A novel drug is defined based on its āmechanism of actionā (i.e. the way the antimicrobials interact with the microbe to kill them or limit their growth) or itās core structural motif.
This means that recently developed antibiotics are closely related āanaloguesā of existing drugs and therefore are susceptible to the same resistance patterns or see resistance arise faster than with truly novel drugs
Could you give a sense of what would happen in case no more ātruly novelā antibiotics were discovered, developed and commercialised until 2100? For example, how would deaths due to antibiotic resistance grow until 2100 in this pessimistic case?
Great question and something weāre hoping to dive into in some more detail in a future post. Modelling on this generally isnāt considered to be very reliable but as a start, the commonly sited number of 10M+ deaths by 2050 is modelled on a āworst caseā scenario where there is very high levels of resistance to the most widespread infections. Therefore, this is probably fairly close to the upper end estimate that we can expect year on year. Details of the modelling here.
Drugs which arenāt novel are likely to have quite short periods before they are widely resisted, due to their similarities to existing drugs. The average time to first resistance for drugs commercialised from the 1970s ā 2000s was just 2 ā 3 years vs. 11 years for drugs pre-1960 (although overuse will certainty have played a part in this rapid resistance as well).
Without new drugs (and accurate and cheap diagnostics to go with them) we could also enter a bad feedback loop where more resistant infections lead to doctors proscribing more 2nd, 3rd and last line antimicrobials in infections where they are only partially effective. Therefore, giving further opportunities for microbes to develop resistance than they would have had if we had more specific drugs available in the first place.
Thanks for sharing!
Could you give a sense of what would happen in case no more ātruly novelā antibiotics were discovered, developed and commercialised until 2100? For example, how would deaths due to antibiotic resistance grow until 2100 in this pessimistic case?
Great question and something weāre hoping to dive into in some more detail in a future post. Modelling on this generally isnāt considered to be very reliable but as a start, the commonly sited number of 10M+ deaths by 2050 is modelled on a āworst caseā scenario where there is very high levels of resistance to the most widespread infections. Therefore, this is probably fairly close to the upper end estimate that we can expect year on year. Details of the modelling here.
Drugs which arenāt novel are likely to have quite short periods before they are widely resisted, due to their similarities to existing drugs. The average time to first resistance for drugs commercialised from the 1970s ā 2000s was just 2 ā 3 years vs. 11 years for drugs pre-1960 (although overuse will certainty have played a part in this rapid resistance as well).
Without new drugs (and accurate and cheap diagnostics to go with them) we could also enter a bad feedback loop where more resistant infections lead to doctors proscribing more 2nd, 3rd and last line antimicrobials in infections where they are only partially effective. Therefore, giving further opportunities for microbes to develop resistance than they would have had if we had more specific drugs available in the first place.