Antimicrobial Resistance – The Silent Pandemic

The potential risk that bacteria, might become resistant to antibacterial medicines, has been already acknowledged by the pioneers of antibiotic research.In the 21st century, antimicrobial resistance has become a global public health problem -a silent pandemic that threatens mankind.In 2019, bacterial infections were associated with 7.7 million deaths, of which almost 1.27 million were directly attributable to antimicrobial drug resistance.In the same year, the WHO declared Antimicrobial Resistance as one of ten threats to global health.Factors contributing to the antibiotic crisis are a low outcome of new antibiotic principles, infeasible trial conduct standards and economic limitations.As a consequence, big pharma divested own research and development over the last 20 years.Efforts to identify new active ingredients and mechanisms to overcome antimicrobial resistance have since been driven primarily by small and medium-sized companies.Recent R&D incentives in Europe and national efforts of scientists and regulatory bodies seek to tackle this big challenge.The recent update (2024) of the WHO Bacterial Priority Pathogens includes 15 families of antibiotic resistant pathogens.Future development strategies should focus on antibiotics that are active against multidrug-resistant (especially carbapenem resistant) Gram-negative bacteria and tuberculosis.Particularly important antibiotic classes for the treatment of bacterial infections, whose efficacy must be maintained at all costs include 3rd to 5th generation cephalosporins and macrolides.The current antibacterial clinical drug pipeline continues to be dominated by combinations of -lactam antibiotics with -lactamase inhibitors and bacteriophages targeting WHO priority pathogens.Among the innovative agents there are two novel boronate-based serine -lactamase inhibitors (taniborbactam and xeruborbactam) which target also metallo--lactamases which continue to grow in prevalence.As part of the national 'Phage4Cure' project, the clinical development of a bacteriophage-cocktail consisting of three phages directed against multidrug-resistant Pseudomonas aeruginosa was recently started at the Charit Research Organisation (Berlin, Germany).