How to avert an antibiotic apocalypse: We need more than new drugs alone

Forbes magazine ran a story recently entitled "How to avert an antibiotic apocalypse". It begins with a simple proposition:

Want to protect your kids from drug-resistant bacteria? Open your wallet. Governments and insurance companies need to commit to paying 10 or 50 times more than they already do if industry is going to put resources into fighting the threat of superbugs.

Who wouldn't agree that we need an invigorated pipeline of new, effective, and safe antimicrobial drugs to help us counter the specter of resistance? But it does make me wonder: Is it really a good idea to place new weapons in our arsenal when we have demonstrated few reasons to think that we will use them responsibly?

Of course new antimicrobial agents are desperately needed to treat infections resistant to currently available drugs, and understanding the reasons for the stalled pipeline is key to to achieving development goals. However, it seems to me that the question of whether, given our current practices and the state of research, we are doomed to repeat the past with a new set of effective drugs -- assuming they can be and are developed -- is fair game.

The problem of resistance is complex and has been reviewed several times (see, e.g., here, here, and here) but the ultimate solutions remain unclear. Almost certainly they include a combination of new antimicrobial drug and vaccine development, antibiotic stewardship, better hospital infection prevention, and management or elimination of environmental reservoirs of resistance such as those produced by large farms and wastewater treatment facilities, among others.

Hopefully, by comprehensively addressing these and related issues, we can avoid repeating the past when new drugs do appear. If we don't improve in all areas, it stands to reason that we run the risk of seeing resistance develop against new drugs, too.

(image source: Wikipedia)