Nature: editorial
A three-step plan for antibiotics
If the threat of antibiotic resistance is to be managed, existing drugs must be marshalled more effectively and new medicines must get to market fast.
27 May 2014
If the first step towards solving a problem is to acknowledge its existence, then some important progress has been made on the thorny issue of antibiotic resistance. Last July,
Nature noted approvingly a “notable rise in awareness among policy-makers and the public” on the issue and credited the advocacy of scientists for the surge (see
Nature 499, 379; 2013). That rise has continued, but with increased public and political awareness comes a greater demand for action. Much of that heavy expectation will fall on scientists. So, after the advocacy, how can the antibiotic-resistance threat be countered?
...
...Doctors and others who routinely overprescribe antibiotics for everything from sore throats to bronchitis need clear and explicit instructions from the top to stop. Medical schools that do not drum into their trainees the importance of prudence must start to do so.
It is not enough for doctors to urge their patients to finish the prescribed course when they are dishing out the pills with such abandon.
A study published in the
Journal of the American Medical Association last week showed that despite guidelines that veto such use of antibiotics for acute bronchitis and decades of research showing no benefit, the number of antibiotic prescriptions for this indication rose in the United States from 1996 to 2010 (
M. L. Barnett and J. A. Linder J. Am. Med. Assoc. 311, 2020–2022; 2014).
Over-the-counter sales of antibiotics must be banned. The countries that allow it are squandering a precious resource as surely as if they were tipping oil down the toilet.
Regional regulations that limit the use of antibiotics to speed up the growth of livestock should extend worldwide.
Public education — both to restrict the waste of antibiotics and to build support for measures to restrict unnecessary use — is vital.
These are low-hanging fruit and they must be picked with all possible urgency. They need top-down political action, and that means governments.
Cross-party consensus should be explicitly hammered out and publicized — there is no equivalent of Big Oil or Big Tobacco in this debate to delay and obfuscate...
...
Research can improve diagnosis too, to both speed up treatment of patients and minimize the waste of ineffective drugs. As a Comment article on
page 557 points out, genome sequencing of infectious bacteria can rapidly identify resistance genes.
So samples from an infected patient — analysed in clinical microbiology labs as close to point of care as possible — could steer drug treatment, at least in the developed world.
Mass spectrometry was introduced for clinical use in this way a few years ago, it notes, and is now commonly used to identify pathogens from signature microbial peptides. Such a rapid front-line diagnostic kit to improve antibiotic use is one of the six major challenges identified by the UK government in its new Longitude Prize, intended to boost innovation...
...
We have come a long way in a year. But the real work starts now.
