The President’s Council of Advisors on Science and Technology (PCAST) recently convened to discuss the ongoing problem of “superbugs”—bacteria that have become resistant to antibiotics. The Council’s panel of scientists, researchers and engineers released a seven-part proposal on bacterial resistance to antimicrobial therapies in September that lays out the stakes for medical professionals and offers many practical recommendations.^1-3

Historically, complications from disease were common and often serious. Roughly 30% of children died before their first birthday.¹ A scrape or insect bite could be a fatal malady, and consequences of sore throats often included rheumatic fever and heart failure. ^1,2 

Life changed with the advent of antibiotics in the 20th century, which have since saved millions of lives and increased life expectancy.^1,3 Within the last decade, however, bacterial resistance has become a crisis—one that is outpacing the development of new countermeasures for treating infections in humans.^1-3

Keep An Eye on It
A major part of combating antibiotic resistance is providing adequate surveillance and rapid response capacity.^1-3 Surveillance—the systematic collection and analysis of samples to ascertain the presence and characteristics of antibiotic-resistant bacteria—is absolutely essential for detecting resistant pathogens, tracing their spread and determining their origin.^1,2 Real-time tracking can help with early detection and identification of outbreaks or epidemics and rapid response to prevent the spread.²

Topical ophthalmic drugs generally achieve significantly higher concentrations than their systemic counterparts achieve in serum levels.⁴ Nevertheless, the ophthalmic community should still heed the warnings regarding bacterial adaptation.

Counting the Cost
The CDC estimates that antibiotic-resistant infections cost the United States $20 to $50 billion or more annually in direct health care, and up to $35 billion in lost productivity.^1,2 A staggering 23,000 deaths annually are reported as a result of antibiotic-resistant infections.¹ Thus, aggressive action is necessary to contain this public health and financial crisis.

PCAST gives a number of recommendations in its report:^1-3

1. Appoint a White House Director for National Antibiotic Resistance Policy, who should develop a National Action Plan for Antibiotic Resistance.

2. Establish a national laboratory network for pathogen surveillance based on genome analysis. 

3. Allocate $150 million per year over seven years to support investigation of non-traditional approaches to overcoming antibiotic resistance.   

4. Initiate clinical trials with new antibiotics. Establish an infrastructure and common protocols, and develop new regulatory pathways to evaluate urgently needed antibiotics.

5. Expand economic incentives for developing antibiotics. PCAST estimates an investment of $800 million will yield one new FDA-approved antibiotic each year.

6. Revise stewardship of existing antibiotics in health care by creating Medicare and Medicaid reimbursement incentives that encourage appropriate antibiotic use and establishing federal regulations for hospitals, long-term care facilities and outpatient settings. 

7. Limit the use of antibiotics in animal agriculture.

Overall, there is still much to be learned regarding resistance. Staying ahead will require novel approaches including anti-sense therapies, new narrow-spectrum drugs, agents to enhance immune response and drugs to attack virulence factors.^1-3   

1. Report to the President on Combating Antibiotic Resistance, Executive Office of the President/President’s Council of Advisors on Science and Technology, September 2014.
2. Medscape. The President’s Report on Antibiotic Resistance: What Does it Mean to Clinicians? Available at: www.medscape.com/viewarticle/834525. Accessed December 15, 2014.
3. The White House. Executive Order—Combating Antibiotic-Resistant Bacteria. Available at: www.whitehouse.gov/the-press-office/2014/09/18/executive-order-combating-antibiotic-resistant-bacteria
4. Haas W, Pillar CM, Torres M, et al. Monitoring antibiotic resistance in ocular microorganisms: results from the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) 2009 surveillance study. Am J Ophthalmol 2011:152:567-74.