Expansion of Emerging Infectious Disease Sooner
Antibiotics can be said that the most important progress in the history of modern medicine. It is estimated that deaths in the United States decreased by 220 per 100,000 with the introduction of sulfonamides and penicillin in the early antibiotic era.
Far exceeds the benefits to be gained with other medical advances in the last century. The main threat we now face is the increasing resistance to antibiotics, which endanger much of this progress. It must be recognized that the evolution of bacterial resistance can not be avoided. But the damage is highly promoted by the use of antibiotics. The problems faced was the resistance of microbial growth and as a result of the use and abuse of drugs, which have unintended consequences clearly more resistance.
In the past, antibiotic resistance is a challenge that is usually met by the development of new antibiotics, but newer problem is the pharmaceutical industry almost all interested in producing new drugs.
So, 1983-2010, U.S. Food and Drug Administration (FDA) approval of new antibiotics continues to decline, from 4 per year in the early 1980s to less than 1 antibiotic per year now.
Perhaps more important than the reduction of drugs to fight the bacterium is bacterial resistance and clinical effects. Infection Disease Society of America (IDSA) recognized this problem in 2004 with the creation of antibiotics Availability Task Force (AATF). This organization summarizes the issues in the relevant documents, beginning with "Bad Bugs, No Drugs," a review of interviews with executives from pharmaceutical companies that historically is the largest producer of antibiotics. their reasons for returning to the development of antibiotics is good business:
* Antibiotics are a short term drug which is usually consumed for 1-2 weeks, but agents on cardiovascular, rheumatologic, and neurological, consumed by patients for decades.
* Investment is needed to "bring the drug to kepasaran" estimated almost $ 1 billion, the possibility of "return on investment" to antibiotics is almost nil.
* We also heard: "If you develop a cure for resistant bacteria, the doctor tells you to reserve them for a relatively rare condition."
* Changes in the environment unpredictable and highly risky in clinical areas.
Pathogens of concern. Meanwhile, the organism of concern continue to grow in number. the main bacteria that is defined as "ESKAPE" microbes in reference to Enterobacter, Staphylococcus aureus, Klebsiella, Acinetobacter, Pseudomonas aeruginosa, and Enterococcus. Ten years ago, we witnessed the global spread of new strains of S. aureus containing the Panton-Valentine Leukocidin, referred to here as "USA 300 strain.
"It is dominating the attention to resistance to the" bad bugs, "but an even greater attention has recently been expressed about gram-negative bacilli, especially those producing carbapenemases. This includes Carbapenemase K. pneumoniae-producing Enterobacteriaceae that emerged in the United States began in the 2000s.
However, the most worrying of all has occurred recently in New Delhi-Metallo beta-lactamase (name of his town of origin) who first become infected patients hospitalized in New Delhi and then spread, first with a trip to England and then globally.
The organism is resistant to nearly all currently available antibiotics except for colistin and tigecycline.
The concern in the European health agencies have recently produced remarkable monograph with a comprehensive review at this time the development of new drugs for resistant bacteria.
They show that the last new class of drugs active against gram-. negative bacteria back almost 40 years! They also attempted to identify a new class of tight for gram-negative bacteria in development, including in-depth study on drug trials in 2 phases or more.
None required Historically, approximately 8 years of drug discovery to FDA approval showed that, even if now working aggressively and successfully, there is little possibility of a new drug discovered before 2015.
Public attention to the crisis of antibiotic resistance in the face of a relatively dry pipeline is a priority issue that suddenly withdrawn. On November 4, 2009, President Obama and Prime Minister of Sweden Fredrik Reinfeldt, who represented the European Union, formed the Transatlantic Task Force on Antibiotic Resistance (TATFAR) to provide engineering attacks against this issue by the United States and Europe. The other two relevant congressional requests have been proposed, including Senate Bill 2313: Strategies To Address Antibiotic Resistance (STAAR Act), and House bill 6331, largely designed to provide incentives for pharmaceutical companies to develop antibiotics.
In addition, the National Institute of Allergy and Infectious Diseases National Institutes of Health announced plans to build a collaborative network of academic centers to test new antibiotics and the issues that are relevant to antibiotic resistance.
Center for Disease Control and Prevention (CDC) announced "so smart about antibiotic program" to provide guidance, especially through the ministry of antibiotics, in increasing the use of the drugs we have today.
It should be noted that France, which has the highest rate of antibiotic use in the EU, addressing the perceived problems with the misuse of antibiotics is expensive and very ambitious campaign directed at both consumers and physicians. 5-year goal is to reduce the likelihood of prescribing antibiotics for viral respiratory tract infections by 25%. A recent report indicates that this goal is achieved.
For the United States, antibiotic resistance was responsible for nearly 100,000 deaths caused by hospital infections per year earned an annual cost estimated $ 23,000,000,000. This is clearly attracted the attention of the Centers for Medicare & Medicaid Services, in the hope that the misuse of antibiotics will lead to public reporting and financial penalties.
The conclusion is that resistance has now reached a stage of crisis, largely because of the lack of new antimicrobial agents to maintain the effectiveness of which has been enjoyed for more than 50 years. The good news is that the consensus has been reached that this is an important issue, although it was too late realized. Physicians should be aware of this issue and agreed to assist in efforts to maintain the current activity of drugs that are available through the conservation of antibiotics that are consistent with good practice.
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