The need to incentivise antibiotic research | Letters
David Cox reports on the "war on bugs" and development of "superantibiotics" (23 October). A blunderbuss is effective against the enemy, but what of the collateral damage? We humans contain more bacteria than human cells - our microbiome - which are key for many aspects of health. A more modern approach is to identify precisely the bacteria responsible for a disease, and use a narrow-spectrum antibiotic to target it. A neat example of the pitfalls of killing too wide a range of bacteria is provided by vancomycin, mentioned in the article, which is used to treat Clostridium difficile-associated diarrhoea. Unfortunately, it also kills the normal bacteria in the bowel, leaving a vacuum into which C difficile can recur, and studies have now shown vancomycin to be less effective than more targeted antibiotics in preventing recurrence.
The current commercial landscape does not favour development of new antibiotics. Efforts, such as those discussed at the G20 in Hamburg, are being made to change this with "push and pull mechanisms" to create incentives for innovation. History shows that thoughtful governmental action can make development of new drugs for small patient populations viable: the Orphan Drug Act, signed into law in the US in 1984 and replicated in the EU, was followed by a rush of new drug approvals for rare diseases. This can incentivise the pharmaceutical industry in efforts to discover new antibiotics that can be deployed with precision and offer superior benefits over current medicines.
Prof David Roblin
President of R&D, Summit Therapeutics