The affordability of antibiotics is fueling drug resistance, leading to a legitimate threat of superbugs, Ezekiel Emanuel, MD, PhD, wrote in an op-ed for The Washington Post.
Dr. Emanuel, former health policy adviser to the Obama administration, states that lower prices cause a reduced barrier for physicians to prescribe antibiotics and a high patient demand for the drugs. These factors lead to overprescribing, which spurs resistance to antibiotics.
Reduced antibiotic costs also discourage the development of new antibiotics, since a breakthrough drug created to fight antibiotic-resistant infections would be used sparingly to avoid breeding resistance, thereby lowering its financial returns.
Dr. Emanuel claims we're already seeing the effects of antibiotic resistance. Last month, physicians found a strain of E. coli infecting a Pennsylvania woman that is resistant to colistin, the antibiotic of last resort. With the threat of superbugs on the horizon, he thinks major changes must be made in the healthcare field to slow the development of resistant bugs and spur the development of new antibiotics.
Here are his four steps toward a solution:
1. Make every hospital implement a drug stewardship program to reduce inappropriate antibiotic use. By appointing one pharmacist responsible for overseeing antibiotic use and tracking and reporting physicians' individual antibiotic prescribing and resistance patterns, hospitals can save money and lower resistance, according to Dr. Emanuel. Currently, these types of programs are voluntary. He thinks Medicare should require all hospitals to implement these policies and report results annually as a condition of participation and payment.
2. Antibiotic prescriptions should be electronically reviewed to make sure they meet national guidelines. According to Dr. Emanuel, this strategy would reduce the amount of inappropriate prescriptions for colds, sore throats and other minor viral ailments. He believes makers of EHRs and major pharmacies should be required to develop such capabilities, while health systems and physicians should have to install them as part of their quality reporting requirements in Medicare programs.
3. The government and industry should collaborate to fund pre-clinical research on antibiotics. The study of how drugs access and fight infections is not a current focus for drug companies or the National Institutes of Health. Studying gram negative bacteria like E. coli — the most resistant and dangerous type — is essential for developing drugs to fend off emerging infections, according to Dr. Emanuel.
4. Offer financial prizes for researchers and companies who develop new antibiotics. Currently, drug prices pay for research. But Dr. Emanuel wonders what would happen if anyone who secured approval for a new antibiotic won a large monetary prize instead? He explains that the prizes could be funded collectively by the United States and other developed countries through a small tax on hospitals. Furthermore, all participating countries could agree on stewardship rules for the new drug to prevent resistance.
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