Opportunistic etiological agents causing lung infections: emerging need to transform lung-targeted delivery

New Breakthrough Drugs Target Deadly Superbugs

Antibiotics, once hailed as lifesaving medical marvels, are increasingly losing ground against evolving bacteria that outsmart these drugs. Known as "superbugs," these antibiotic-resistant pathogens claimed 1.14 million lives globally in 2021, according to The Lancet. India, heavily impacted by antimicrobial resistance, witnesses nearly 300,000 deaths annually due to such infections, with 60,000 newborns lost each year.

Despite this grim backdrop, new hope is emerging from India's pharmaceutical sector, where groundbreaking locally-developed antibiotics show promise in combating resistant pathogens and preserving last-resort treatments.

Game-changing innovations

Enmetazobactam, developed by Chennai-based Orchid Pharma, is India's first FDA-approved antimicrobial drug. This injectable treatment tackles severe conditions like pneumonia, urinary tract infections (UTIs), and bloodstream infections by neutralizing bacteria's defensive enzymes, such as beta-lactamase. By disarming these enzymes, the drug ensures antibiotics remain effective, especially critical options like carbapenems. Clinical trials across 19 countries have demonstrated its potency, making it a crucial weapon for critically ill patients.

Mumbai-based Wockhardt is advancing two potential superbug treatments:

Zaynich, a new antibiotic in Phase-3 trials, has shown remarkable results in compassionate-use cases where it saved 30 critically ill patients unresponsive to other drugs. Expected to launch next year, it promises to be a "groundbreaking" solution, according to Dr. Habib Khorakiwala, Wockhardt's founder.

Nafithromycin (MIQNAF), a three-day oral treatment for community-acquired pneumonia, boasts a 97% success rate. With resistance to existing treatments as high as 60%, this drug could be a game-changer when released commercially next year.

Another notable effort is by Bengaluru-based Bugworks Research, which is developing a new class of antibiotics in collaboration with the Global Antibiotic Research and Development Partnership (GARDP). Although still in early trials, the drug targets severe drug-resistant infections and could hit the market in five to eight years.

Alarming trends in resistance

The urgency of these developments is underscored by findings from the Indian Council of Medical Research (ICMR). A 2023 survey of 100,000 bacterial cultures revealed alarming trends:

E. Coli, linked to foodborne illnesses, shows declining antibiotic effectiveness.

Klebsiella pneumoniae, a pathogen causing pneumonia and meningitis, is exhibiting rising resistance.

Acinetobacter baumannii, a multidrug-resistant bug targeting critical care patients, poses growing challenges.

Worryingly, resistance to carbapenems—considered last-resort antibiotics—has surged, with some treatments proving less than 15% effective against these pathogens.

Addressing misuse and overprescription

Experts emphasize that new drugs alone won't solve the crisis. India must reform its antibiotic prescription practices, which often favor broad-spectrum antibiotics that kill beneficial bacteria and promote resistance. Narrow-spectrum antibiotics should be prioritized, but the lack of antibiograms in hospitals forces doctors to prescribe blindly.

"Without proper mechanisms to ensure responsible use, even these groundbreaking drugs risk being misused," warns Dr. Kamini Walia of ICMR.

Holistic solutions

A multi-pronged approach is crucial to combating antimicrobial resistance. This includes:

Improved sanitation, hygiene, and vaccine coverage.

Stronger hospital infection controls.

Physician education and public awareness about the dangers of self-medication.

"Antimicrobial resistance is not just a healthcare issue; it's a systemic challenge tied to equity and accountability," says Dr. Walia.

A call for urgent action

While India's pharmaceutical breakthroughs offer hope, the battle against superbugs demands systemic reforms and global cooperation. Without swift action, even minor infections risk becoming untreatable, threatening a future where modern medicine's most essential tools are rendered powerless.

Use Of Unregulated Tests For UTIs In Nursing Home Residents Skyrockets, Report Shows

Claims for unregulated rapid molecular diagnostic tests for urinary tract infections (UTIs) in older adults have soared 60-fold from 2016 to 2023, according to Medicare data. The rise was most significant among those living in nursing homes, increasing from 1% in 2016 to 12% in 2020.

A report published Nov. 26 in JAMA Network Open assessed the number of claims for multiplex molecular syndromic panels for UTIs among Medicare beneficiaries. The study examined more than 36 million older community-dwelling adults and nursing home residents with Medicare Part A and Part B benefits. Investigators evaluated 1,679,328 claims for UTI multiplex testing. Between 2016 and 2023, the rate of UTI multiplex testing jumped from 2.4 to 148.1 claims per 10,000 fee-for-service beneficiaries annually. Meanwhile, the rate of urine cultures didn't go up during that time frame. 

Multiplex panels give quicker results compared to traditionally used urine cultures. The multiplex panel tests are more sensitive and can identify multiple pathogens and some antibiotic-resistance genes. But UTI multiplex testing costs about 70 times higher than urine cultures; the median cost for a multiplex panel was $585 in 2023, compared with $8 for a urine culture.

There's limited evidence showing the benefit of UTI multiplex testing over urine culture, the authors noted. Plus, they're not approved by the Food and Drug Administration for UTIs, though they have a green-light to be used for blood, respiratory and other types of infections.

"Multiplex panels for UTIs are of particular interest for monitoring, given the large number of UTIs and the frequency with which antibiotics are given for asymptomatic bacteriuria, which may result in patient harm," the authors wrote.

Authors of the report said that more research is needed to differentiate asymptomatic bacteriuria from UTIs, the lack of specificity in UTI multiplex tests may lead to more antibiotic overprescribing. 

"Clinicians should be aware of the lack of data supporting this testing and the potential to further contribute to inappropriate antibiotic prescribing," the authors wrote. 

A team from the University of Colorado School of Medicine and the University of Maryland School of Medicine wrote in an editorial that the report raises concerns that the widespread and unregulated use of these tests will make a bad situation worse, particularly in settings such as nursing homes, where there is limited antimicrobial stewardship support.

Indian Pharma Develops More Effective Drug To Combat Antibiotic-resistance

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