Chapter 9 : The Looming Crisis in Antibiotic Availability

Abstract:

There are three responses to the antibiotic resistance problem. One is to try to educate physicians and patients about the appropriate use of antibiotics, in the hope that education programs will change the behavior of both groups. A second response would be to limit a physician’s freedom to prescribe antibiotics by placing veto power in the hands of a pharmacist or infectious disease specialist. A third response would be to step up the discovery of new antibiotics. It is true that the profitability of antibiotics is not as great as that of drugs for treating neurological diseases, heart disease, cancer, and depression. Vancomycin was hailed as the solution to methicillin-resistant Staphylococcus aureus (MRSA) infections, but vancomycin-resistant strains of S. aureus have already begun to emerge. These strains have so far been susceptible to at least one other antibiotic, but the fact that S. aureus can become resistant to vancomycin raises the specter of the future evolution of a strain that is resistant to all available antibiotics. One suggestion for encouraging the pharmaceutical companies to reenter the antibiotic discovery area is to make antibiotics “orphan drugs.” Patients who see their medical costs spiraling out of control might find this “pill” hard to swallow because it would keep drug prices higher longer, but drugs are a relatively minor component of medical costs as a whole.