New Antibiotics on the Horizon, but More Responsible Use Needed

Scientists are making real progress in developing new antibiotics. The pharma company Roche just announced that it would begin late-stage clinical trials in the coming year for a novel antibiotic that appears to be effective against a superbug resistant to most commonly used drugs. And not long before that, researchers reported a discovery that could lead to a whole new class of antibiotic treatments. (Here’s the paper, for anyone with a Nature subscription.)

This is extraordinarily good news, because with the rapid spread of antibiotic resistance making our current treatments less effective, we desperately need alternatives to help people recover from bacterial infections.

But new antibiotics are only part of the answer, and a relatively small part at that. Far more important is the prevention of antibiotic resistance, and that comes down to better testing and more responsible use of antibiotics.

A number of technology developers are already working on better testing. The idea is simple: quickly identify which treatments will be effective against a pathogen so doctors don’t waste time giving patients an antibiotic that won’t work, or overusing the really heavy-duty antibiotics when they’re not necessary. Getting this information fast — faster than most current tests can manage — is critical for using targeted treatments most likely to cure the infection.

The bigger barrier lies in using antibiotics more carefully. That’s not something we can solve with a cool testing innovation; it can only happen with deliberate behavior change at every level, including doctors and patients.

Most people aren’t fully aware of how antibiotic resistance emerges, so let’s tackle that first. You don’t need to be a microbiologist or an infectious disease specialist to understand the basics. There are two main points to know, and everything follows from there.

First: we aren’t the only ones trying to kill bacteria, and we’re certainly not the most successful. Bacteria have been locked in battle with each other for millions of years. Within certain environments, such as our gastrointestinal tracts, many species of bacteria live in close proximity to each other, fighting for every square inch of territory they can claim. Bacteria have evolved highly effective means of killing each other. Our antibiotics typically come from the weapons developed by bacteria against each other — we spot something that works well, and commandeer it for our own medicinal needs.

The second thing worth knowing is that, despite the often-murderous nature of bacteria, these organisms share a common interest in evolving to be stronger. To that end, they have developed a remarkable mechanism known in the scientific realm as horizonal gene transfer: they can bundle up pieces of their own genomes and hand them off to other bacteria, even those that aren’t their own species. Think of it as a bacterial high-five: Hey, good to see you, here are some genes you might find interesting. Among the genes bacteria particularly love to swap are ones that make them resistant to certain compounds, including antibiotics.

So when you’ve got a bacterial infection, and you take an antibiotic, the drug sweeps through your system with the potential to affect any kind of bacteria in its path. Broad-spectrum antibiotics — often favored by doctors and given as the first treatment to many patients — are the flamethrowers of treatments. They kill virtually any type of bacteria. More targeted antibiotics might only work against certain species; they’re the fine-tuned laser. In either case, these antibiotics work against their targets as long as the bacteria aren’t already resistant. Anything that survives in your system likely has some protection against that antibiotic treatment. Later, the genes that code for that protection can be shared with other bacteria that enter your body — both the harmless colonizers and the dangerous pathogens.

Antibiotic resistance isn’t some far-off phenomenon that happens somewhere out there in the world. Each of us is essentially a walking test tube, brewing the perfect conditions to create antibiotic-resistant bacterial strains within ourselves. (Strains that we could share with other people when we get sick.)

Even though it seems intuitive to start with broad-spectrum antibiotics, that approach is encouraging the evolution of resistance among bacteria to the most powerful drugs we have. Starting with more targeted antibiotics whenever possible would help to ensure that these broad-spectrum antibiotics maintain their effectiveness against more bacteria. And avoiding antibiotics when they’re not appropriate — such as taking them when you have a viral infection — is very important too.

So let’s celebrate the good news about promising new antibiotic treatments, but also remember that each of us has a role to play in addressing the antibiotic resistance crisis. Next time your doctor suggests an antibiotic, ask: Is this really necessary, and is it the most targeted treatment we could use for this situation?