Re-development of old antibiotics

In the face of increasing antimicrobial resistance and the paucity of new antimicrobial agents it has become clear that new antimicrobial strategies are urgently needed. One of these is to revisit old antibiotics to ensure that they are used correctly and to their full potential, as well as to determine whether one or several of them can help alleviate the pressure on more recent agents. Strategies are urgently needed to ‘re-develop’ these drugs using modern standards, integrating new knowledge into regulatory frameworks and communicating the knowledge from the research bench to the bedside. Without a systematic approach to re-developing these old drugs and rigorously testing them according to today’s standards, there is a significant risk of doing harm to patients and further increasing multidrug resistance.

The recently published paper REVIVING OLD ANTIBIOTICS describes factors to be considered and outlines steps and actions needed to re-develop old antibiotics so that they can be used effectively for the treatment of infections.

Theuretzbacher U, Van Bambeke F, Cantón R, Giske CG, Mouton JW, Nation RL, Paul M, Turnidge JD, Kahlmeter G: Reviving old antibiotics. J Antimicrob Chemother. 2015 Jun 10. pii: dkv157

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2 Responses to Re-development of old antibiotics

  1. I was hoping you could make a comment on whether microbes lose resistance once the drug pressure has disappeared. In other words, will old antibiotics that have not been used for a while be effective if used?

    • There is no general rule regarding loosing resistance to an antibiotic if not used anymore. Today, we are often dealing with co-resistances that link unrelated antibiotic groups and thus, selection pressure is exerted by any of the involved groups. Stopping the use of one of the common antibiotic groups may result in a small decrease of its resistance (depending on the resistance mechanism) but will most likely not substantially reduce or even eliminate resistance.
      Reviving old antibiotics from unrelated antibacterial groups which have not been used for decades usually means no or almost no resistance. With increased usage this situation can quickly change. Inadequate dosing regimens may even accelerate the emergence of resistance.

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