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Director of Drug Information Department of Pharmacy Tufts-New England Medical Center 750 Washington Street Boston, Massachusetts 02111-1533 fax 617/636-4567 madra{at}tufts-nemc.org
Infectious Disease Specialist Department of Pharmacy Tufts-New England Medical Center
Published Online, October 5, 2004. www.theannals.com, DOI 10.1345/aph.1D156b
Recently, the Infectious Diseases Society of America (IDSA) issued a white paper titled "Bad Bugs, No Drugs. As Antibiotic Discovery Stagnates... A Public Health Crisis Brews."3 This paper implores the government and public agencies to act before we experience a national crisis due to drug-resistant bacterial infections. The IDSA, rightfully so, identifies the pharmaceutical and biotechnology industries as "clearly suited to take the lead in developing the new antibiotics needed to treat bacterial diseases." Therefore, the report includes requests for legislative actions, administrative recommendations, and funding resources from federal and public agencies to spur the industries' interest in antibiotic research and development.
It is clear that the pharmaceutical and biotechnology industries do not consider the development of antimicrobial agents to be fiscally advantageous. In the 1930s and 1940s, 4 new classes of antibiotics with novel antibacterial targets were introduced. In the 1950s and 1960s, 6 new classes were available. In the 1970s, 1980s, and 1990s, no novel class was licensed. In 2000, one novel class, the oxazolidinones (linezolid), was approved, as was a cyclic lipopeptide (daptomycin) in 2003.4 At this time, only 6 antibacterial agents are in the research and development programs of pharmaceutical and biotechnology companies.5 Given the time it will take to implement IDSA's recommendations and the time lag between the development and marketing of a new drug, the public health crisis will not merely be brewing, but will have erupted and developed into an epidemic. Therefore, we may be left with no options but to examine the utility of older therapies.
We are intrigued by some of the authors' suggested strategies, such as antibiotic rotation for preventing the emergence of VISA and VRSA. To the best of our knowledge, cycling has been studied only with antibiotics that possess a gram-negative spectrum of activity with mixed results and in a closed setting. The sparsity of drugs for the treatment of gram-positive resistant organisms may have prevented antibiotic cycling. However, with the availability of linezolid, vancomycin, TMP/SMX, and daptomycin (for selected skin and skin structure infections only), the possibility of cycling to prevent or reduce resistance to gram-positive organisms is an option that is worthy of investigation.
We share the authors' desire for stronger evidence in the form of randomized trials to support the use of TMP/SMX for the treatment of MRSA. We call not on any federal or public agency, but rather on the pharmaceutical industry to rise to the occasion and conduct trials that compare agents such as linezolid or vancomycin with TMP/SMX for the treatment of MRSA.
Footnotes
Letters are subject to review prior to acceptance. They should address areas related to pharmacy practice, research, or education, or articles recently published. Corrections of previously published material also are accepted. Letters are limited to no more than five authors. In cases where adverse drug effects are described, the Naranjo ADR probability scale should be used to determine the likelihood that the adverse effect was drug-related (Clin Pharmacol Ther 1981;30:239-45). Text: limit 500 words. References: limit 5. Art: limit 1 table or figure.
References
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