reviews the FDA's five special designations for drug development regarding their safety, efficacy/clinical benefit, clinical trials, innovation, economic incentives, development timelines, and price. METHODS We conducted a keyword search to identify studies analyzing the impact of the FDA's special designations (orphan, fast track, accelerated approval, priority review, and breakthrough therapy) on the safety, efficacy/clinical benefit, trials, innovativeness, economic incentives, development times, and pricing of new drugs. Results were summarized in a narrative overview. RESULTS Expedited approval reduces new drugs' time to market. However, faster drug development and regulatory review are associated with more unrecognized adverse events and post-marketing safety revisions. Clinical trials supporting special FDA approvals frequently use small, non-randomized, open-label designs. Required post-approval trials to monitor unknown adverse events are often delayed or not even initiated. Evidence suggests that drugs approved under special review pathways, marketed as "breakthroughs", are more innovative and deliver a higher clinical benefit than those receiving standard FDA approval. Special designations are an economically viable strategy for investors and pharmaceutical companies to develop drugs for rare diseases with unmet medical needs, due to financial incentives, expedited development timelines, higher clinical trial success rates, alongside greater prices. Nonetheless, patients, physicians, and insurers are concerned about spending money on drugs without a proven benefit or even on drugs that turn out to be ineffective. While European countries established performance- and financial-based managed entry agreements to account for this uncertainty in clinical trial evidence and cost-effectiveness, the pricing and reimbursement of these drugs remain largely unregulated in the US. CONCLUSION Special FDA designations shorten clinical development and FDA approval times for new drugs treating rare and severe diseases with unmet medical needs. Special-designated drugs offer a greater clinical benefit to patients. However, physicians, patients, and insurers must be aware that special-designated drugs are often approved based on non-robust trials, associated with more unrecognized side effects, and sold for higher prices.
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Affiliation(s)
- Daniel Tobias Michaeli
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.
- TUM School of Management, Technical University of Munich, Munich, Germany.
| | - Thomas Michaeli
- Department of Personalized Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
- DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
- Division of Personalized Medical Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Albers
- Department of Orthopaedics and Sport Orthopaedics, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Tobias Boch
- Department of Personalized Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
- DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
- Division of Personalized Medical Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Keck JM, Viteri A, Schultz J, Fong R, Whitman C, Poush M, Martin M. New Agents Are Coming, and So Is the Resistance. Antibiotics (Basel) 2024; 13:648. [PMID: 39061330 PMCID: PMC11273847 DOI: 10.3390/antibiotics13070648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
Antimicrobial resistance is a global threat that requires urgent attention to slow the spread of resistant pathogens. The United States Centers for Disease Control and Prevention (CDC) has emphasized clinician-driven antimicrobial stewardship approaches including the reporting and proper documentation of antimicrobial usage and resistance. Additional efforts have targeted the development of new antimicrobial agents, but narrow profit margins have hindered manufacturers from investing in novel antimicrobials for clinical use and therefore the production of new antibiotics has decreased. In order to combat this, both antimicrobial drug discovery processes and healthcare reimbursement programs must be improved. Without action, this poses a high probability to culminate in a deadly post-antibiotic era. This review will highlight some of the global health challenges faced both today and in the future. Furthermore, the new Infectious Diseases Society of America (IDSA) guidelines for resistant Gram-negative pathogens will be discussed. This includes new antimicrobial agents which have gained or are likely to gain FDA approval. Emphasis will be placed on which human pathogens each of these agents cover, as well as how these new agents could be utilized in clinical practice.
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Affiliation(s)
- J. Myles Keck
- Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Alina Viteri
- Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | | | - Rebecca Fong
- Department of Pharmacy, Central Arkansas Veterans Healthcare System, Little Rock, AR 72205, USA
| | - Charles Whitman
- Department of Pharmacy, Central Arkansas Veterans Healthcare System, Little Rock, AR 72205, USA
| | - Madeline Poush
- Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Marlee Martin
- Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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5
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Schinas G, Spernovasilis N, Akinosoglou K. Antifungal pipeline: Is there light at the end of the tunnel? World J Clin Cases 2024; 12:2686-2691. [PMID: 38899281 PMCID: PMC11185321 DOI: 10.12998/wjcc.v12.i16.2686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/19/2024] [Accepted: 04/19/2024] [Indexed: 05/29/2024] Open
Abstract
The misuse and overuse of classic antifungals have accelerated the development of resistance mechanisms, diminishing the efficacy of established therapeutic pathways and necessitating a shift towards alternative targets. Despite this pressing need for new treatments, the antifungal drug pipeline has been largely stagnant for the past three decades, primarily due to the high risks and costs associated with antifungal drug development, compounded by uncertain market returns. Extensive research durations, special patient populations and rigorous regulatory demands pose significant barriers to bringing novel antifungal agents to market. In response, the "push-pull" incentive model has emerged as a vital strategy to invigorate the pipeline and encourage innovation. This editorial critically examines the current clinical landscape and spotlights emerging antifungal agents, such as Fosmanogepix, Ibrexafungerp, and Olorofim, while also unraveling the multifaceted challenges faced in new antifungal drug development. The generation of novel antifungals offers a beacon of hope in the battle against antimicrobial resistance, but it is premature to declare them as definitive solutions. Their future role hinges on thorough clinical validation, cost-effectiveness assessments, and continuous post-marketing surveillance. Only through strategic implementation and integration with market strategies we can transform the landscape of antifungal development, addressing both the resistance crisis and the treatment challenges.
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Affiliation(s)
- Georgios Schinas
- Department of Medicine, University of Patras, Patras 26504, Greece
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Wasan H, Reeta KH, Gupta YK. Strategies to improve antibiotic access and a way forward for lower middle-income countries. J Antimicrob Chemother 2024; 79:1-10. [PMID: 38008421 DOI: 10.1093/jac/dkad291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023] Open
Abstract
Antibiotics have substantially improved life expectancy in past decades through direct control or prevention of infections. However, emerging antibiotic resistance and lack of access to effective antibiotics have significantly increased the death toll from infectious diseases, making it one of the biggest threats to global health. Addressing the antibiotic crisis to meet future needs require considerable investment in both research and development along with ensuring a viable marketplace to encourage innovation. Fortunately, there has been some improvement in the number of antibiotics approved or in different phases of development through collective global efforts. However, the universal access to these essential novel and generic antibiotics, especially in low- and middle-income countries (LMICs), is challenged by poor economic incentives, regulatory hurdles and poor health infrastructure. Recently, the agenda of securing and expanding access has gained global attention. Several mechanisms are now being proposed and implemented to improve access to essential antibiotics. This review provides an insight into the major barriers to antibiotic access as well as the models proposed and implemented to mitigate accessibility issues. These models include but are not limited to market entry rewards, subscription models and transferable exclusivity vouchers. Further, global access programmes including, Global Antibiotic Research and Development Partnership, Antimicrobial Resistance Action Fund and SECURE Platform are discussed. We also propose the way forward for improving access in LMICs with suggested measures to improve access to generic and novel antibiotics.
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Affiliation(s)
- Himika Wasan
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - K H Reeta
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Yogendra Kumar Gupta
- All India Institute of Medical Sciences, Jammu, India
- India Strategy Development, Global Antibiotics Research & Development Partnership (GARDP), New Delhi, India
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7
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Misawa T. [Fundamental Studies on Development of Next-generation Medium Sized Peptide Drugs]. YAKUGAKU ZASSHI 2022; 142:1061-1066. [PMID: 36184440 DOI: 10.1248/yakushi.22-00115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Medium-sized peptides are expected as a next-generation drug discovery modality because they combine the properties of conventional small-molecule drugs and biopharmaceuticals. Nonetheless, peptides are easily degraded by digestive enzymes such as protease in the body, which could be problematic for the development of peptide-based drugs. To overcome such a problem, peptide-based foldamers containing non-proteinogenic amino acids or cyclized peptides have been reported. In addition, peptides must form stable secondary structures and their side chains should be correctly positioned to exert their bioactivity. In our lab, bioactive peptides have been developed based on regulation of secondary structures by introducing non-proteinogenic amino acids such as acyclic α,α-disubstituted amino acids (dAAs), cyclic dAAs, cyclic β-amino acids, and side-chain stapling. Based on these knowledges, I have been performing research on the development of bioactive peptides based on the secondary structural control of peptides as categorized in the following manner: (1) rational design of antimicrobial foldamers; (2) post-functionalization of helical peptides; (3) development of carrier peptides for intracellular delivery of siRNA utilizing the helical template peptides.
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Affiliation(s)
- Takashi Misawa
- Division of Organic Chemistry, National Institute of Health Sciences
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8
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Outterson K, Orubu ESF, Rex J, Årdal C, Zaman MH. Patient Access in 14 High-Income Countries to New Antibacterials Approved by the US Food and Drug Administration, European Medicines Agency, Japanese Pharmaceuticals and Medical Devices Agency, or Health Canada, 2010-2020. Clin Infect Dis 2022; 74:1183-1190. [PMID: 34251436 PMCID: PMC8994582 DOI: 10.1093/cid/ciab612] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Inaccessibility of medicines in low- and middle-income countries is a frequent challenge. Yet it is typically assumed that high-income countries have complete access to the full arsenal of medicines. This study tests this assumption for new antibacterials, which are saved as a last resort in order to prevent the development of resistance, resulting in insufficient revenues to offset costs. Prior studies report only regulatory approval, missing the important lag that occurs between approval and commercial launch, although some antibiotics never launch in some countries. METHODS We identified all antibacterials approved and launched in the G7 and 7 other high-income countries in Europe for the decade beginning 1 January 2010, using quantitative methods to explore associations. RESULTS Eighteen new antibacterials were identified. The majority were accessible in only 3 countries (United States, United Kingdom, and Sweden), with the remaining 11 high-income countries having access to less than half of them. European marketing authorization did not lead to automatic European access, as 14 of the antibacterials were approved by the European Medicines Agency but many fewer were commercially launched. There was no significant difference in access between "innovative" and "noninnovative" antibacterials. Median annual sales in the first launched market (generally the United States) for these 18 antibiotics were low, $16.2M. CONCLUSIONS Patient access to new antibacterials is limited in some high-income countries including Canada, Japan, France, Germany, Italy, and Spain. With low expected sales, companies may have decided to delay or forego commercialization due to expectations of insufficient profitability.
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Affiliation(s)
- Kevin Outterson
- Boston University School of Law, Boston, Massachusetts, USA
- CARB-X, Boston, Massachusetts, USA
| | - Ebiowei S F Orubu
- Social Innovation on Drug Resistance Program, Boston University, Boston, Massachusetts, USA
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
| | - John Rex
- F2G Limited, Eccles, Cheshire, United Kingdom
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Christine Årdal
- Antimicrobial Resistance Centre, Norwegian Institute of Public Health, Oslo, Norway
| | - Muhammad H Zaman
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
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9
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Pharmacodynamics of Meropenem and Tobramycin for Neonatal Meningoencephalitis: Novel Approaches to Facilitate the Development of New Agents to Address the Challenge of Antimicrobial Resistance. Antimicrob Agents Chemother 2022; 66:e0218121. [PMID: 35315689 DOI: 10.1128/aac.02181-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Neonatal sepsis is an underrecognized burden on health care systems throughout the world. Antimicrobial drug resistance (AMR) is increasingly prevalent and compromises the use of currently recommended first-line agents. The development of new antimicrobial agents for neonates and children is mandated by regulatory agencies. However, there remains uncertainty about suitable development pathways, especially because of the propensity of premature babies to develop meningoencephalitis as a complication of neonatal sepsis and difficulties studying this disease in clinical settings. We developed a new platform and approach to accelerate the development of antimicrobial agents for neonatal bacterial meningoencephalitis using Pseudomonas aeruginosa as the challenge organism. We defined the pharmacodynamics of meropenem and tobramycin in these models. The percentage of partitioning of meropenem and tobramycin into the cerebrospinal fluid was comparable at 14.3 and 13.7%, respectively. Despite this similarity, there were striking differences in their pharmacodynamics. Meropenem resulted in bactericidal activity in both the cerebrospinal fluid and cerebrum, whereas tobramycin had minimal antibacterial activity. A hollow fiber infection model (HFIM) using neonatal CSF concentration time profiles yielded pharmacodynamics comparable to those observed in the rabbit model. These new experimental models can be used to estimate the pharmacodynamics of currently licensed agents and those in development and their potential efficacy for neonatal bacterial meningoencephalitis.
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10
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Butler MS, Gigante V, Sati H, Paulin S, Al-Sulaiman L, Rex JH, Fernandes P, Arias CA, Paul M, Thwaites GE, Czaplewski L, Alm RA, Lienhardt C, Spigelman M, Silver LL, Ohmagari N, Kozlov R, Harbarth S, Beyer P. Analysis of the Clinical Pipeline of Treatments for Drug-Resistant Bacterial Infections: Despite Progress, More Action Is Needed. Antimicrob Agents Chemother 2022; 66:e0199121. [PMID: 35007139 PMCID: PMC8923189 DOI: 10.1128/aac.01991-21] [Citation(s) in RCA: 109] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
There is an urgent global need for new strategies and drugs to control and treat multidrug-resistant bacterial infections. In 2017, the World Health Organization (WHO) released a list of 12 antibiotic-resistant priority pathogens and began to critically analyze the antibacterial clinical pipeline. This review analyzes "traditional" and "nontraditional" antibacterial agents and modulators in clinical development current on 30 June 2021 with activity against the WHO priority pathogens mycobacteria and Clostridioides difficile. Since 2017, 12 new antibacterial drugs have been approved globally, but only vaborbactam belongs to a new antibacterial class. Also innovative is the cephalosporin derivative cefiderocol, which incorporates an iron-chelating siderophore that facilitates Gram-negative bacteria cell entry. Overall, there were 76 antibacterial agents in clinical development (45 traditional and 31 nontraditional), with 28 in phase 1, 32 in phase 2, 12 in phase 3, and 4 under regulatory evaluation. Forty-one out of 76 (54%) targeted WHO priority pathogens, 16 (21%) were against mycobacteria, 15 (20%) were against C. difficile, and 4 (5%) were nontraditional agents with broad-spectrum effects. Nineteen of the 76 antibacterial agents have new pharmacophores, and 4 of these have new modes of actions not previously exploited by marketed antibacterial drugs. Despite there being 76 antibacterial clinical candidates, this analysis indicated that there were still relatively few clinically differentiated antibacterial agents in late-stage clinical development, especially against critical-priority pathogens. We believe that future antibacterial research and development (R&D) should focus on the development of innovative and clinically differentiated candidates that have clear and feasible progression pathways to the market.
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Affiliation(s)
- Mark S. Butler
- MSBChem Consulting, Brisbane, Queensland, Australia
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland, Australia
| | | | - Hatim Sati
- Antimicrobial Resistance Division, WHO, Geneva, Switzerland
| | - Sarah Paulin
- Antimicrobial Resistance Division, WHO, Geneva, Switzerland
| | | | - John H. Rex
- F2G Limited, Eccles, Manchester, United Kingdom
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Prabhavathi Fernandes
- Scientific Advisory Committee, GARDP, Geneva, Switzerland
- The National Biodefense Science Board, U.S. Department of Health and Human Services, Washington, DC, USA
| | - Cesar A. Arias
- Center for Infectious Diseases Research, Houston Methodist Research Institute, Houston, Texas, USA
- Center for Infectious Diseases, UTHealth School of Public Health, Houston, Texas, USA
| | - Mical Paul
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Guy E. Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, United Kingdom
| | - Lloyd Czaplewski
- Chemical Biology Ventures Ltd., Abingdon, Oxfordshire, United Kingdom
| | | | - Christian Lienhardt
- Université de Montpellier, INSERM, Institut de Recherche pour le Développement, Montpellier, France
| | | | | | - Norio Ohmagari
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Roman Kozlov
- Institute of Antimicrobial Chemotherapy, Smolensk State Medical University, Smolensk, Russia
| | - Stephan Harbarth
- National Center for Infection Prevention, Swissnoso, Bern, Switzerland
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, WHO Collaborating Center for Patient Safety, Geneva, Switzerland
| | - Peter Beyer
- Antimicrobial Resistance Division, WHO, Geneva, Switzerland
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11
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Iskandar K, Murugaiyan J, Hammoudi Halat D, Hage SE, Chibabhai V, Adukkadukkam S, Roques C, Molinier L, Salameh P, Van Dongen M. Antibiotic Discovery and Resistance: The Chase and the Race. Antibiotics (Basel) 2022; 11:182. [PMID: 35203785 PMCID: PMC8868473 DOI: 10.3390/antibiotics11020182] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/23/2022] [Accepted: 01/26/2022] [Indexed: 12/14/2022] Open
Abstract
The history of antimicrobial resistance (AMR) evolution and the diversity of the environmental resistome indicate that AMR is an ancient natural phenomenon. Acquired resistance is a public health concern influenced by the anthropogenic use of antibiotics, leading to the selection of resistant genes. Data show that AMR is spreading globally at different rates, outpacing all efforts to mitigate this crisis. The search for new antibiotic classes is one of the key strategies in the fight against AMR. Since the 1980s, newly marketed antibiotics were either modifications or improvements of known molecules. The World Health Organization (WHO) describes the current pipeline as bleak, and warns about the scarcity of new leads. A quantitative and qualitative analysis of the pre-clinical and clinical pipeline indicates that few antibiotics may reach the market in a few years, predominantly not those that fit the innovative requirements to tackle the challenging spread of AMR. Diversity and innovation are the mainstays to cope with the rapid evolution of AMR. The discovery and development of antibiotics must address resistance to old and novel antibiotics. Here, we review the history and challenges of antibiotics discovery and describe different innovative new leads mechanisms expected to replenish the pipeline, while maintaining a promising possibility to shift the chase and the race between the spread of AMR, preserving antibiotic effectiveness, and meeting innovative leads requirements.
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Affiliation(s)
- Katia Iskandar
- Department of Mathématiques Informatique et Télécommunications, Université Toulouse III, Paul Sabatier, INSERM, UMR 1295, 31000 Toulouse, France
- INSPECT-LB: Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban, Beirut 6573, Lebanon;
- Faculty of Pharmacy, Lebanese University, Beirut 6573, Lebanon
| | - Jayaseelan Murugaiyan
- Department of Biological Sciences, SRM University–AP, Amaravati 522502, India; (J.M.); (S.A.)
| | - Dalal Hammoudi Halat
- Department of Pharmaceutical Sciences, School of Pharmacy, Lebanese International University, Bekaa Campus, Beirut 1103, Lebanon
| | - Said El Hage
- Faculty of Medicine, Lebanese University, Beirut 6573, Lebanon;
| | - Vindana Chibabhai
- Division of Clinical Microbiology and Infectious Diseases, School of Pathology, University of the Witwatersrand, Johannesburg 2193, South Africa;
- Microbiology Laboratory, National Health Laboratory Service, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg 2193, South Africa
| | - Saranya Adukkadukkam
- Department of Biological Sciences, SRM University–AP, Amaravati 522502, India; (J.M.); (S.A.)
| | - Christine Roques
- Laboratoire de Génie Chimique, Department of Bioprocédés et Systèmes Microbiens, Université Paul Sabtier, Toulouse III, UMR 5503, 31330 Toulouse, France;
| | - Laurent Molinier
- Department of Medical Information, Centre Hospitalier Universitaire, INSERM, UMR 1295, Université Paul Sabatier Toulouse III, 31000 Toulouse, France;
| | - Pascale Salameh
- INSPECT-LB: Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban, Beirut 6573, Lebanon;
- Faculty of Medicine, Lebanese University, Beirut 6573, Lebanon;
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia 2408, Cyprus
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12
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Gandhi N, Schulman KA. New Medicare Technology Add-On Payment Could Be Used As A Market Support Mechanism To Accelerate Antibiotic Innovation. Health Aff (Millwood) 2021; 40:1926-1934. [PMID: 34871069 DOI: 10.1377/hlthaff.2021.00062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Despite growing antibiotic resistance, the clinical drug development pipeline for antibiotics has been sparse largely because of an unsustainable business model. We illustrate three models to accelerate antibiotic development, using Medicare new technology add-on payments as a market support mechanism. The first two models subsidize drug development for Medicare beneficiaries, and the third model applies a payment for every patient with a resistant infection to essentially create a funding pool. We found that the reimbursement required to sustain research and development would range from $637 to $121,365, depending on the payment model and the incidence of the resistant infection in question. With a $300 million public research subsidy, the payment for an antibiotic would drop to between $273 and $10,396 per course. Our market support model could increase the likelihood of attracting private investment for antibiotic development.
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Affiliation(s)
- Neil Gandhi
- Neil Gandhi is a resident in emergency medicine at the University of California Los Angeles, in Los Angeles, California. He was a graduate student at the Stanford University School of Medicine, in Stanford, California, when this work was performed
| | - Kevin A Schulman
- Kevin A. Schulman is a professor of medicine at the Stanford University School of Medicine and a professor at the Graduate School of Business, Stanford University
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13
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Cama J, Leszczynski R, Tang PK, Khalid A, Lok V, Dowson CG, Ebata A. To Push or To Pull? In a Post-COVID World, Supporting and Incentivizing Antimicrobial Drug Development Must Become a Governmental Priority. ACS Infect Dis 2021; 7:2029-2042. [PMID: 33606496 PMCID: PMC7931625 DOI: 10.1021/acsinfecdis.0c00681] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The COVID-19 pandemic has refocused attention worldwide on the dangers of infectious diseases, in terms of both global health and the effects on the world economy. Even in high income countries, health systems have been found wanting in dealing with the new infectious agent. However, the even greater long-term danger of antimicrobial resistance in pathogenic bacteria and fungi is still under-appreciated, especially among the general public. Although antimicrobial drug development faces significant scientific challenges, the gravest challenge at the moment appears to be economic, where the lack of a viable market has led to a collapse in drug development pipelines. There is therefore a critical need for governments across the world to further incentivize the development of antimicrobials. Most incentive strategies over the past decade have focused on so-called "push" incentives that bridge the costs of antimicrobial research and development, but these have been insufficient for reviving the pipeline. In this Perspective, we analyze the current incentive strategies in place for antimicrobial drug development, and focus on "pull" incentives, which instead aim to improve revenue generation and thereby resolve the antimicrobial market failure challenge. We further analyze these incentives in a broader "One Health" context and stress the importance of developing and enforcing strict protocols to ensure appropriate manufacturing practices and responsible use. Our analysis reiterates the importance of international cooperation, coordination across antimicrobial research, and sustained funding in tackling this significant global challenge. A failure to invest wisely and continuously to incentivize antimicrobial pipelines will have catastrophic consequences for global health and wellbeing in the years to come.
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Affiliation(s)
- J. Cama
- Living
Systems Institute, University of Exeter, Stocker Road, Exeter EX4 4QD, U.K.
- College
of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter EX4 4QF, U.K.
- ,
| | - R. Leszczynski
- Polygeia,
Global Health Student Think Tank, London, U.K.https://www.polygeia.com/
| | - P. K. Tang
- Polygeia,
Global Health Student Think Tank, London, U.K.https://www.polygeia.com/
- Faculty
of Life Sciences and Medicine, King’s
College London, Great
Maze Pond, London SE1 1UK, U.K.
| | - A. Khalid
- Polygeia,
Global Health Student Think Tank, London, U.K.https://www.polygeia.com/
- School
of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, U.K.
| | - V. Lok
- Polygeia,
Global Health Student Think Tank, London, U.K.https://www.polygeia.com/
- School of
Biological and Chemical Sciences, Queen
Mary University of London, Mile End Road, London E1 4NS, U.K.
| | - C. G. Dowson
- School
of Life Sciences, Gibbet Hill Campus, University
of Warwick, Coventry CV4 7AL, U.K.
- Antibiotic
Research U.K., Genesis 5, York Science Park, Heslington, York YO10 5DQ, U.K.
| | - A. Ebata
- Institute
of Development Studies, Library Road, Brighton BN1 9RE, U.K.
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14
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McClelland S, Lamoureux B, Larson E. Trends in antimicrobial resistance legislation 2011-2019: A review of the US policy response to the antimicrobial resistance threat and its public health Impact. Am J Infect Control 2021; 49:813-817. [PMID: 33417969 DOI: 10.1016/j.ajic.2020.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Antimicrobial resistance is a continued global threat to public health. In recognition of this threat, the executive branch of the United States government consolidated guidelines through the President's Council of Advisors on Science and Technology and Executive Order 13676. METHODS An analysis was conducted to assess the US government's response to this growing threat. Human and animal health legislation from 2011 to 2019 was reviewed using the congressional legislative database where 28 pieces of antimicrobial distinct legislation was identified. RESULTS The majority of the bills identified were human health related and common themes found were incentivizing the development of new products, biodefense, expanded scope of use, and stewardship. Much fewer were identified pertaining to animal health; of those identified, common themes included stricter veterinary oversight, barriers to approval pathways for new products, and stewardship. CONCLUSIONS The public health impact of these legislative efforts is in part related to a broader political tension of the role of government vs local authorities in managing regulatory enforcement and guidelines.
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15
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Rome BN, Kesselheim AS. Transferrable Market Exclusivity Extensions to Promote Antibiotic Development: An Economic Analysis. Clin Infect Dis 2021; 71:1671-1675. [PMID: 31630159 DOI: 10.1093/cid/ciz1039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/15/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To address the growing threat of multidrug-resistant organisms, policymakers are seeking ideas to promote development of novel antibiotics. In 2018, the REVAMP Act was proposed in Congress to reward manufacturers of certain novel antibiotics with transferrable market exclusivity vouchers. METHODS We estimated the economic impact of this proposal by identifying antimicrobial drugs approved by the FDA from 2007-2016 that would likely have qualified for an exclusivity voucher and matching each drug to the highest-revenue fast-track drug facing generic entry within 4 years after the antibiotic was approved. Assuming a spending decrease of 75% after generic entry, we calculated the per-drug and total societal costs of these transferrable market exclusivity extensions over a decade. RESULTS We identified 10 antimicrobials that would have qualified for an exclusivity voucher, each of which was matched with 1 of 17 fast-track drugs facing generic entry through July 2019. These 10 drugs had a median annual revenue before generic entry of $249 million (range, $26 million-$2.7 billion). Accounting for a 75% spending reduction after generic entry, the median excess spending associated with 12 months of extended exclusivity was $187 million, for a total of $4.5 billion over 10 years. CONCLUSIONS While market exclusivity extensions are a politically appealing mechanism to encourage novel antibiotic development, this approach would cost public and private payers billions of dollars over the next decade.
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Affiliation(s)
- Benjamin N Rome
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron S Kesselheim
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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16
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Clancy CJ, Nguyen MH. Coronavirus Disease 2019, Superinfections, and Antimicrobial Development: What Can We Expect? Clin Infect Dis 2021; 71:2736-2743. [PMID: 32361747 PMCID: PMC7197597 DOI: 10.1093/cid/ciaa524] [Citation(s) in RCA: 159] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/29/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) arose at a time of great concern about antimicrobial resistance (AMR). No studies have specifically assessed COVID-19-associated superinfections or AMR. Based on limited data from case series, it is reasonable to anticipate that an appreciable minority of patients with severe COVID-19 will develop superinfections, most commonly pneumonia due to nosocomial bacteria and Aspergillus. Microbiology and AMR patterns are likely to reflect institutional ecology. Broad-spectrum antimicrobial use is likely to be widespread among hospitalized patients, both as directed and empiric therapy. Stewardship will have a crucial role in limiting unnecessary antimicrobial use and AMR. Congressional COVID-19 relief bills are considering antimicrobial reimbursement reforms and antimicrobial subscription models, but it is unclear if these will be included in final legislation. Prospective studies on COVID-19 superinfections are needed, data from which can inform rational antimicrobial treatment and stewardship strategies, and models for market reform and sustainable drug development.
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Affiliation(s)
- Cornelius J Clancy
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - M Hong Nguyen
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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17
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Dutescu IA, Hillier SA. Encouraging the Development of New Antibiotics: Are Financial Incentives the Right Way Forward? A Systematic Review and Case Study. Infect Drug Resist 2021; 14:415-434. [PMID: 33574682 PMCID: PMC7872909 DOI: 10.2147/idr.s287792] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 12/25/2020] [Indexed: 12/11/2022] Open
Abstract
Antibiotic resistance is an urgent public health threat that has received substantial attention from the world's leading health agencies and national governmental bodies alike. However, despite increasing rates of antibiotic resistance, pharmaceutical companies are reluctant to develop new antibiotics due to scientific, regulatory, and financial barriers. Nonetheless, only a handful of countries have addressed this by implementing or proposing financial incentive models to promote antibiotic innovation. This study is comprised of a systematic review that aimed to understand which antibiotic incentive strategies are most recommended within the literature and subsequently analyzed these incentives to determine which are most likely to sustainably revitalize the antibiotic pipeline. Through a case study of Canada, we apply our incentive analysis to the Canadian landscape to provide decision-makers with a possible path forward. Based on our findings, we propose that Canada support the ongoing efforts of other countries by implementing a fully delinked subscription-based market entry reward. This paper seeks to spark action in Canada by shifting the national paradigm to one where antibiotic research and development is prioritized as a key element to addressing antibiotic resistance.
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Affiliation(s)
- Ilinca A Dutescu
- School of Health Policy & Management, Faculty of Health, York University, Toronto, ON, Canada
| | - Sean A Hillier
- School of Health Policy & Management, Faculty of Health, York University, Toronto, ON, Canada
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18
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Årdal C, Lacotte Y, Ploy MC. Financing Pull Mechanisms for Antibiotic-Related Innovation: Opportunities for Europe. Clin Infect Dis 2020; 71:1994-1999. [PMID: 32060511 PMCID: PMC7643740 DOI: 10.1093/cid/ciaa153] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/14/2020] [Indexed: 11/14/2022] Open
Abstract
Antibiotic innovation is in serious jeopardy as companies continue to abandon the market due to a lack of profitability. Novel antibiotics must be used sparingly to hinder the spread of resistance, but small companies cannot survive on revenues that do not cover operational costs. When these companies either go bankrupt or move onto other therapeutic areas, these antibiotics may be no longer accessible to patients. Although significant research efforts have detailed incentives to stimulate antibiotic innovation, little attention has been paid to the financing of these incentives. In this article, we take a closer look at 4 potential financing models (diagnosis-related group carve-out, stewardship taxes, transferable exclusivity voucher, and a European-based "pay or play" model) and evaluate them from a European perspective. The attractiveness of these models and the willingness for countries to test them are currently being vetted through the European Joint Action on AMR and Healthcare-Associated Infections (EU-JAMRAI).
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Affiliation(s)
- Christine Årdal
- Norwegian Institute of Public Health, Antimicrobial Resistance Centre, Oslo, Norway
| | - Yohann Lacotte
- Université Limoges, INSERM, CHU Limoges, UMR 1092, Limoges, France
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19
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Vickers RJ, Bassetti M, Clancy CJ, Garey KW, Greenberg DE, Nguyen MH, Roblin D, Tillotson GS, Wilcox MH. Combating resistance while maintaining innovation: the future of antimicrobial stewardship. Future Microbiol 2019; 14:1331-1341. [PMID: 31526186 DOI: 10.2217/fmb-2019-0227] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Antimicrobial resistance represents a significant global health threat. However, a commercial model that does not offer a return on investment resulting in a lack of investment in antibiotic R&D, means that the current pipeline of antibiotics lacks sufficient innovation to meet this challenge. Those responsible for defining, promoting and monitoring the rationale use of antibiotics (the antimicrobial stewardship programme) are key to addressing current shortcomings. In this personal perspective, we discuss the future role stewardship can play in stimulating innovation, a need to move away from a pharmacy budget dominated view of antibiotic use, and the impact of the ever-increasing sophistication and interdisciplinary nature of antimicrobial control programs. Changes are needed to optimize clinical outcomes for patients.
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Affiliation(s)
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, Genoa & Hospital Policlinico San Martino, Genoa, Italy
| | - Cornelius J Clancy
- University of Pittsburgh, Division of Infectious Diseases, Pittsburgh, PA, USA
| | - Kevin W Garey
- Department of Pharmacy Practice & Translational Research, University of Houston College of Pharmacy, Houston, TX, USA
| | - David E Greenberg
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Minh-Hong Nguyen
- University of Pittsburgh, Division of Infectious Diseases, Pittsburgh, PA, USA
| | | | | | - Mark H Wilcox
- Department of Microbiology, Leeds Teaching Hospitals & University of Leeds, Leeds, UK
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20
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Breaching the Barrier: Quantifying Antibiotic Permeability across Gram-negative Bacterial Membranes. J Mol Biol 2019; 431:3531-3546. [DOI: 10.1016/j.jmb.2019.03.031] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/29/2019] [Accepted: 03/28/2019] [Indexed: 11/22/2022]
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21
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Rex JH, Fernandez Lynch H, Cohen IG, Darrow JJ, Outterson K. Designing development programs for non-traditional antibacterial agents. Nat Commun 2019; 10:3416. [PMID: 31366924 PMCID: PMC6668399 DOI: 10.1038/s41467-019-11303-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/05/2019] [Indexed: 12/14/2022] Open
Abstract
In the face of rising rates of antibacterial resistance, many responses are being pursued in parallel, including 'non-traditional' antibacterial agents (agents that are not small-molecule drugs and/or do not act by directly targeting bacterial components necessary for bacterial growth). In this Perspective, we argue that the distinction between traditional and non-traditional agents has only limited relevance for regulatory purposes. Rather, most agents in both categories can and should be developed using standard measures of clinical efficacy demonstrated with non-inferiority or superiority trial designs according to existing regulatory frameworks. There may, however, be products with non-traditional goals focused on population-level benefits that would benefit from extension of current paradigms. Discussion of such potential paradigms should be undertaken by the development community.
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Affiliation(s)
- John H Rex
- F2G Limited, Eccles, Cheshire, M30 0LX, UK.
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA.
| | - Holly Fernandez Lynch
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - I Glenn Cohen
- Harvard Law School, Cambridge, MA, 02138, USA
- Petrie-Flom Center, Cambridge, MA, 02138, USA
| | | | - Kevin Outterson
- Boston University School of Law, CARB-X, Boston, MA, 02215, USA
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22
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van Hengel AJ, Marin L. Research, Innovation, and Policy: An Alliance Combating Antimicrobial Resistance. Trends Microbiol 2019; 27:287-289. [PMID: 30638776 DOI: 10.1016/j.tim.2018.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/27/2018] [Accepted: 12/13/2018] [Indexed: 11/26/2022]
Abstract
The surge in antimicrobial resistance (AMR) has created a crisis that has become top priority for public health and global policy. Researchers, developers, innovators, funders, and policymakers need to curb AMR's rising trend by acting synergistically, boosting investment in developing solutions. This science-policy interface is now taking shape.
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Affiliation(s)
- Arjon J van Hengel
- Directorate-General for Research & Innovation, European Commission, Brussels, Belgium.
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23
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Zhang JS, Liu G, Zhang WS, Shi HY, Lu G, Zhao CA, Li CC, Li YQ, Shao YN, Tian DY, Ding MJ, Li CY, Luo LJ, Dong XY, Jin P, Wang P, Zhu CM, Wang CQ, Zheng YJ, Deng JK, Sharland M, Hsia YF, Shen KL, Yang YH. Antibiotic usage in Chinese children: a point prevalence survey. World J Pediatr 2018; 14:335-343. [PMID: 30062648 DOI: 10.1007/s12519-018-0176-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 07/11/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Children as a population have high antimicrobial prescribing rates which may lead to high resistance of bacteria according to data from some single-center surveys of antibiotic prescribing rates in China. The acquirement of baseline data of antibiotic prescribing is the basis of developing intervention strategies on inappropriate antimicrobial prescriptions. Few studies show clearly the pattern and detailed information on classes of antibiotics and distribution of indications of antibiotic prescriptions in children in China. This study aims to assess the antibiotic prescribing patterns among children and neonates hospitalized in 18 hospitals in China. METHODS A 24-hour point prevalence survey on antimicrobial prescribing was conducted in hospitalized neonates and children in China from December 1st, 2016 to February 28th, 2017. Information on the antibiotic use of patients under 18 years of age who were administered one or more on-going antibiotics in the selected wards over a 24-hour period was collected. These data were submitted to the GARPEC (Global Antimicrobial Resistance, Prescribing and Efficacy in Children and Neonates) web-based application ( https://pidrg-database.sgul.ac.uk/redcap/ ). For statistical analysis, Microsoft Excel 2007 and SPSS 22.0 were used. RESULTS The antibiotic data were collected in 35 wards in 18 hospitals from 9 provinces. In total, 67.76% (975/1439) of the patients (n = 1439) were given at least one antibiotic, including 58.1% (173/298) of neonates (n = 298) and 70.3% (802/1141) of children (n = 1141). In neonates, the three most frequently prescribed antibiotics were third-generation cephalosporins (41.7%), penicillins plus enzyme inhibitor (23.8%), and carbapenems (11.2%). In children, the three most frequently prescribed antibiotics were third-generation cephalosporins (35.5%), macrolides (23.2%), and penicillins plus enzyme inhibitors (15.9%). The most common indication for antibiotics was proven or probable bacterial lower respiratory tract infection (30.9% in neonates and 66.6% in children). CONCLUSIONS Antibiotics are commonly prescribed in the Chinese children population. It is likely that the third-generation cephalosporins and macrolides are currently overused in Chinese children. Efforts must be made to ensure safe and appropriate antibiotic prescribing to reduce and prevent the future development of antibiotic resistance.
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Affiliation(s)
- Jiao-Sheng Zhang
- Department of Infectious diseases, Shenzhen Children's Hospital, Shenzhen, China
| | - Gang Liu
- Department of Infectious diseases, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, China
| | - Wen-Shuang Zhang
- Department of Respiratory Medicine, Tianjin Children's Hospital, Tianjin, China
| | - Hai-Yan Shi
- Department of Pharmacology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Gen Lu
- Department of Respiratory Medicine, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Chang-An Zhao
- Emergency Department, Guangdong Maternal and Child Health Care Hospital, Guangzhou, China
| | - Chang-Chong Li
- Department of Pediatric Respiratory Medicine, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yan-Qi Li
- Department of Respiratory Medicine, Xi'an Children's Hospital, Xi'an, China
| | - Ya-Nan Shao
- Department of Respiratory Medicine, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dai-Yin Tian
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ming-Jie Ding
- Department of Respiratory Medicine, Jinan Children's Hospital, Jinan, China
| | - Chun-Yan Li
- Department of Respiratory Medicine, The First Hospital of Jilin University, Changchun, China
| | - Li-Juan Luo
- Department of Infectious diseases, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiao-Yan Dong
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai, China
| | - Ping Jin
- Pediatric Intensive Care Unit, Bao'an Maternity and Child Health Hospital, Shenzhen, China
| | - Ping Wang
- Neonatal Department, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Chun-Mei Zhu
- Department of Respiratory Medicine, Children's Hospital Attached to The Capital Institute of Pediatrics, Beijing, China
| | - Chuan-Qing Wang
- Infection-control Department, Fudan University Pediatric Hospital, Shanghai, China
| | - Yue-Jie Zheng
- Department of Respiratory Medicine, Shenzhen Children's Hospital, Shenzhen, China
| | - Ji-Kui Deng
- Department of Infectious diseases, Shenzhen Children's Hospital, Shenzhen, China
| | - Mike Sharland
- Pediatric Infectious Diseases Research Group, St George's, University of London, London, UK
| | - Ying-Fen Hsia
- Pediatric Infectious Diseases Research Group, St George's, University of London, London, UK
| | - Kun-Ling Shen
- Department of Respiratory Medicine, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yong-Hong Yang
- Beijing Pediatric Research Institute, Beijing Children's Hospital Affiliated to Capital Medical University, 56 Nanlishi Road, Beijing, China.
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24
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Lum K, Bhatti T, Holland S, Guthrie M, Sassman S. Diagnosis Confirmation Model: A Value-Based Pricing Model for Inpatient Novel Antibiotics. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2018; 46:66-74. [PMID: 30146960 DOI: 10.1177/1073110518782917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Diagnosis Confirmation Model (DCM) includes a dual-pricing mechanism designed to support value-based pricing of novel antibiotics while improving the alignment of financial incentives with their optimal use in patients at high risk of drug-resistant infections. DCM is a market-based model and complementary to delinked models. Policymakers interested in stimulating antibiotic innovation could consider tailoring the DCM to their reimbursement systems and incorporating it into the suite of incentives to improve the economics of antibiotics.
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Affiliation(s)
- Ka Lum
- Ka Lum, Ph.D., M.B.A., was the Head of Global Pricing & Market Access of Immunology, Infectious Diseases and Ophthalmology at Genentech, a member of the Roche Group. She holds a Bachelor of Science in Chemistry, a Bachelor of Arts in Applied Mathematics, a Doctor of Philosophy in Chemistry, and a Master of Business Administration from UC Berkeley. Taimur Bhatti, M.Sc., is an International Payer Strategy Leader in Infectious Diseases at Hoffmann-La Roche. He holds a Bachelor of Science in Biomedical Engineering from Duke University and a Master in Science in Health Economics/Pharmaceutical Sciences from the University of Toronto (Canada). Silas Holland, M.P.H., M.A., is a Director of Global Public Policy at Merck and Co., Inc. responsible for infectious disease global health policy, primarily focusing on antibiotics/antifungals. He holds a Bachelor of Science in Biology from Duke University and has postgraduate degrees in education (Loyola Marymount University) and public health (University of Pretoria, South Africa). Mark Guthrie, M.B.A., is the Global Pricing and Market Access Pipeline Head for Immunology, Infectious Disease and Ophthalmology at Genentech, a member of the Roche Group. He has a Master of Business Administration in Healthcare Management from the University of Baltimore and a Bachelor of Arts in Economics from Denison University. Stephanie Sassman is a Lifecycle Leader in Immunology at Genentech, a member of the Roche Group. She holds a Bachelor of Business Administration from the University of Texas at Austin
| | - Taimur Bhatti
- Ka Lum, Ph.D., M.B.A., was the Head of Global Pricing & Market Access of Immunology, Infectious Diseases and Ophthalmology at Genentech, a member of the Roche Group. She holds a Bachelor of Science in Chemistry, a Bachelor of Arts in Applied Mathematics, a Doctor of Philosophy in Chemistry, and a Master of Business Administration from UC Berkeley. Taimur Bhatti, M.Sc., is an International Payer Strategy Leader in Infectious Diseases at Hoffmann-La Roche. He holds a Bachelor of Science in Biomedical Engineering from Duke University and a Master in Science in Health Economics/Pharmaceutical Sciences from the University of Toronto (Canada). Silas Holland, M.P.H., M.A., is a Director of Global Public Policy at Merck and Co., Inc. responsible for infectious disease global health policy, primarily focusing on antibiotics/antifungals. He holds a Bachelor of Science in Biology from Duke University and has postgraduate degrees in education (Loyola Marymount University) and public health (University of Pretoria, South Africa). Mark Guthrie, M.B.A., is the Global Pricing and Market Access Pipeline Head for Immunology, Infectious Disease and Ophthalmology at Genentech, a member of the Roche Group. He has a Master of Business Administration in Healthcare Management from the University of Baltimore and a Bachelor of Arts in Economics from Denison University. Stephanie Sassman is a Lifecycle Leader in Immunology at Genentech, a member of the Roche Group. She holds a Bachelor of Business Administration from the University of Texas at Austin
| | - Silas Holland
- Ka Lum, Ph.D., M.B.A., was the Head of Global Pricing & Market Access of Immunology, Infectious Diseases and Ophthalmology at Genentech, a member of the Roche Group. She holds a Bachelor of Science in Chemistry, a Bachelor of Arts in Applied Mathematics, a Doctor of Philosophy in Chemistry, and a Master of Business Administration from UC Berkeley. Taimur Bhatti, M.Sc., is an International Payer Strategy Leader in Infectious Diseases at Hoffmann-La Roche. He holds a Bachelor of Science in Biomedical Engineering from Duke University and a Master in Science in Health Economics/Pharmaceutical Sciences from the University of Toronto (Canada). Silas Holland, M.P.H., M.A., is a Director of Global Public Policy at Merck and Co., Inc. responsible for infectious disease global health policy, primarily focusing on antibiotics/antifungals. He holds a Bachelor of Science in Biology from Duke University and has postgraduate degrees in education (Loyola Marymount University) and public health (University of Pretoria, South Africa). Mark Guthrie, M.B.A., is the Global Pricing and Market Access Pipeline Head for Immunology, Infectious Disease and Ophthalmology at Genentech, a member of the Roche Group. He has a Master of Business Administration in Healthcare Management from the University of Baltimore and a Bachelor of Arts in Economics from Denison University. Stephanie Sassman is a Lifecycle Leader in Immunology at Genentech, a member of the Roche Group. She holds a Bachelor of Business Administration from the University of Texas at Austin
| | - Mark Guthrie
- Ka Lum, Ph.D., M.B.A., was the Head of Global Pricing & Market Access of Immunology, Infectious Diseases and Ophthalmology at Genentech, a member of the Roche Group. She holds a Bachelor of Science in Chemistry, a Bachelor of Arts in Applied Mathematics, a Doctor of Philosophy in Chemistry, and a Master of Business Administration from UC Berkeley. Taimur Bhatti, M.Sc., is an International Payer Strategy Leader in Infectious Diseases at Hoffmann-La Roche. He holds a Bachelor of Science in Biomedical Engineering from Duke University and a Master in Science in Health Economics/Pharmaceutical Sciences from the University of Toronto (Canada). Silas Holland, M.P.H., M.A., is a Director of Global Public Policy at Merck and Co., Inc. responsible for infectious disease global health policy, primarily focusing on antibiotics/antifungals. He holds a Bachelor of Science in Biology from Duke University and has postgraduate degrees in education (Loyola Marymount University) and public health (University of Pretoria, South Africa). Mark Guthrie, M.B.A., is the Global Pricing and Market Access Pipeline Head for Immunology, Infectious Disease and Ophthalmology at Genentech, a member of the Roche Group. He has a Master of Business Administration in Healthcare Management from the University of Baltimore and a Bachelor of Arts in Economics from Denison University. Stephanie Sassman is a Lifecycle Leader in Immunology at Genentech, a member of the Roche Group. She holds a Bachelor of Business Administration from the University of Texas at Austin
| | - Stephanie Sassman
- Ka Lum, Ph.D., M.B.A., was the Head of Global Pricing & Market Access of Immunology, Infectious Diseases and Ophthalmology at Genentech, a member of the Roche Group. She holds a Bachelor of Science in Chemistry, a Bachelor of Arts in Applied Mathematics, a Doctor of Philosophy in Chemistry, and a Master of Business Administration from UC Berkeley. Taimur Bhatti, M.Sc., is an International Payer Strategy Leader in Infectious Diseases at Hoffmann-La Roche. He holds a Bachelor of Science in Biomedical Engineering from Duke University and a Master in Science in Health Economics/Pharmaceutical Sciences from the University of Toronto (Canada). Silas Holland, M.P.H., M.A., is a Director of Global Public Policy at Merck and Co., Inc. responsible for infectious disease global health policy, primarily focusing on antibiotics/antifungals. He holds a Bachelor of Science in Biology from Duke University and has postgraduate degrees in education (Loyola Marymount University) and public health (University of Pretoria, South Africa). Mark Guthrie, M.B.A., is the Global Pricing and Market Access Pipeline Head for Immunology, Infectious Disease and Ophthalmology at Genentech, a member of the Roche Group. He has a Master of Business Administration in Healthcare Management from the University of Baltimore and a Bachelor of Arts in Economics from Denison University. Stephanie Sassman is a Lifecycle Leader in Immunology at Genentech, a member of the Roche Group. She holds a Bachelor of Business Administration from the University of Texas at Austin
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Wei HS. Pathogenic bacteria in abdominal cavity drainage of patients with intraabdominal infection and their drug resistance. Shijie Huaren Xiaohua Zazhi 2018; 26:550-556. [DOI: 10.11569/wcjd.v26.i9.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To identify the pathogenic bacteria in abdominal cavity drainage of patients with intraabdominal infection and to analyze their drug resistance.
METHODS From January 2015 to November 2017, 92 patients with intraperitoneal infection were treated by celiac drainage at our hospital. The bacterial culture and drug susceptibility results of peritoneal drainage fluid were statistically analyzed, and the differences in different bacterial populations and drug resistance were analyzed. Cox regression model was used to explore the independent risk factors affecting the prognosis of patients.
RESULTS A total of 145 bacterial strains were cultured, including 46 Gram-positive and 97 Gram-negative strains. The top five pathogens were Escherichia coli (31.72%), Klebsiellosis pneumoniae (24.14%), Staphylococcus aureus (15.86%), Enterococcus (11.72%), and Pseudomonas aeruginosa (7.59%). Staphylococcus aureus and Enterococcus were two Gram-positive strains that had high resistance rates but were highly sensitive to vancomycin. Enterococci had high resistance rates to erythromycin, chloramphenicol, and levofloxacin than Staphylococcus aureus, which had a high resistance rate to ampicillin. Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and other three kinds of G-bacteria had high resistance rates, but all of them had a high sensitivity to β-lactams/β-lactamase inhibitors, imipenem/Cistadine and amikacin; among them, extended spectrum beta lactamase (ESBL) producing strains and Pseudomonas aeruginosa had high resistance rates to ceftriaxone, ceftazidime, cefepime, and levofloxacin. Univariate Cox regression analysis showed that age, multidrug resistant organism (MDRO), nosocomial infection, ESBL positivity, and time from fever to culture were related to death in patients with intraabdominal infection. Multivariate Cox regression analysis showed that MDRO, ESBL positivity, and time from fever to culture were independent risk factors for death in patients with intraabdominal infection.
CONCLUSION Main pathogens in peritoneal drainage fluid of patients with intraabdominal infection are Gram-negative bacteria, and the pathogens are highly resistant to commonly used antibiotics. MDRO, ESBL positivity, and time from fever to culture are independent risk factors for death from intraabdominal infection.
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Shlaes DM, Bradford PA. Antibiotics-From There to Where?: How the antibiotic miracle is threatened by resistance and a broken market and what we can do about it. Pathog Immun 2018; 3:19-43. [PMID: 30993248 PMCID: PMC6423724 DOI: 10.20411/pai.v3i1.231] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 02/18/2018] [Indexed: 12/15/2022] Open
Abstract
To fully appreciate the importance of antibiotics to everyday life, we must step back to the edge of the pre-antibiotic era when these lifesaving drugs were first introduced into clinical use.
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Affiliation(s)
- David M. Shlaes
- Anti-infectives Consulting (retired), Stonington, Connecticut
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Towse A, Hoyle CK, Goodall J, Hirsch M, Mestre-Ferrandiz J, Rex JH. Time for a change in how new antibiotics are reimbursed: Development of an insurance framework for funding new antibiotics based on a policy of risk mitigation. Health Policy 2017; 121:1025-1030. [PMID: 28888660 DOI: 10.1016/j.healthpol.2017.07.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 06/30/2017] [Accepted: 07/30/2017] [Indexed: 10/19/2022]
Abstract
Healthcare systems depend on the availability of new antibiotics. However, there is a lack of treatments for infections caused by multidrug resistant (MDR) pathogens and a weak development pipeline of new therapies. One core challenge to the development of new antibiotics targeting MDR pathogens is that expected revenues are insufficient to drive long-term investment. In the USA and Europe, financial incentives have focussed on supporting R&D, reducing regulatory burden, and extending market exclusivity. Using resistance data to estimate global revenues, we demonstrate that the combined effects of these incentives are unlikely to rekindle investment in antibiotics. We analyse two supplemental approaches: a commercial incentive (a premium price model) and a new business model (an insurance model). A premium price model is familiar and readily implemented but the required price and local budget impact is highly uncertain and sensitive to cross-sectional and longitudinal variation in prevalence of antibiotic resistance. An insurance model delivering risk mitigation for payers, providers and manufacturers would provide an incentive to drive investment in the development of new antibiotics while also facilitating antibiotic conservation. We suggest significant efforts should be made to test the insurance model as one route to stimulate investment in novel antibiotics.
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Affiliation(s)
- Adrian Towse
- Office of Health Economics, Southside, 7th Floor, 105 Victoria Street, London, SW1E 6QT, UK.
| | | | - Jonathan Goodall
- 1 Francis Crick Avenue, Cambridge Biomedical Campus, Cambridge, CB2 0AA, UK
| | - Mark Hirsch
- 1 Francis Crick Avenue, Cambridge Biomedical Campus, Cambridge, CB2 0AA, UK
| | - Jorge Mestre-Ferrandiz
- Office of Health Economics, Southside, 7th Floor, 105 Victoria Street, London, SW1E 6QT, UK
| | - John H Rex
- AstraZeneca Pharmaceuticals, 35 Gatehouse Park, Waltham, MA, USA
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