A handful of alternatives to antibiotics - such as treatments
and preventative measures based on live microorganisms or
'probiotics' - have the potential to combat bacterial infections in
the next decade, but they are unlikely to replace traditional
antibiotics.
A new report assesses whether alternatives to antibiotics could
contribute to controlling the rise of drug-resistant infections,
one of the greatest global public health threats of our time.
The findings strongly suggest that alternatives will not be a
solution to the problem of drug-resistant infections in the
immediate future. Traditional antibiotics continue to be the best
way of fighting bacterial infection, and we must do all we can to
preserve the effectiveness of existing antibiotics and invent new
ones.
Probiotics are the only alternative treatment likely to receive
product approval in the next decade, although they will only be
able to treat very specific infections. Unlike popular probiotics
regularly taken by healthy people, these would be probiotic
treatments specifically tailored for people with defined conditions
and available only with medical oversight.
Other possible alternative therapeutics are progressing more
slowly. Along with vaccines, probiotics are also expected to have a
role in the prevention of infections.
The authors of the independent report, commissioned by the
Wellcome Trust and co-funded by the Department of Health, consulted
a wide range of experts who identified novel non-antibiotic
approaches that will most likely deliver new options for the
treatment and prevention of infections within the next 10
years.
The report makes a conservative estimate that £1.5 billion is
needed over the next 10 years to develop the key alternatives to
antibiotics and demonstrate their clinical efficacy. The cost of
alternatives is a small part of a much bigger effort that is needed
from international governments and funders to tackle drug-resistant
infections, which includes developing new diagnostics, refreshing
the pipeline for traditional antibiotics and international policy
changes.
The report focusses on substitutes to antibiotic compounds that
target either the bacteria themselves or the host organism. The
authors reviewed agents that could be taken orally, by inhalation
or by injection to treat invasive bacterial infections.
Nineteen alternatives to antibiotics were identified that are
actively being progressed, several in Phase II or Phase III trials.
The most advanced novel therapies are probiotic-based treatments
for Clostridium difficile, a common cause of diarrhoea, for which
the report estimates there will be product approval within the next
decade. This treatment uses live bacteria that benefit the
digestive system to tackle the C. difficile infection.
The most advanced preventative alternatives include probiotics
for prevention of C. difficile infection and novel antibodies for
prevention of bacterial infections caused by the bacteria
Staphylococcus aureus and Pseudomonas aeruginosa.
Other potential alternatives to antibiotics, either treatments
or prevention strategies, are progressing more slowly and include
bacteriophages (viruses that infect and kill bacteria) and lysins
(enzymes produced by bacteriophages that digest the cell wall of
bacteria). While both have potential to replace the use of some
antibiotics, the therapies may be limited to targeting only one
bacterial species at a time.
Antibiotic 'enhancers', which use alternative therapies in
combination with antibiotics, could also be useful to improve
treatment, but insufficient research makes development less likely
in the near term.
Dr Lloyd Czaplewski, Director of Abgentis Limited and co-author
of the report said, "We are at the end of a 70-year era of
life-saving antibiotics being readily available, and we are now
faced with a generational challenge. The search for new antibiotics
and alternatives to antibiotics needs to be on the same scale as
other international endeavours in science, like CERN and the
Francis Crick Institute. It is vitally important that the global
community commits to developing new therapies in the next decade
and beyond."
Dr Mike Turner, Head of Infection and Immunobiology at the
Wellcome Trust said, "Drug-resistant infections are one of the
greatest threats to our health, and with limited antibiotics
available we must find effective solutions rapidly. Some
alternative therapies look promising and may contribute to
addressing the problem in the longer term. This report clearly
shows however, that conventional antibiotics will still be
necessary. Our current cost estimates may be conservative given the
scale of the problem, and levels of funding are likely to have a
significant impact on global response."
The report, Alternatives to antibiotics: a pipeline portfolio review, is
published in The Lancet Infectious Diseases.