Past, Present, and Future of Antibacterial Economics: Increasing Bacterial Resistance, Limited Antibiotic Pipeline, and Societal Implications

Abstract

Growing antimicrobial resistance and a dwindling antibiotic pipeline have resulted in an emerging postantibiotic era, as patients are now dying from bacterial infections that were once treatable. The fast-paced "Golden Age" of antibiotic development that started in the 1940s has lost momentum; from the 1980s to the early 2000s, there was a 90% decline in the approval of new antibiotics as well as the discovery of few new novel classes. Many companies have shifted away from development due to scientific, regulatory, and economic hurdles that proved antibiotic development to be less attractive compared with more lucrative therapeutic areas. National and global efforts are focusing attention toward potential solutions for reinvigorating the antibiotic pipeline and include "push" incentives such as public-private partnerships and "pull" incentives such as reimbursement reform and market exclusivity. Hybrid models of incentives, global coordination among stakeholders, and the appropriate balance of antibiotic pricing, volume of drug used, and proper antimicrobial stewardship are key to maximizing efforts toward drug development to ensure access to patients in need of these therapies.

In vivo Antibacterial Activity of Green Algae Ulva reticulata against Staphylococcus aureus in Drosophila Model of Infection

“…[1][2][3][4][5] To overcome this challenge, the discovery of new antibacterial drugs with a possible novel mechanism of action is urgently required. 6,7 Unfortunately, despite the huge effort given by countless research groups and pharmaceutical companies worldwide, the rate of discovery of new effective antibiotics is progressively declining, [7][8][9] which is substantially diminishing our hope of providing a solution to this ever-growing crisis. One of the reasons for the declining in the rate of antibiotic drug discovery is the high cost of in vivo testing of antibacterial activity using mammalian model systems.…”

Identification of Asparagopsis armata‐associated bacteria and characterization of their bioactive potential

“…In fact, recent statistics pointing out that, in 2050, infectious diseases will be the first cause of death all over the world, followed by cancer (O'Neill, ). The overuse and misuse of antimicrobial drugs have resulted in a continuous rise of antimicrobial‐resistant bacteria, against which most of the known antimicrobials are no longer effective (Luepke et al., ; Penesyan, Marshall‐Jones, Holmstrom, Kjelleberg, & Egan, ). As for cancer, the occurrence of tumor resistance to the available chemotherapeutics is also a major cause of concern.…”

How externalities impact an evaluation of strategies to prevent antimicrobial resistance in health care organizations

“…In the United States, the Centers for Disease Control and Prevention has estimated that 2 million patients a year have infections due to antimicrobial resistant bacteria leading to 23,000 deaths annually [3]. One of the significant determinants of antimicrobial resistance is the selection pressure placed by the use, misuse and overuse of antimicrobials which provides a comparative advantage to the small fraction of organisms naturally resistant to the antimicrobials [4–6].…”

“…For example, the estimated annual direct and indirect costs of antimicrobial resistance is $55 billion in the United States [3]. It is also projected that by 2050, 10 million lives a year and a cumulative USD $100 trillion of economic output are at risk due to the increase in antimicrobial resistant infections [8].…”