Becker's Hospital Review

33 ANTIBIOTIC RESISTANCE & STEWARDSHIP Antibiotic combinations may boost resistance, study finds By Anuja Vaidya G iving patients multiple antibiotics is a popular strategy for treating antibiotic-resistant infections, but a study published Jan. 9 found that this method may actually be strengthening resistance, according to e Scientific American. e study, published in the journal Science, found that developing tolerance to one of the antibiotics in a combination may increase the likelihood of developing resistance to the second drug. Antibiotic tolerance indicates that the drug takes more time to kill the bacteria. Researchers studied the evolution of methicillin-resistant Staphylococcus aureus, a common healthcare-associated infection that can be lethal in patients who have the infection for more than two weeks despite being treated with antibiotics. One patient first received the antibiotic vancomycin, and aer four days another antibiotic rifampicin was added to his or her regimen. en, the vancomycin was swapped out for daptomycin. Researchers found that the microbes in the bacteria taken from the patient that had developed tolerance against vancomycin were also being eliminated more slowly by daptomycin. e rifampicin-daptomycin combination was not more effective than just using one antibiotic. e researchers showed similar development of resistance in other bacteria with other different antibiotic combinations. e study indicates that clinicians may need to laboratory test bacteria infecting their patients to determine whether it is tolerant to an antibiotic that is part of a patient's planned treatment. n Antibiotic developers are struggling to stay in business, increasing the risk of superbugs By Maia Anderson D rugmakers are finding it increasingly difficult to develop antibiotics while staying in business, but antibiotic-resistant superbugs are an escalating threat in the U.S., according to The Wall Street Journal. Superbugs kill more than 35,000 people in the U.S. each year and sicken 2.8 million, according to CDC data. Bac- teria and fungi develop mechanisms to resist older drugs, so new antibiotics are needed to protect against such threats, but drugmakers are struggling to find a viable business model that allows them to develop the antibiot- ics. Melinta Therapeutics, one of the country's largest drug- makers specializing in antibiotics, filed for bankruptcy in December, citing slow sales growth and high costs, according to the Journal. A primary reason drugmakers are struggling is because physicians aren't motivated to prescribe new antibiotics, which compete with older, cheaper ones. Antibiotics are also used more carefully now than they used to be, as physicians now know that overuse accelerates drug-resis- tant bacteria. Most antibiotic developers are also smaller companies, which have much less revenue to fund sales and market- ing costs. Small antibiotic drugmakers make up more than 90 percent of all antibiotics under development, accord- ing to the Journal. Deals such as when Merck acquired antibiotic maker Cubist for $8 billion in 2014 boosted investor interest in antibiotic companies, but most antibiotic companies have not been bought by larger companies. The U.S. government has pushed to increase antibiotic development in recent years, providing $1 billion in sup- port since 2010, according to the Journal. The DISARM Act, short for Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms, was introduced last year to have Medicare pay for certain antibiotics. The legislation would provide an immediate positive impact, Ted Schroeder, CEO of Nabriva Thera- peutics, a small antibiotics maker, told the Journal. But the bill may be stalled due to impeachment proceed- ings and the 2020 election. If it isn't passed this year, Mr. Schroeder told the Journal, "it's a pretty bleak future." n

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