title: Suppression of Emergence of Resistance in Pathogenic Bacteria: Keeping Our Powder Dry, Part 2.
abstract: We are in a crisis of bacterial resistance. For economic reasons, most pharmaceutical companies are abandoning antimicrobial discovery efforts, while, in health care itself, infection control and antibiotic stewardship programs have generally failed to prevent the spread of drug-resistant bacteria. At this point, what can be done? The first step has been taken. Governments and international bodies have declared there is a worldwide crisis in antibiotic drug resistance. As discovery efforts begin anew, what more can be done to protect newly developing agents and improve the use of new drugs to suppress resistance emergence? A neglected path has been the use of recent knowledge regarding antibiotic dosing as single agents and in combination to minimize resistance emergence, while also providing sufficient early bacterial kill. In this review, we look at the data for resistance suppression. Approaches include increasing the intensity of therapy to suppress resistant subpopulations; developing concepts of clinical breakpoints to include issues surrounding suppression of resistance; and paying attention to the duration of therapy, which is another important issue for resistance suppression. New understanding of optimizing combination therapy is of interest for difficult-to-treat pathogens like Pseudomonas aeruginosa, Acinetobacter spp., and multidrug-resistant (MDR) Enterobacteriaceae. These lessons need to be applied to our old drugs as well to preserve them and to be put into national and international antibiotic resistance strategies. As importantly, from a regulatory perspective, new chemical entities should have a resistance suppression plan at the time of regulatory review. In this way, we can make the best of our current situation and improve future prospects.
authors.affiliation: Institute for Therapeutic Innovation, University of Florida, Orlando, Florida, USA gdrusano@ufl.edu.
authors.forename: G L
authors.initials: GL
authors.lastname: Drusano
authors.affiliation: Antimicrobial Pharmacodynamics and Therapeutics, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom.
authors.forename: William
authors.initials: W
authors.lastname: Hope
authors.affiliation: Bristol Centre for Antimicrobial Research and Evaluation, Department of Microbiology, Southmead Hospital, Bristol, United Kingdom.
authors.forename: Alasdair
authors.initials: A
authors.lastname: MacGowan
authors.affiliation: Institute for Therapeutic Innovation, University of Florida, Orlando, Florida, USA.
authors.forename: Arnold
authors.initials: A
authors.lastname: Louie
mesh_terms: D000150:Acinetobacter / Q000187:drug effects / Q000472:pathogenicity; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D004359:Drug Therapy, Combination; D016972:Enterobacter cloacae / Q000187:drug effects / Q000472:pathogenicity; D004926:Escherichia coli / Q000187:drug effects / Q000472:pathogenicity; D006801:Humans; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000472:pathogenicity; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000472:pathogenicity; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000472:pathogenicity
chemical_list: D000900:Anti-Bacterial Agents