Will the World Eventually Run out of Effective Antibiotics?

Check out this answer from Consensus:

The world is facing a critical shortage of effective antibiotics due to the slow pace of new antibiotic development and the rapid emergence of antibiotic resistance. To address this, a concerted global effort involving significant investments, comprehensive policies, and integrated measures across human, animal, and environmental sectors is essential. Without such efforts, the efficacy of antibiotics will continue to decline, posing a severe threat to public health.

The global rise of antibiotic resistance poses a significant threat to public health, as the effectiveness of existing antibiotics diminishes. This issue is exacerbated by the slow pace of new antibiotic development, raising concerns about whether the world will eventually run out of effective antibiotics.

Key Insights

• Decline in New Antibiotic Classes:
  • Since 1962, only two new classes of antibiotics have been marketed, compared to over 20 new classes between 1940 and 19621 3.
  • The current antibiotic pipeline includes 27 compounds in clinical development, but only two are new classes, both in early Phase I trials1.
• Antibiotic Resistance and Food Production:
  • The use of antibiotics in food animals contributes significantly to the global challenge of antibiotic resistance2.
  • Antibiotic-resistant bacteria from food animals can spread to humans, highlighting the need for integrated measures to combat this issue2.
• Need for Comprehensive Measures:
  • Multifaceted and integrated measures, following the One Health approach, are essential to curb the emergence and spread of antibiotic resistance2.
  • National action plans should encompass human, animal, and environmental sectors to improve policies and interventions2.
• Challenges in Antibiotic Development:
  • High attrition rates in early clinical development and regulatory hurdles make it unlikely that new antibiotic classes will be marketed soon1.
  • Past failures in discovering new molecules highlight the need for significant investments and incentives to fund antibiotic discovery3.

Will the world eventually run out of effective antibiotics?

Mark Blaskovich has answered Likely

An expert from University of Queensland in Chemistry, Biotechnology

Unless we fix the economic model for developing new antibiotics, there will soon be no companies left to develop new antibiotics. Almost all major pharma companies have shut down their discovery programs, with Novartis (one of the few remaining) exiting earlier this year. Two smaller biotech companies (supposedly the future of antibiotic research) just got antibiotics approved, but are now facing severe financial difficulties (Achaogen and Melinta). Completely new types of antibiotics are very hard to discover, and even more difficult to progress through to an approved drug. There less than 50 antibiotics in the clinical pipeline (https://www.pewtrusts.org/en/research-and-analysis/data-visualizations/2014/antibiotics-currently-in-clinical-development), compared to >800 oncology drugs.

Will the world eventually run out of effective antibiotics?

Daniel Elad has answered Unlikely

An expert from The Hebrew University of Jerusalem in Veterinary Science, Bacteriology, Mycology

The answer is very complex and has to take into consideration several aspects. Here are some:

1. The economic aspect has already been discussed here. Interestingly, while the development of new antibacterial drug groups has mostly stagnated, new antimycotic drugs keep appearing and additional ones in various development stages. This, in spite of the latter being probably in lower demand. Another, future, factor may be incentives/subsidies from the regulatory authorities to promote the development of new antibacterial drugs in case of impending catastrophes (might be too late though).
2. Discovering/producing new antibiotics: several recent trends have made these procedures less expensive. Among these the introduction of new screening methods, (meta)genomic approaches and redirecting existing drugs used for other ailments and thus already approved for use, some of which have been found to have antibacterial activity.
3. Activity: current antibacterial drugs have relatively “coarse” targets such as ribosomes, cell wall etc. It has been hoped for a long time that advances in molecular genetics will result in more specific targets at the genome level thus increasing their variety. This has not materialized so far but it may still happen in the future.
4. Anti-resistance combinations. A new phenomenon that has been reported in the last years is the identification of compounds that reverse bacterial resistance.
5. Another problem with antibiotics is their interaction with the microbiome. Antibiotics (even the narrow spectrum ones) will act on a variety of bacteria thus often promoting severe and even life threatening infections. On the other hand, resident bacteria unrelated to the infection may inactivate the drugs. Moreover, these interactions vary between patients and so does the treatment outcome. Further discoveries involving the microbiome and its characterization at the individual patient may contribute to antibiotic therapy rationalization.
6. Drug withdrawal: The abuse of antibiotic use in hospitals, the community and agriculture is the central factor for resistance emergence. Consequently, restrictive antibiotic drug use policies have been enacted in different countries, aimed at limiting the insurgence of resistance and the reduction of the selective pressure. However, when an antibiotic drug is withdrawn several possibilities exist: the resistant bacterium is energetically inferior to the wild type if there in no selective pressure and will disappear or it will develop compensatory mutations making it as fit as the wild type or more in which case it will survive and thus resistant strains will reemerge as soon as antibiotics are reintroduced. Thus the results of these policies have not always been as expected.

So, yes, we may eventually run out of new antibiotics but till then there are a many, still untapped, options that make this scenario unlikely in the foreseeable future.

Will the world eventually run out of effective antibiotics?

Divya Ramnath has answered Likely

An expert from University of Queensland in Molecular Biology, Hepatology, Infectious diseases

This is quite likely as many companies no longer support new antibiotics development, and bacteria are evolving to be resistant to many of the existing antibiotics.

Will the world eventually run out of effective antibiotics?

Rafael Franco has answered Extremely Unlikely

An expert from Universitat de Barcelona in Parkinson’s Disease, Alzheimer’s Disease, Antioxidants, Nutrition, Pharmacology, Asthma, Cell Biology, Biochemistry

This to me is, if you allow me the word: bullshit and we, scientists, are “creating” this (to me) false idea. Now in Spain you cannot buy any antibiotic in a pharmacy unless you have a prescription from a doctor.

Classical antibiotics are safe and IF CORRECTLY ADMINISTERED for 7/8 days they will not introduce any resistance.

Resistances are more likely to be introduced by new generation antibiotics if, again, not correctly administered for 7/8 days.

It is my belief that reluctance to prescribe antibiotics (soft/classical ones) is to say the lest, very questionable. On the one hand, there are doctors that tell to carry children to them every day to “see” if he/she needs antibiotics. This makes no sense (to me). Also, not everybody can go every day to the doctor.

On the other hand, I would like (really like) to know the figures about more/less pulmonary infections needing to go to emergency rooms and needing Hospital stays versus cases 5-10 years ago (even comparison of the number of deaths due to pulmonary infection). My hypothesis, if there are more % of cases/deaths now, is that the problem is not resistance but delay in administering the antibiotic(s)

Will the world eventually run out of effective antibiotics?

Graham Lappin has answered Uncertain

An expert from University of Lincoln in Pharmacology, Drug Use, Toxicology, Biochemistry, Nutrition

If nothing changes then antibiotics are likely to become ineffective over time as microorganisms become resistant. The World Health Organisation (WHO) is indeed very concerned: https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance

As others have said in the replies, part of the problem is the financial incentives for pharmaceutical companies to discover and develop new antibiotics. Some blame the pharma industry for their lack of interest in antibiotics, which has some truth but on the other hand, like any business, they are not inclined to follow unprofitable routes. I have had some role in drug development and in my experience three things need to happen to head off a situation where we have no, or very few effective antibiotics. 1) Governments need to invest in, or to change the financial incentives for pharma, 2) small outfits such as SMEs or academia need to take innovative approaches to discovering new antibiotics along with the availability of appropriate research funding and 3) prescribing regimens have to change to limit antibiotic use to cases where they are genuinely required. All three require a co-ordinated and concerted world-wide effort. Not to be too persimistic as some changes are happening, the question is are they enough? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5746591/

Running out of antibiotics is not inevitable, it is a problem that can be solved with the right approaches, it more a matter of political will – the WHO again: https://www.who.int/bulletin/volumes/89/3/11-030311/en/

Will the world eventually run out of effective antibiotics?

Jerry Tsang has answered Likely

An expert from Edinburgh University in Medicine, Biological Materials, Anatomy, Microbiology

A review led by Lord O’Neill in 2014 outlined the extent of the issue (O’Neill et al 2014).

No new classes of antibiotics have been discovered since the 1980s. Current prescribing practices and the lack of regulation in both the clinical and the veterinary medical sectors have been shown to be driving the development of antimicrobial resistance. In addition the current payment system for pharmaceutical companies actively discourages investment in the development of new antibiotics, diagnostics, vaccines and other alternative antimicrobial treatments.

The WHO estimates that ~10 million deaths per year will be caused by antimicrobial resistance. However this estimate is based on imprecise assumptions and represents, at best, a “ballpark” figure (de Kraker et al 2016).

In order to avoid the doomsday scenario outlined in the question both aspects of the problem must be addressed

Will the world eventually run out of effective antibiotics?

Joel Herring has answered Likely

An expert from Queensland University of Technology in Chemistry, Organic Chemistry

The proliferation of antibiotic resistance coupled with the decline in current and emerging pharma companies producing new antibiotics makes for a grim future.