Margaret Riley, a molecular biologist at the University of Massachusetts Amherst, tried and failed for 15 years to find funding to study and develop a new antibiotic for urinary tract infections caused by the insertion of a catheter -- an affliction suffered by 1 million people per year who typically contract it while admitted to U.S. hospitals. She approached the National Institutes of Health and pharmaceutical companies, to no avail.
Recently, though, Riley was contacted by Xiao-Qing Qiu, a researcher with Pheromonicin Biotech Ltd. in China, who asked if she was interested in collaborating with his lab, which, she says, has received financial support from the Chinese government to develop novel antibiotics. Riley now plans to develop her drug there instead of in the U.S. “I want to solve the problem and if I have to fly to Beijing to do my animal trials, that's what I'll have to do,” she says.
Antibiotics -- the primary weapons against harmful bacteria like those that cause strep throats or staph infections -- have become less effective in recent years as the bacteria that they attack morph into "superbugs": new strains that are resistant to many prescriptions. But neither the U.S. government nor pharmaceutical companies have seemed to care much about developing new antibiotics or warding off resistance.
Now the Obama administration has pledged a major investment of $1.2 billion across a half-dozen agencies to classify and monitor antibiotic-resistant bacteria, discover new antibiotics and improve the methods by which doctors prescribe them. “I think it's phenomenal and long overdue,” Riley says. The biggest chunk of the money allotted to the effort as part of the 2016 budget proposal -- nearly $1 billion -- will go to the Department of Health and Human Services, which will effectively double the agency’s funding from 2015.
“I think for many decades, the assumption was always that one way or another, new antibiotics would be discovered and we didn't have to worry that much about resistance because there would always be another bullet in the belt,” Joe Guglielmo, dean of the school of pharmacy at the University of California, San Francisco, says.
Meanwhile, antibiotic-resistant bacteria cause 2 million illnesses and 23,000 deaths a year in the U.S., according to the Centers for Disease Control and Prevention. Riley says that’s a very conservative estimate and that the real number of deaths is likely double or triple that number. The economic price is high, too -- as much as $20 billion a year in health care costs and $35 billion in lost productivity due to people staying home from work.
Even the antibiotics that doctors do employ use a "shotgun approach" that targets healthy as well as harmful bacteria, Chris Butler, a physician and professor of medicine at the University of Oxford, says. Part of the administration's aim with the new funding is to help researchers look for antibiotics that are engineered to kill only foreign bacteria instead of also attacking the beneficial microbes within a person’s body. The all-or-nothing nature of today’s antibiotics can cause more harm than good -- especially for children who take antibiotics while young and may sustain long-term damage to their microbiome.
Another longtime hurdle to progress is a fundamental lack of information that still plagues the field even though the first antibiotic -- penicillin -- was discovered in 1928. “We’re at the tip of the iceberg in understanding how many antibiotic-resistant genes there are and what they are,” Riley says. Beth Bell, director for the National Center for Emerging and Zoonotic Infectious Diseases at the CDC, adds that right now, her agency analyzes only about 10 percent of the strains of salmonella, a common culprit of foodborne illnesses, that are reported in the U.S. With the $280 million that Obama plans to grant to the CDC, administrators would establish regional centers that could analyze 100 percent of salmonella cases.
Until these bacteria are better understood, physicians will struggle to prescribe antibiotics most effectively. It's often difficult for physicians to determine which strains of problematic bacteria a patient possesses during a routine visit. “We need the sort of basic diagnostics to help us say, this patient sitting in front of me now will benefit from antibiotics but I can safely withhold antibiotics from another patient,” Butler says. Obama’s budget proposal also grants more than $100 million to develop new therapies and diagnostics.
Aside from finding new antibiotics and filling in knowledge gaps, the administration is also taking aim at a lesser-known problem. Studies have shown that doctors are in the habit of offering antibiotics to patients for viral infections like a cold, which these drugs don't cure. Jeffrey Linder, a professor at Harvard Medical School and a physician at Brigham and Women’s Hospital in Boston, once found that about 5 percent more patients with an acute respiratory infection will receive a prescription for an antibiotic, which can't treat these infections, during an appointment in the fourth hour of a doctor’s shift than in the first hour. Linder attributes this to physician fatigue. If doctors prescribed more appropriately and decreased the number of antibiotics in circulation, bacteria would become resistant at a far slower rate -- and their patients would avoid potential side effects and developing resistance to a medicine that they may someday really need.
With the additional millions in funding, Bell says the CDC would set up a nationwide reporting system for antibiotic use in hospitals, establish national standards and possibly offer financial incentives to hospitals for reducing antibiotic use that would be tied to the Centers of Medicare and Medicaid Services.
Overall, researchers are delighted to see that Obama's budget proposal includes what they consider a comprehensive and science-based approach to antibiotic resistance -- even if it’s a bit overdue. “It's already translated into new opportunities,” Riley says. “There's been new attention on novel approaches to antibiotics."