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Antimicrobial Resistance 2020

How to change the fight against AMR?

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Deborah O’Neil

Board Member, BEAM Alliance

Novel interventions to stem the rising tide of AMR are urgently needed. SMEs are the innovation engine in this field.

A multi-directional approach is critical to win the war against antimicrobial resistance (AMR). SMEs are developing interventions that tackle AMR in six different areas to meet patients’ requirements1.

Diversifying the field of fight against AMR

The first requirement is to avoid infection. This can be done through vaccination, restoration and maintenance of optimal immune function, highly specific weapons that prevent or correct dysbiosis and a ‘breach’ of the microbiota by pathogenic microbes.

Accurate and rapid diagnosis of bacterial pathogens is the second requirement, so that the appropriate antimicrobial therapy can be administered at the earliest opportunity. This will avoid empirical treatment and its consequent risks of resistance wherever possible.

Limiting the pathogen’s ability to develop or spread resistance is the fifth requirement and is critical in putting the brakes on the AMR juggernaut.

Thirdly, the cure of an established infection is sought through direct inhibition or killing of the causative pathogen. Novel strategies can complement the approach. They aim at increasing the speed to cure and minimising antibiotic exposure time, re-arming the immune system or dismantling the very specific resistance or tolerance mechanisms.

Protecting the body from tissue or microbiota damage because of infection is the fourth requirement and is key to avoiding further, potentially long-term medical complications of infectious disease.

Limiting the pathogen’s ability to develop or spread resistance is the fifth requirement and is critical in putting the brakes on the AMR juggernaut.

Finally, blocking the spreading ability of the pathogen itself helps to break the dynamics of contamination at a community level.  

Market and regulation: the missing link in the evolution of AMR fight

However, this promising landscape of SME generated solutions to AMR faces a paradox. Diversity and novelty in antimicrobial approaches is critical in changing the trajectory of AMR. But current evaluation methods (e.g. Minimum Inhibitory Concentration) are unable to demonstrate any benefit outside the killing/inhibiting effect and in turn, the potential monetary and societal value of these next-gen antimicrobial interventions. New evaluation methods are needed.

Furthermore, the AMR field has been ‘tarnished’ somewhat by previous market failures of antibiotic companies; failures that are not directly relevant to the business model and case for next-gen SME-created interventions now in the pipeline, but nonetheless for the time-being, still jeopardise the chances of commercial success for SMEs. These problems must be solved.

Infectious disease is a rapidly evolving field. Since pathogens are evolving and develop resistance, SMEs have also evolved and changed their way of thinking, creating new approaches to disarm those resistance. The regulatory and financial framework must now catch up to enable the potentially game-changing products developed by SMEs to reach patients.

1 This categorisation work was run by the VeRI BEAM Network, funded through a JPIAMR-VRI Network Call. For more information about JPIAMR and AMR research, please visit:

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