In the grand scheme of things, antibiotics are fairly new additions to our medical repertoire. Germ theory achieved general scientific acceptance around the 1860s [1]. It is logical that in order to produce microorganism-fighting compounds, we must first accept that microorganisms exist. In 1909, after 605 failed compounds, scientists discovered a well-tolerated treatment for syphilis. The compound dubbed ‘606’ or ‘Salvarsan’ became widely prescribed for the then-endemic disease [2]. In antibiotics’ history, things drastically changed in 1928 when on Penicillin was accidentally discovered on a moldy petri dish and began to be prescribed in the 1940s [3]. With Penicillin came the ushering in of the ‘antibiotic era’. For the first time in history, doctors had weapons in their arsenal against bacterial illness. Things seemed good, for a while.
Antibiotic or antimicrobial resistance, like any good villain, has been lurking just beyond the shadows since the first antibiotics debuted. Penicillin resistance was first observed in 1946. Resistant bacteria to the first Sulfonamide drug was documented only six years after its introduction. This trend of small gaps between new antibiotic launch and first resistance has continued throughout the past 80 years of antibiotic development [4].
Jumping to current day, antibiotic resistance is making headlines, and not in a good way. There is concern that we may be transcending the ‘antibiotic era’. We have recently been faced with outbreaks of illnesses like Extensively Drug Resistant Tuberculosis (XDR-TB), Methycillin-Resistant Staphylococcus aureus (MRSA), Vancomycin-Resistant Enterococcus (VRE), drug-resistant Gonorrhea, and worse: pan drug-resistant bacteria – bacteria resistant to all currently available antibiotics [5, 6]. Are we again entering a time where we need to be “Blessed” after a sneeze, because all we have are a hope and a prayer for survival?
This article will not describe the, sometimes controversial, influencing factors in the rising rates of antibiotic resistance. However, we do know that a critical way to stay ahead of resistance – is to create new drugs.
What is being done?
In 2014, the foundation was laid for what is being called the “21st Century Cures Initiative”. United States’ lawmakers have drafted the proposed bill as a means to reduce the cost of and speed up the drug development process [7]. The bill, if passed, would be groundbreaking. Some of the major impediments to new antibiotic development have been the long process, high costs and low final payout [8]. Why would a compound that is so important and so widely used have a low payout? Because, as compared to drugs for chronic conditions, antibiotics only need to be taken for a short period in order to treat the target disease [8].
Since 1998, only 11 new antibiotics have been approved by the Food and Drug Administration (FDA) [10]. However, recently things seem to be looking up. Two new antibiotics, targeted at treating skin infections, were approved in 2014 – Dalbavancin and Tedizolid [11, 12]. So far this year, two major developments in the battle against antimicrobial resistance were announced in the same article published by Nature in January 2015 [13]. Possibly most promising news of all, a method for growing uncultured bacteria was developed: iChip technology. iChip, which solves the issue of environmental microorganisms that are otherwise unculturable in petri dishes, involves burying a mesh-like membrane in the soil, allowing microorganisms to grow in the chip compartments, and then digging it up and transferring the more established colonies onto petri dishes [14].
After using this method to produce 10,000 cultures, Dr. Kim Lewis of Northeastern University and his team, (literally) unearthed 25 new antibiotics [15]. However, it was only one compound, now termed Teixobactin, that stood out. Teixobactin is what we call a new class of antibiotics, it has a different mechanism of action against bacteria than any that has been discovered to date. This is the most critical type of antibiotic to develop – a completely novel one. If tested and passed by the FDA, it would be the first new class of antibiotic in the past 25 years [15].
Dr. Mark Woolhouse of the University of Edinburgh sums up the progress quite nicely: “Any report of a new antibiotic is auspicious, but what most excites me is the tantalising prospect that this is just the tip of the iceberg” [15]. Teixobactin has yet to be safety- or efficacy-tested in humans, but the possibility of new antibiotics appears to be more near than far right now.
[1] http://www.sciencemuseum.org.uk/broughttolife/techniques/germtheory.aspx
[2] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3109405/
[3] http://www.cbsnews.com/news/almanac-the-discovery-of-penicillin/
[4] http://www.nature.com/nrd/journal/v12/n5/fig_tab/nrd3975_T1.html
[5] http://www.ncagr.gov/oep/oneMedicine/noms/2012/14_Jeffery_Watts_State_of_Antibiotic_Development.pdf
[6] http://www.tufts.edu/med/apua/news/news-newsletter-vol-30-no-1-2.shtml
[7] http://news.sciencemag.org/biology/2014/11/after-election-2014-21st-century-cures
[8] http://www.who.int/bulletin/volumes/89/2/11-030211/en/
[10] http://www.healthline.com/health/antibiotics/why-pipeline-running-dry
[11] http://www.medscape.com/viewarticle/825678
[12] http://www.medscape.com/viewarticle/827168
[13] http://www.nature.com/nature/journal/vaop/ncurrent/full/nature14098.html
[14] http://medicalxpress.com/news/2015-01-antibiotics-superbugs-hard.html
