The Economics of Antibiotics
In the United States, for example, resistance to the bacterium methicillin-resistant Staphylococcus aureus (MRSA), has reached 60 percent. This means six out of 10 patients with this virulent staph infection can no longer be treated with oxacillin, a relatively low cost drug. But what still amounts to a cost problem in rich countries is becoming a serious threat to public health in the developing world: lower-income countries face a growing toll of death and morbidity from curable infections because the generally available antibiotics no longer work.
Reasons for the problem: externalities, third party payment, bad government. A good read. HT: Timothy Taylor.
It costs nearly $1 billion to bring a drug to market. About 8 to 12 years after approval, the drug is subject to generic competition. As a result, drug makers prefer to develop drugs that treat widespread, chronic conditions. The average patient who uses an antibiotic is through a course of treatment in 10 days. The average patient who begins a course of treatment with a hypertensive or high cholesterol drug more or less stays on the drug therapy class indefinitely (although about half drop out).
What a sad anecdote of one group having too much and another having too little.
Historically antibiotic resistance starts very quickly after the introduction of any new antibiotic, as proven after penicillin was released to the public after WWII.
We’re in a new era where genetics rules – not only for fingerprinting MRSA for better epidemiologic nosocomial controls but for novel drug target strategies.
Specifically, all S. Aureus strains involve copper-sensitive operon repressor (CsoR) and other CsoR-like proteins. The CsoR regulates the expression of copper resistance genes. This emulates proven work in progress targeting sulfur assimilation in M. tuberculosis.
Specializing in immunodeficiency, I’d be remiss not to add that we can never lose sight of the famous Louis Pasteur – Claude Bernard microbe v host debate. No matter how “super” the “bug” is, never forget all the unique variables for each individual patient host.
Dorothy Calabrese MD, San Clemente, CA
I can only see this problem getting worse. Perhaps there needs to be some kind of an international effort to corral the world’s doctors into abiding by strict standards on when and to whom to prescribe antibiotics. This of course, would only be directed toward doctors in the developing world.
No international body should ever tell American doctors what to do.
This is a problem that has been developing in several major developing countries over the last decade with respect to other ailments that require antibiotics. It could be a matter of time before the problem gets even worse in the western countries.