title: Novel approaches are needed to develop tomorrow's antibacterial therapies.
abstract: Society faces a crisis of rising antibiotic resistance even as the pipeline of new antibiotics has been drying up. Antibiotics are a public trust; every individual's use of antibiotics affects their efficacy for everyone else. As such, responses to the antibiotic crisis must take a societal perspective. The market failure of antibiotics is due to a combination of scientific challenges to discovering and developing new antibiotics, unfavorable economics, and a hostile regulatory environment. Scientific solutions include changing the way we screen for new antibiotics. More transformationally, developing new treatments that seek to disarm pathogens without killing them, or that modulate the host inflammatory response to infection, will reduce selective pressure and hence minimize resistance emergence. Economic transformation will require new business models to support antibiotic development. Finally, regulatory reform is needed so that clinical development programs are feasible, rigorous, and clinically relevant. Pulmonary and critical care specialists can have tremendous impact on the continued availability of effective antibiotics. Encouraging use of molecular diagnostic tests to allow pathogen-targeted, narrow-spectrum antibiotic therapy, using short rather than unnecessarily long course therapy, reducing inappropriate antibiotic use for probable viral infections, and reducing infection rates will help preserve the antibiotics we have for future generations.
authors.affiliation: 1 Los Angeles County-University of Southern California Medical Center, Los Angeles, California.
authors.forename: Brad
authors.initials: B
authors.lastname: Spellberg
authors.forename: John
authors.initials: J
authors.lastname: Bartlett
authors.forename: Rich
authors.initials: R
authors.lastname: Wunderink
authors.forename: David N
authors.initials: DN
authors.lastname: Gilbert
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics / Q000592:standards / Q000627:therapeutic use*; D002986:Clinical Trials as Topic / Q000191:economics / Q000331:legislation & jurisprudence* / Q000639:trends; D017277:Drug Approval / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D055808:Drug Discovery / Q000191:economics / Q000379:methods / Q000592:standards*; D004345:Drug Industry / Q000191:economics / Q000379:methods / Q000592:standards*; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D004363:Drug Utilization / Q000592:standards*; D006801:Humans; D008826:Microbial Sensitivity Tests; D014481:United States; D014486:United States Food and Drug Administration
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotic resistance; antibiotics; drug; market failure; regulations