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An interesting conversation took place this week between Ezra Klein (Washington Post), Kevin Outterson (The Incidental Economist), and Megan McArdle (The Atlantic) on the emergence of drug-resistant bacterial infections (stemming from this Remapping article). 

The gist of the discussion covers two concerning trends – the climbing rates of resistant infections and the declining rates of FDA drug approvals for new antibiotics.  Kevin Outterson in particular has some interesting graphs that show what’s really happened with FDA approvals for new antibiotics – the picture is more complex than it’s often made out to be.

But not to be lost in this debate about the future of antibiotics is the fact that we still have drugs that work to treat most bacterial infections.  We are not yet faced with an imminent return to the “pre-antibiotic era.”  In addition to putting incentives in place to encourage new drug development, there are many missed opportunities to conserve the antibiotics we do have.

On a systemic level, there is evidence that antimicrobial stewardship programs are growing in the United States, as hospitals begin to focus in on resistance as a particularly problematic factor in hospital-acquired infections, which kill an estimated 99,000 Americans annually.  In a recent survey of IDSA Emerging Infections Network members, 73% reported planning or participating in a stewardship program in their hospital, up from 50% a decade ago.  Physician education interventions, particularly those that employ active education strategies, can be effective components of these antimicrobial stewardship campaigns.

Additionally, the potential role of pharmaceutical companies in stewardship is often dismissed, since there is an inherent contradiction in encouraging prudent antibiotic use AND investment in new drug development.  Restricting antibiotic prescriptions cuts into potential profits for drug companies, making antibiotics relatively less lucrative in the pharmaceutical world.  Establishing incentives for pharmaceutical companies to care about stewardship, for example by tying enhanced Medicare reimbursement to new antibiotics that meet set “effectiveness targets,” discourages overselling of drugs and aligns stewardship and R&D goals.  Read more about Aaron Kesselheim and Kevin Outterson’s research on pharmaceutical incentives for stewardship here.

Recent events – including reports of MRSA in supermarket meat and the outbreak of multi-drug resistant E. coli in German sprouts – have prompted some important debates about the future of antibiotics.  Conservation, as well as new drug development, should be front and center of this conversation.

Image credit: Flickr: Auntie P