Very few days go by when there is not something in the news about the dangers of bacteria. While viruses have undoubtedly fewer treatment options, they have not made the front page in recent years due to the increasing problem of bacterial resistance.
Many experts believe we may, in the future, find ourselves in a horrifically unique situation whereby all our once effective antibacterials are rendered useless. I mean completely useless. The process of creating new antibacterials to replace those resigned to the ‘medical scrapheap’ was once like a conveyor belt and drugs companies could simply screen thousands of compounds to find new leads.
Nowadays it seems more like a race against time for researchers to find new drugs. A race which is slowly being lost. There are two logical reasons for this; the first is that we are reaching a natural climax whereby there are simply fewer and fewer compounds we can make, which are active against microorganisms. The second theory takes the rather different, 21st Century outlook.
Antibacterials don’t make enough money. Simple.
Let me paint you the picture. I’m feeling wealthy and generous so I give two large pharmaceutical companies a (very) large sum of money and say “here you go, I want you to invest this in a new drug to treat an indication of your choosing. You have to discover a new lead compound, make it pass all pharmacodynamic and pharmacokinetic testing, it must be as safe as possible and more effective than all the other drugs currently on the market for this indication. Oh, and you must turn a healthy profit over the next few decades...”
In 10 years' time, company A has just successfully taken a new antihypertensive to market. It is not the first choice for many doctors when prescribing, it does not sell for very much (as it had to undercut its competitors in an already crowded antihypertensive market) and is only a first-line treatment for certain situations, or when patients are intolerant to other drugs. This does not seem very promising.
At the same time, company B has just started marketing a new antibiotic which is much more effective than its competitors, sells at a higher price and is hailed by prescribers as another temporary solution to resistance in the illness it treats. Well done company B. Or maybe not...
I return to both companies after another 20 years (and by now I’m feeling quite old). Company A is turning a healthy profit from their antihypertensive, and has since launched the second generation drug. This company not only has profit, but longevity.
Company B is yet to recover their drug development costs. They haven’t made enough profit on the antibiotic to reinvest in new treatments, and five years ago NICE removed their drug from its prescribing guidelines due to the inevitable issue of bacterial resistance.
Why are companies reluctant to invest in antibacterials? It’s simply down to the old medical proverb;
"Treat a man for an infection and he is treated in a fortnight. Treat a man for hypertension and he is treated for the rest of his life."
This is why company A sold more units and made more money. This is therefore why fewer antimicrobials are being developed now, at a time when we really do need them most.