Does the world need another antibiotic?

Given the arduous process of developing innovative antibiotics, the environmental impact of widespread antibiotic use and the potential abuse, it is suggested that our focus should shift towards developing alternative therapies, such as phage therapy, to address bacterial infections and the growing threat of antimicrobial resistance. In view of the substantial evidence gathered from studies revealing the increasing resistance of microbes to different classes of antibiotics in Nigeria and other parts of the world, the world does not need another antibiotic.

Developing a new antibiotic with a novel mechanism of action is an excruciatingly difficult and capital-intensive process. Pharmaceutical companies involved in the development of new antibiotics invest significant time, effort, and capital into its discovery. The process involves extensive research, screening of compounds, optimisation, clinical trials, and regulatory approvals, which can take up to a decade or more. Furthermore, the success rate of new antibiotic candidates progressing through these stages is alarmingly low, with many potential drugs failing in clinical trials due to efficacy, safety, or tolerability concerns. The immense challenges associated with antibiotic development, coupled with the potential abuse by humans, make it an unattractive and risky endeavor for pharmaceutical companies.

A more alarming reason to discourage the development of new antibiotics is the environmental impact of antibiotic use. The widespread use of antibiotics, along with the release of these compounds into the environment by the population in Nigeria contributes significantly to the development of antibiotic resistance. Hence, the more antibiotics being produced, the higher the potential for resistant microbes to emerge. Antibiotics are released into the environment through wastewater, agricultural practices, hospitals, and pharmaceutical waste. This constant exposure of bacteria to sub-lethal concentrations of antibiotics provides ample opportunities for the development and dissemination of resistance mechanisms. In addition, the environmental persistence of antibiotics allows for the long-term selection of resistant bacteria and the transfer of resistance genes between different microbial species. Hence, phage therapy stands as a profitable alternative to new antibiotic development.

Given the challenges and limitations of traditional antibiotics, we must explore alternative therapies, such as phage therapy, to combat emerging resistance. Bacteriophage attack the target bacteria by attaching to the cell wall, then injecting its genetic material. Phage replication takes places inside bacteria. Cell lysis occurs, releasing more phages to infect other bacteria, effectively eliminating the infection. More importantly, phage therapy, as a targeted and specific treatment, has the potential to revolutionise the field of microbial therapy. Bacteriophages can infect and kill specific bacterial pathogens, effectively bypassing the concerns of resistance that plague traditional antibiotics. In addition, phages have the ability to adapt and evolve alongside bacteria, ensuring their efficacy even in the face of evolving resistance mechanisms. This dynamic nature of phages makes them a promising solution for the treatment of multidrug-resistant infections.

The development of another antibiotic is an uphill battle, marked by extensive costs, time, and effort. The environmental impact of widespread antibiotic use further highlights the urgent need to explore alternative therapies. Instead of absolutely relying on the development of new antibiotics, our efforts should be directed toward researching and advancing alternative therapies, such as phage therapy.