This week, according to major media outlets around the world, a "breakthrough" antibiotic was discovered. This new antibiotic — found in dirt, no less — "could prove resistant to resistance," one excited headline read.
The discovery of teixobactin, the antibiotic, was published in the prestigious journal Nature, and at a time when most of the news in this area relates to scary drug-resistant superbugs, journalists pounced on the positive finding.
Researchers who work on the problem of antibiotic resistance, however, were much less excited. To put it plainly, they think the media over-hyped the new "miracle drug" and had several important reservations about teixobactin and whether it would actually be helpful in humans. Here's what they said.
First thing's first: a note on antimicrobial resistance
Part of the positive reception around this new Nature paper probably has to do with the doomsday scenario we're facing when it comes to antimicrobial resistance. It really is a concerning problem in health. A recent report commissioned by the UK government predicted that, by 2050, antimicrobial resistant infections will kill 10 million people across the world — more than the current toll from cancer.
Microbes naturally evolve to resist the drugs that we invent for treating the infections they cause but for decades, we've been speeding up their evolution by overusing antibiotics when they're not needed, by not completing prescribed courses of treatment, and by breaking infection control protocols in hospitals and clinics where these superbugs can easily spread.
Right now, antibiotic-resistant infections are associated with 23,000 deaths and two million illnesses in the US every year. Drug-resistant gonorrhea is a reality everywhere from Canada to South Africa; popular antibacterials for urinary tract infections have been rendered useless in many parts of the world; and some foretell a not too distant future in which we'll lose the ability to treat diseases like cancer and meet the demands of our antibiotic-dependent food supply. The White House put the health-care costs of resistant infections at $20-billion.
That’s not to mention, as many have long pointed out, that the business model for creating antibiotics is broken, so researchers and drug companies have little incentive to pour their time and resources into solving this dire problem. That's why a promising new antibiotic, backed by government funding, was certainly a positive development.
Before declaring this a miracle drug, we need to learn about whether it works in people
"The data on the new drug is just in vitro and mouse models," noted Kevin Outterson, a health law professor and antibiotics expert at Boston University. That's a very, very long way from being studied in humans, and knowing whether it's truly safe and effective.
To get a sense of just how long, consider the pathway involved in getting a drug on to store shelves in the US:
The new antibiotic would need to go through three phases of clinical trials in people.
Before testing it humans, researchers would need to hand over their really promising data from animal studies to the FDA and get the regulator's approval to start recruiting patients.
That's called the "pre-clinical" phase of drug development, and it's where the researchers who published in Nature are right now.
For every 5,000 compounds discovered at this stage, only about five are allowed to be tried in humans. "The failure rate from promising mouse trial to FDA approval is huge," said Outterson. So the odds are stacked very heavily against this drug being the miracle the media is promising, let alone a safe and effective one in people.
Having an answer to the question of whether this is a miracle is still years away
"It is a long way to clinical testing still," said Dr. John-Arne Røttingen, director of the division of infectious disease control at the Norwegian Institute of Public Heath. "Maybe four to five years before it at best can get approval."
According to the New York Times, the Nature researchers said they aim to start studies in people in about two years, and if the drug successfully passes through all the necessary clinical trials hurdles, it will not be available for at least five years.
So while the news media this week made claims like, "Antibiotic Pulled From Dirt Ends 25-Year Drug Drought," the researchers emphasized that it would still be a long time before any such claim could even be tested.
This drug — or any other — definitely doesn’t solve the antibiotic resistance crisis
The media narrative around this new discovery suggested that, in order to beat superbugs, we need to create more antibiotics to fight them off.
In reality, a large part of the solution to the problem of antibiotic resistance actually lies with just using less of the ones we have.
"Discovery of new antibiotics is important," said Dr. Paul Glasziou, a professor of Evidence-Based Medicine at Bond University. "But that will be a short-lived solution unless we learn to reserve antibiotics for when they are really needed."
So even if this week's "miracle" does amount to an effective new drug, if we abuse in the manner we have all the other antibiotics we've discovered, it'll be rendered useless, too.
"Resistance develops rapidly," said Glasziou, "but is also reversible with time if we use fewer antibiotics." He pointed to studies that have shown that countries that use more antibiotics tend to have more of a resistance crisis, but also that that the damage can be reversed through more judicious prescribing.
One of the strengths of this new antibiotic is that it seems less likely to become resistant. But, as Outterson said, it's still really too early to tell at this point. "This was not a robust test for whether resistance will emerge if this drug were given to millions of people over several years," he said.
The other issue: right now, the drug appears to only treat a class of bacteria called "gram-positive", which causes infections like listeria, staph, and TB. It cannot, however, target gram-negative bacteria, which cause really problematic drug-resistant infections such as pneumonia and gonorrhea.
The truly exciting thing about teixobactin
Teixobactin was found using a recently discovered gizmo (the iChip) that allowed the scientists to extract the drug from bacteria in dirt. In other words, the researchers were able to use the tool to grow previously uncultivable bacteria for their antibiotic.
Right now, it's estimated that microbiologists only work with one percent of microbes, "the ones that will grow politely in the lab," as the Washington Post put it. "But there are potential antibiotics all over the world being created by plants, fungi, and microorganisms." Scientists looked to plants to find a treatment for malaria, and mold to discover penicillin. The iChip allows them to search in other places now, like dirt.
"It's going back to the era starting at the early development of antibiotics," said Dr. Jeremy Farrar, an emerging infections specialist and head of the Wellcome Trust in the UK. "The scientists were asking, 'Can we somehow better harness what’s going on naturally and make a class of new drugs available that we’ve never considered?' That's the nice thing about this paper: they worked out a nice system for that." He added: "It’s not the antibiotic."