By Cornelius J. Clancy, MD
The coronavirus infects and kills more Americans each day.
While the advice is to never take antibiotics for a virus, most patients hospitalized with COVID-19 receive antibiotics to prevent or to presumptively treat secondary bacterial or fungal pneumonia.
In fact, some patients, especially those on ventilators, aren't dying from the virus, but from other infections they contract in the hospital. According to one study, secondary infections were present in half of those who died from coronavirus.
Unfortunately, bacterial infections are growing resistant to our most powerful antibiotics. In a study published in Lancet Respiratory Medicine, most of the bacteria and fungi causing secondary infections in patients with COVID-19 were antibiotic-resistant superbugs. Patients won't win their fight against coronavirus -- or future pandemics -- until we add new and improved antibiotics to our arsenal.
Every time people take antibiotics, some bacteria may survive, multiply, and evolve to become resistant to existing treatments. Today, common bacterial infections like strep throat no longer respond to run-of-the-mill antibiotics.
Superbugs are on track to kill 10 million people annually by 2050. Already, antibiotic resistant microbes account for 700,000 deaths each year.
Unfortunately, drug companies aren't developing enough new antibiotics. Not because they don't want to, but because they can't. It doesn't make financial sense.
It costs over a billion dollars and 10 to 15 years to develop a new drug. Normally, pharmaceutical firms recoup this investment by selling large quantities of their drugs to consumers.
But antibiotics have to be used as sparingly as possible. The model that enables companies to recoup their research and development dollars on most drugs simply doesn't work.
That's why firms are shutting down antibiotic departments and shifting investments to less risky disease areas. It's been over three decades since a new class of antibiotics hit the market.
Without antibiotics to treat secondary infections, pandemics become far more deadly. Consider the Spanish flu, which killed 50 million people worldwide and took place before antibiotics were invented.
Most of these deaths can be traced to secondary bacterial pneumonia, according to a National Institute of Allergy and Infectious Disease study that examined lung tissue from 58 autopsies. The study notes that if it weren't for secondary infections most patients would have recovered and concludes that treatment of secondary bacterial pneumonia, as well as stockpiling of antibiotics should be high priorities for pandemic planning.
In a 2008 article, NAID Director Dr. Anthony Fauci confirmed that most of the millions of Spanish flu deaths were from bacteria, not the virus itself.
We're on track to repeat history.
Fortunately, there are several actions the government could take to accelerate the creation of antibiotics. The Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms (DISARM) Act would reward hospitals that appropriately prescribe antibiotics. This would stoke demand for such drugs, and thus encourage biotech firms to invest in antibiotics research and development.
Lawmakers could also offer a reward to companies that develop superbug-killing drugs. A study by Drive-AB, a project funded by the European Commission, found that "market entry rewards" offer our best shot at a robust antibiotics pipeline. Subscription plans like Netflix can also achieve similar results, since the reward to the company is the same whether we use almost no antibiotics or binge during a pandemic.
Our antibiotics arsenal is severely lacking. Without new medicines, we go into battle against superbugs defenseless.
Cornelius J. Clancy, MD is an associate professor of medicine and director of the XDR Pathogen Lab at the University of Pittsburgh. This piece originally ran in the Pittsburgh Tribune-Review.
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