Superbugs: how can we combat this health threat caused by antimicrobial resistance?

What is antimicrobial resistance?

Antibiotics are drugs used to combat infections and diseases caused by bacteria, such as pneumonia, bronchitis, ear infections or septicemia, and are not useless against viruses or fungi. Antibiotics block the growth of bacteria. However, massive and repeated exposure of bacteria to antibiotics creates “selection pressures”, leading to the creation and dissemination of resistant bacteria.

In addition to the massive use of antibiotics, their misuse is also responsible for this antimicrobial resistance: treatment that is too short or too long, at inappropriate dosages. Antibiotics may also be prescribed for certain viral respiratory infections, such as influenza, which are often confused with bacterial respiratory infections.

Antibiotic resistance is a major public health issue, with 125,000 infections in France linked to multi-resistant bacteria and 5,500 associated deaths per year. Worldwide, this figure rises to 1.3 million deaths per year.

Antimicrobial resistance and superbugs, a major public health issue

Superbugs with a resistance spreading to more and more treatments

While some strains are resistant to just one antibiotic, others acquire resistance to several, and become multi-resistant (so-called superbugs). Antibiotics that are still active against these multi-resistant bacteria are known as second-line antibiotics, and are often only injectable in hospital, greatly complicating patient care and running the risk of nosocomial infections. In the worst-case scenario, which is still rare in France, bacteria can become totally resistant, i.e. resistant to all available antibiotics, placing patients in an irremediable therapeutic impasse.

For a long time, cases of AMR were only detected in hospitals or nursing homes. Today, however, the phenomenon is spreading outside these institutions, even for minor antibiotic treatments.

According to the WHO, the world is heading towards a post-antibiotic era, where common infections and minor wounds that have been treated for decades could once again be lethal.

A global spread that also involves animals

Human health is not the only one concerned. According to the WHO, half of all antibiotics produced worldwide are used in animals. They are used both as drug and as growth promoters, helping animals to gain weight. Resistance to antibiotics developed on farms can then be transmitted to humans via animal consumption. They can also contaminate human and animal excrement, and consequently end up in rivers and groundwater, where they are again ingested by humans and animals.

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What measures can be taken to combat antimicrobial resistance and superbugs?

First measure: reduce antibiotic use

The most important thing is to succeed in lowering this selection pressure on bacteria, and that means reducing the use of antibiotics. Since 2016, overall consumption has fallen in Europe. However, France remains particularly concerned by this overconsumption of antibiotics, which is 30% higher than the average consumption in Europe.

Actions to be taken include:

• Raising awareness and understanding of AMR: a European Antibiotic Information Day is held every year on November 18.
• Better use of antibiotics, i.e. choosing the right molecule, at the right dose and for the right duration.
• Prevent the transmission of resistant bacteria through hygiene precautions such as hand washing.
• Preventing respiratory viruses through vaccination, avoiding confusion with respiratory bacterial infections.

Second measure: involve the pharmaceutical industry in the fight against superbugs

The pharmaceutical industry also has a role to play on several levels:

• Manufacture responsibly and control sales volumes of antibiotics.
• Promote prevention and limit the use of antibiotics. Swiss start-up LimmaTech has recently developed a vaccine against four strains of E. Coli, responsible for 70-80% of urinary tract infections.
• Develop diagnostic tools to ensure that the right antibiotic is used. Aurobac Therapeutics, which specializes in antibiotic therapy, has set itself the mission of developing “a new approach to precision medicine, from diagnosis to therapy”.
• To widely share data from global antibiotic surveillance studies via programs or platforms such as ATLAS (Antimicrobial Testing Leadership and Surveillance), sponsored by Pfizer.
• Finally, invent new funding models, in collaboration with public bodies, to stimulate innovation and research in particular.

Third measure: develop the research needed to adapt new therapies to superbugs

Encouraging research to replace the use of antibiotics is also essential. Alternative strategies also exist:

• phage therapy, for example, is currently being developed: phages are viruses that infect and specifically kill certain bacteria.
• anti-microbial peptides, which, like antibiotics, disrupt bacteria from the inside by targeting their DNA or RNA.
• finally, the use of technologies based on CRISPR-Cas9 could make it possible to target and destroy the parts of the bacterial genome responsible for resistance.

The pharmaceutical industry, at the heart of a healthcare ecosystem linking healthcare professionals, patients and politicians, can play a major role in the fight against antimicrobial resistance and superbugs. They can implement preventive and awareness-raising measures, complementing those undertaken by the State in particular. The fight against AMR and superbugs inevitably involves the development of new therapies, and therefore the need to encourage both industrial and academic research. Alcimed is ready to help players and solutions geared towards this fight against antimicrobial resistance. Don’t hesitate to contact our team!

About the author, 

Richard, Senior Project Manager in Alcimed’s Life Sciences team in France