Infection therapy: the problem of drug resistance – and possible solutions

Abstract

SummaryThe rising antibiotic resistance in major bacterial pathogens together with the breakdown of the antibiotic discovery platform creates a critical situation for infection therapy. Recent developments reviving new antibiotic discovery from defining chemical rules for membrane‐passing compounds to isolation chips for soil bacteria and exploring the human microbiome for antibiotic‐producing bacteria are discussed. The potential of bacteriocins, tailocins, phage lysins, phages, probiotics and commensal blends as alternatives to antibiotics is evaluated.

The urgent need for microbiology literacy in society

“…Thus, we have on one hand microbiologists, who have little influence on policy decisions at any level, and on the other policy makers and decision takers who lack key knowledge essential for informed decisions. How will we effectively address crises facing us, if neither the underlying causes of the crises nor potential solutions (e.g., Brüssow, ) can be understood and assessed by policy makers and stakeholders?…”

The DIY Digital Medical Centre

“…(i) microbial biosensors for diagnosis, monitoring and epidemiology (Chang et al, 2017), (ii) nutritional therapy for persistent diarrhoea (Sarker et al, 2017), (iii) new therapeutic strategies for treatment of infections caused by drug-resistant microbes (Br€ ussow, 2017;Wong and Santiago, 2017) and recurrent infections by persister cells and biofilms (Wood, 2017), (iv) the use of designed bacteria to deliver therapeutics (Alvarez and Fernandez, 2017), (v) use of metal-based antimicrobials (Turner, 2017), (vi) microbiome therapies (Cryan, 2017;O'Toole and Paoli, 2017;Osman, 2017), (vii) use of synbiotics (synergistic combinations of prebiotics and probiotics) in prevention and therapy (Gurry, 2017), (viii) tumour-targeting bacteria-based cancer therapies (Felgner et al, 2017), and (ix) the use of microbial treatment of clinical environment surfaces to reduce drug-resistant pathogen burdens (Caselli, 2017) The BKH is thus a crucial motor of medical advancement and its translation into clinical practice. It will also counteract the current trend in expertise fragmentation and lead to more holistic assessments of patient symptoms, and result in the replacement of linear sequential trial-and-error decision tree treatment schedules, based on patient responses to conventional practice drugs, by treatment schedules based on comprehensive exploration of the multidimensional space of personalized medicine that considers patient genomics/microbiome/ physiology/health status/lifestyle, and all available intervention options and their predicted consequences for different individuals.…”

“… microbial biosensors for diagnosis, monitoring and epidemiology (Chang et al ., ), nutritional therapy for persistent diarrhoea (Sarker et al ., ), new therapeutic strategies for treatment of infections caused by drug‐resistant microbes (Brüssow, ; Wong and Santiago, ) and recurrent infections by persister cells and biofilms (Wood, ), the use of designed bacteria to deliver therapeutics (Alvarez and Fernandez, ), use of metal‐based antimicrobials (Turner, ), microbiome therapies (Cryan, ; O'Toole and Paoli, ; Osman, ), use of synbiotics (synergistic combinations of prebiotics and probiotics) in prevention and therapy (Gurry, ), tumour‐targeting bacteria‐based cancer therapies (Felgner et al ., ), and the use of microbial treatment of clinical environment surfaces to reduce drug‐resistant pathogen burdens (Caselli, ) …”

Commentary to “Patients not patents: drug research and development as a public enterprise”

“…Newer antimicrobials and newer modalities for controlling the microbes are indeed coming up slowly but steadily …”

“…Newer antimicrobials and newer modalities for controlling the microbes are indeed coming up slowly but steadily. 5,6 The phrase "the industry tends to focus on drugs to treat chronic conditions that affect many people" appears to contradict the analysis by Downing et al, 4 which reveals that around half of the newer molecules (47.6%) approved between 2005 and 2012 were for acute and intermediate disease conditions.…”