Further, newly approved drugs for most other ailments are immediately prescribed, whereas new antibiotics are typically held in reserve and only prescribed for infections that more established antibiotics can’t treat. 7 Antibiotics regimens are typically administered for very limited durations making them far less profitable than drugs used to treat chronic ailments. This reduced output of antibiotics has several causes. In 2004 for example, only 1.6% of drugs in clinical development by the world’s 15 largest drug companies were antibiotics. 6Ī flagging interest in antibiotics by the pharmaceutical industry is one factor that has contributed to an increased occurrence of hard to treat bacterial infections. 5 Antimicrobials currently account for over 30% of hospital pharmacy budgets in the US. The annual impact of resistant infections is estimated to be $20 billion in excess health care costs and 8 million additional hospital days in the United States (US) 3, 4 and over 1.6€ billion and 2.5 million additional hospital days in the European Union (EU). 2 Though we are still far from that scenario becoming reality, the trend in the antibiotics field has decidedly been negative for some time now. 1 Given that the three main causes of death in pre-antibiotic America were tuberculosis, pneumonia, and gastrointestinal infections, which combined accounted for 30% of all deaths, this is a frightening prospect. This escalating evolution of resistance coupled with a diminished antibiotic pipeline has led some to claim that a post-antibiotic era is eminent. Historical perspectives, mechanisms of action and resistance, spectrum of activity, and preeminent members of each class are discussed.ģ00,000 – Pounds of streptomycin ( 24) and oxytetracycline ( 40) sprayed on produce in the US in 1996 42īacterial resistance to antibiotics has been a recognized reality almost since the dawn of the antibiotic era, but only within the past twenty years has the emergence of dangerous, resistant strains occurred with a disturbing regularity. The standings of established antibiotic classes as well as potentially emerging classes are assessed with an emphasis on molecules that have been clinically approved or are in advanced stages of development. The approaches that scientists are employing in the pursuit of new antibacterial agents are briefly described. Synchronously with the waxing of bacterial resistance there has been waning antibiotic development. Factors including economic impact, intrinsic and acquired drug resistance, morbidity and mortality rates, and means of infection are taken into account. Profiles of bacterial species that are deemed to be particularly concerning at the present time are illustrated. In this review the factors that have been linked to this phenomenon are addressed. Dangerous, antibiotic resistant bacteria have been observed with increasing frequency over the past several decades.
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