A New Antibiotic and the evolution of Resistance

Since their discovery, antibiotics have served as a vehicle for medical and human advancement.  There are medical procedures now performed that would be entirely ineffective or even outrageous without the effects of antibiotics.  The effects of antibiotics have largely infiltrated many parts of our lives, as we are practically ensured protection from infection. Despite the miracles performed by antibiotics in the past, antibiotic resistant infections are now killing more lives than the current epidemics of the globe. These epidemics include HIV in America and Ebola. By the year 2050 the cumulative healthcare costs of these resistant infections will total over 100 trillion dollars to the global economy. That will occur only if we continue down the current path of resistance we are experiencing.  There have been decreased incentives for pharmaceutical companies to produce new antibiotics as lead discovery costs are now around a million dollars, with a very low compound advancement. Investment efforts are allocated elsewhere.

Despite this decreased incentive for development, new technologies and approaches are aiding in the arms race against resistance. Researcher Ling et al. has been using novel culturing techniques through an isolation chip process to identify new antimicrobial compounds.  Through this process he has discovered a compound called teixobactin. This compound is produced by the bacterium Eleftheria terrae, which inhibits the growth of Staphylococcus aureus. The compound is shown to be highly effective against gram negative pathogens, particularly tuberculosis.  However despite advancements in clinical trials, it may take years before a commercial product.

It appears as though another promising antibiotic has been found. But what is more important is understanding the challenges we face in this arms race with evolution. Our current understanding of the cell tells us that this antibiotic targets an irreplaceable component of the cell, and this drug should be effective for years to come.  However, we have already learned this lesson through vancomycin, as we previously thought that cells would not be able to adapt to overcome its inhibitory effect through its critical target area. After the large use however, as one could predict, cells became resistant.  For now, we must utilize our advances as they come to combat infection and save lives.

N Engl J Med 2015; 372:1168-1170March 19, 2015

http://www.nejm.org/doi/full/10.1056/NEJMcibr1500292

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