Antibiotic resistance is one of the greatest challenges facing modern medicine. The phenomenon occurs when microbes become resistant to antibiotics; the drugs often used to treat bacterial infections. Any exposure to antibiotics selects for the survival of bacteria which possess resistance genes – those which survive can then go on to infect others, allowing the gene which confers resistance to be passed on.
The problem has partly arisen through the misuse of antibiotics over the years. Since the drugs became widely prescribed in the 1940s, a number of common issues have led to widespread resistance. Firstly, antibiotics were often prescribed for diseases that they are completely useless in fighting against, for instance the common cold which is caused by viruses. Additionally, failure of patients to comply with the protocol for taking antibiotics has contributed significantly to the issue of antibiotic resistance. It is important that those prescribed antibiotics complete the full course of medication, in order to ensure the infection has been cleared. However a common problem has been people failing to complete the course because they begin to feel better – though often the infection of bacteria persists after the patient stops showing clinical signs of illness. In this way, the “strongest” bacteria with the genes for resistance survive, and are more likely to be more virulent and thereby spread.
Subsequently, many early antibiotics are no longer effective against diseases, because the bacteria have become resistant to the drug. So why can’t pharmaceutical companies just develop some new antibiotics, which the bacteria are not resistant to?
An important reason why drug companies do not focus efforts on antibiotics is that they are not financially viable to develop. Drugs take many years to pass through the rigorous pharmaceutical system – it can often take over 15 years for an initial idea for a medicine to reach the market. Furthermore, the majority of projects which enter development do not become a product, either because they are found not to work, or to cause dangerous side effects.
Each drug which fails to make it through the development process costs a pharmaceutical company many millions of pounds. So those which do make it to market have to allow the company to make significant financial gains, in order to allow them to put more money in to future drug development projects. This can be done through charging high prices for products, but the drugs themselves must also be in demand, and be required for long periods of time. A cancer drug, for example, is often a good investment for a pharmaceutical company to develop, as the drug will need to be taken by the patient over an extended period of time, meaning a large amount will have to be purchased.
The problem with antibiotics is that they do not fulfil this criteria. An antibiotic, as opposed to a drug for a long lasting affliction such as cancer, heart conditions or Multiple Sclerosis, is a comparatively “quick fix”. Antibiotics only need to be taken for short periods of time, and are therefore unlikely to earn the same financial rewards as other medicines. Added to that the risk of failed development and the dangers of trialling strong new antibiotics, and it is easy to see why drug companies generally choose to pursue less risky options.
In the future, it may be necessary for antibiotic development to be partially funded by the government or Health Service, in order to provide pharmaceutical companies with more incentive to attempt their progression. However, it is important that the problem is discussed and for us to act quickly. It may take many years for successful new antibiotics to be available, and the problem of resistance will not be diminishing any time soon.