Antibiotics under development insufficient to tackle antimicrobial resistance

Sub: Science and tech

Sec: health

WHO 2023 Report on Antibacterial Agents:

The World Health Organization (WHO) has released its latest report on antibacterial agents in preclinical and clinical development as of December 2023.
The report analyzes traditional and non-traditional antibacterial agents under development globally, addressing the current research and development (R&D) landscape to meet urgent medical needs.

Key Definitions:

Traditional Agents: Directly target bacterial components to inhibit growth or kill pathogens.
Non-Traditional Agents: Lack intrinsic antibacterial activity and work through alternative mechanisms.

Priority Pathogens:

Updated List: The analysis aligns with the updated 2024 WHO bacterial priority pathogen list (BPP).
Focus Areas: Includes drug-resistant Mycobacterium tuberculosis, Clostridioides difficile, and Helicobacter pylori.

Clinical Pipeline

Preclinical Pipeline

Current Data:

Total Agents: 97 antibacterial agents/combinations.
Traditional Agents: 57 (32 targeting WHO BPPs, 19 against M. tuberculosis, 5 against C. difficile, 1 against H. pylori).
Non-Traditional Agents: 40 (30 targeting WHO BPPs, 9 against C. difficile, 1 against H. pylori).

Comparison to 2022:

Previous Data: 80 antibacterial products (46 traditional, 34 non-traditional).
Changes: An increase in both traditional and non-traditional agents in development.

Clinical Phases: Drugs are tested in three phases to assess safety, efficacy, dosing, and interactions.

Current Data:

Total Products: 244 products targeting WHO BPPs and C. difficile.
Increase from 2022: Previously 217 products were in preclinical development.

Developer Demographics:

Small and Medium Enterprises: 95% of developers are micro, small, and medium-sized entities.
Trend: Large pharmaceutical companies have largely exited antibacterial discovery.

Investigational New Drug (IND) Phase:

Current Programmes: 62 in the IND-enabling phase (significant increase from 34 in 2022).

Challenges and Insights:

The report highlights the worsening of AMR and the slow pace of new antibacterial development.
Despite some new product authorizations, there is a lack of innovative products and challenges in patient access across all income levels.
Large pharmaceutical firms have mostly abandoned antibacterial discovery, leaving smaller entities to drive development.
Global Antibiotic Pipeline: Described as weak and fragile, underscoring the need for robust development efforts.

Antimicrobial Resistance (AMR):

AMR is the resistance acquired by any microorganism (bacteria, viruses, fungi, parasite, etc.) against antimicrobial drugs (such as antibiotics, antifungals, antivirals, antimalarials, and anthelmintics) that are used to treat infections.
As a result, standard treatments become ineffective, infections persist and may spread to others.
Microorganisms that develop antimicrobial resistance are sometimes referred to as “superbugs”.
Antimicrobial resistance is now regarded as a major threat to public health across the globe.

Reasons for Spread of AMR
Antibiotic consumption in humans	Unnecessary and injudicious use of antibiotic fixed dose combinations could lead to emergence of bacterial strains resistant to multiple antibiotics.
Social factors	Include self-medication. Access to antibiotics without prescription. Lack of knowledge about when to use antibiotics.
Cultural Activities	Mass bathing in rivers as part of religious mass gathering occasions. Antibiotic Consumption in Food Animals Antibiotics which are critical to human health are commonly used for growth promotion in poultry.
Pharmaceutical Industry Pollution	The wastewater effluents from the antibiotic manufacturing units contain a substantial amount of antibiotics, leading to contamination of rivers and lakes.
Environmental Sanitation	Untreated disposal of sewage water bodies – leading to contamination of rivers with antibiotic residues and antibiotic-resistant organisms. Infection Control Practices in Healthcare Settings A report on hand-washing practices of nurses and doctors found that only 31.8% of them washed hands after contact with patients.

Source: DTE