Growing crisis of antibiotic-resistant bacteria

Scientists, the federal government and the pharmaceutical industry must work together quickly to solve the growing crisis of antibiotic-resistant bacteria, a Virginia Commonwealth University infectious disease expert said in today's issue of The New England Journal of Medicine.

Money is the biggest obstacle to developing new classes of antibiotics, and public health is at stake, said Richard P. Wenzel, M.D., chairman of VCU's Department of Internal Medicine, adding that mortality rates from many infections will increase without effective antibiotics.

Little work has been done in the past 30 years to advance the discovery of new classes of antibiotics to treat infection, Wenzel wrote in an opinion piece for the journal. Four new classes of antibiotics were approved in the 1930s and 1940s, and six more became available in the 1950s and 1960s, he wrote. However, none was approved in the 1970s, 1980s or 1990s, and only two new classes of antibiotics have been approved since 2000.

Over the years, almost half the pneumococci, the bacteria responsible for infections like pneumonia and meningitis, have become resistant to penicillin drugs, and half of all Staph infections in U.S. hospitals are resistant to a newer class of antibiotic, Wenzel wrote. That leaves the vancomycin class, considered the primary rescue antibiotic, as the alternative, and officials are seeing reports of occasional resistance to that drug also.

The pharmaceutical industry traditionally favors investment in research on drugs that have a greater financial return such as those for musculoskeletal diseases and cancer, resulting in fewer scientists working to develop new classes of antibiotics, he wrote.

"With increasing levels of antibiotic resistance, an insecure pipeline and a dwindling number of companies investing in anti-infectives, we have reached an unsettling impasse in medicine."

Wenzel urged cooperation among the scientific community, the Food and Drug Administration and the pharmaceutical industry.

"An urgent dialogue among committed advocates should begin," he wrote, adding that "good public companies need to be profitable and know the cost of disease, but great companies also (should) aspire to serve and know the value of health."

Wenzel, who is president of MCV Physicians, the practice group of the VCU Health System, also is president-elect of the International Society for Infectious Diseases. He was named the first Editor-at-Large of The New England Journal of Medicine in 2001.