Helen Boucher
MD, FIDSA, Treasurer, IDSA, Chief of Infectious Diseases, Tufts Medical Center, Director, Tufts Center for Integrated Management of Antimicrobial Resistance
Emily Spivak
MD, FIDSA, Associate Professor of Medicine in Infectious Diseases and the Medical Director of Antimicrobial Stewardship, University of Utah Health
As infectious diseases specialists we have seen first-hand the devasting impact of the COVID-19 pandemic. We are also witnesses to the frightening by-products of this insidious virus.
If nothing else the pandemic has shown the importance of investments in prevention, public health and biomedical research and plainly demonstrated the growing threat of antimicrobial resistance.
Reducing unnecessary antibiotic use that leads to antibiotic resistance and securing a healthy pipeline of novel antibiotics should be central to national and global efforts to strengthen our preparedness for future infectious diseases outbreaks.
Shortage of antibiotics
Unfortunately, current investments are failing to produce the critical antibiotics our patients need. Most large pharmaceutical companies have halted antibiotic research and development and small companies in the field struggle to remain afloat. In fact, in 2019, two small companies filed for bankruptcy despite launching new antibiotics — underscoring the need for a different approach to sustain antibiotic development.
Antibiotic stewardship programs in health care facilities have improved patient outcomes, reduced inappropriate antibiotic use and resistance and lowered health care costs.
Misuse and overuse of antibiotics
While fixing the pipeline is essential, a lack of drugs is only one piece of the antimicrobial resistance crisis. Excessive antibiotic use is responsible for accelerating the problem. Overuse and misuse of antibiotics is a significant problem that must be curtailed.
Antibiotic stewardship programs in health care facilities have improved patient outcomes, reduced inappropriate antibiotic use and resistance and lowered health care costs. They are essential to our national strategy to combat antimicrobial resistance and strengthen preparedness.
During the COVID-19 pandemic, stewardship programs played the important role of leading facility efforts to administer new COVID-19 therapeutics. Yet, antibiotic stewardship programs are vastly understaffed and lack resources to do work which is proven to reduce antibiotic use and resistance.
The future for antibiotic research and development
These problems give us cause for concern, but there are reasons for optimism. The bipartisan Pioneering Antimicrobial Subscriptions to End Upsurging Resistance (PASTEUR) Act would revitalise antibiotic research and development by changing the way the federal government pays for the most critically needed novel antibiotics. It would pay for value rather than volume through contract payments that are delinked from the use of antibiotics.
PASTEUR also provides desperately needed resources for health care facilities to strengthen stewardship programs. Supported by both parties and introduced in the House and Senate, PASTEUR is awaiting much needed congressional action.
As the COVID-19 pandemic continues to claim lives, we must not only recognise lessons learned, but act on that knowledge to protect patients and public health from infectious diseases threats, including antimicrobial resistance.