Hot topic: Should we use new antibiotics first?

Let’s talk antibiotics. Specifically: Is our policy about how we might use new antibiotics, wrong? 

A little on background first. 

Resistance to existing antibiotics is growing and the pipeline of new ones is thin. 

If we don’t get our act together – so the warnings go – we’ll sleepwalk into a post-antibiotic apocalypse, where surgery is a nightmare and a scratch could be deadly. 

Current thinking is that when a new antibiotic comes along, we should use it very sparingly – as a last antibiotic resort – so as not to encourage resistance to it. 

This ‘policy of last-resort’ has been recommended in reports, including the influential O’Neill report in 2016. 

But what if this policy is wrong? 

That’s the question that Mark Woolhouse, Professor of Infectious Disease Epidemiology at Edinburgh University, put at the BioNow BioInfect conference in Cheshire earlier this month. 

He said he wanted to “challenge” the policy of last resort. 

He asked: “Why should a new antibiotic be reserved as last line?” 

He said modelling suggested it didn’t matter whether you used existing antibiotics first, or the new one first, from a public health benefit point of view. 

He did couch this by saying this was preliminary research, and that the devil’s in the detail. 

Nonetheless, he said using new antibiotics first should be “a possibility”. 

Why would this matter? 

Because if new antibiotics could be used first line, they’d be used in much greater quantities. 

That would massively raise the financial incentive for pharma to invest in them. So, we’d end up with a thicker pipeline of new antibiotics. 

If you’re interested in finding out more, read this pre-print by Mark Woolhouse and colleagues which can be found here or (full text) here.

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