Ricardo Chaves, M.D.
Executive Medical Director, Infectious Diseases, at biopharmaceutical company, Debiopharm
While currently available antibiotics fight infection, they have side effects, including the emergence of antimicrobial resistance(AMR). Pathogen-specific antibiotics may represent a new paradigm to combat AMR.
The development of antibiotics was one of the most life-saving medical interventions in history, agrees Ricardo Chaves, M.D., Executive Medical Director, Infectious Diseases, at biopharmaceutical company Debiopharm in Switzerland.
Targeted antibiotics
While broad-spectrum antibiotics kill a range of pathogens causing infection, these drugs are — by nature — untargeted. Meaning, they can disrupt the finely balanced gut microbiome — a complex community of microorganisms that provides a wealth of essential functions for healthy living and protects us from disease.
“This means that broad-spectrum antibiotics can facilitate certain infections,” says Dr Chaves. For example, the use of antibiotics is associated with Clostridioides difficile colitis (inflammation of the large intestine) following destabilisation of the normal healthy bacterial population of the gut.
Broad-spectrum antibiotics can also lead to selection and overgrowth of antibiotic-resistant organisms that are difficult to treat. To curb the emergence of AMR, Dr Chaves believes in restricting the use of antibiotics that harm the microbiome. He calls for a paradigm shift in antibiotic research, to focus on developing pathogen-specific antibiotics that have a low ecological impact — and can be used for common infections without harm.
Rapid microbiological diagnosis is key for the use of these drugs.
Pathogen-specific antibiotic solution
The use of broad-spectrum antibiotics is vital in some cases, admits Dr Chaves. “ If a patient has sepsis, and the causing pathogen is unknown, broad-spectrum antibiotics need to be administered quickly, otherwise the result could be fatal.”
“But in cases where the cause of infection is known, it’s important to spare the microbiome and administer narrow-spectrum — ideally, pathogen-specific — antibiotics, for patient health and to prevent AMR development. Rapid microbiological diagnosis is key for the use of these drugs.”
Pathogen-specific antibiotics do as their name suggests: target individual disease-causing organisms — while preserving the microbiome. Dr Chaves says that this ‘one drug for one bug’ approach is an exciting innovation; currently, there is no approved pathogen-specific antibiotic, but they are in development. He believes that pathogen-specific antibiotics will be approved within the next few years, and regulators should now lay the ground for approval including assessments of microbiome endpoints in clinical trials.
Two problems solved
For its part, Debiopharm is developing a novel class of pathogen-specific antibiotics, called FabI inhibitors, to treat Staphylococcus spp, Neisseria gonorrhoeae and Acinetobacter baumannii, including multi-resistant strains.
“If we imagine a future where multiple pathogen-specific therapies exist, all common infections would be treatable — and AMR would be preventable,” says Dr Chaves. “We could be solving two different problems at once.”
