In a recent article published earlier this month, Pahil and colleagues reported discovery of a new antibiotic that can kill Acinetobacter and potentially other gram-negative bacteria by blocking the transport of lipopolysaccharide from the cytoplasmic membrane to the cell surface. Gram-negative bacteria are generally difficult to kill due to the presence of lipopolysaccharide on their outer cell surface which blocks entry of most antibiotics. Acinetobacter Baumannii, Pseudomonas aeruginosa, and Enterobacteriaceae, which are all gram-negative bacteria, are WHO’s top priority bacterial pathogens that new antibiotics are urgently needed for. These bacteria have developed resistance to a broad range of antibiotics, including carbapenems and third generation cephalosporins – which are usually reserved for treating multi-drug resistant bacterial infections. Therefore, this discovery is timely as we are quickly running out of treatment options to fight these superbugs. 

Though a significant achievement has been made, more innovations are still needed together with strong stewardship and monitoring programmes, as bacteria will potentially develop resistance to new antibiotics over time. Alternative treatments need to be explored to complement antibiotics. Phage therapy is an attractive alternative that is building interest in the scientific community. At the centre’s seminar series in December, Dr Mariagrazia Di Luca spoke on the opportunities and challenges currently faced by phage therapy. Phages can be targeted to specific bacterial species and thus can avoid unintended harm to off-target beneficial bacteria. This promises a more efficient way of treating infections, especially those caused by multi-drug resistant bacteria, without creating other problems that could stem from a disrupted microbiome if broad-spectrum antibiotics were to be used. Though phage therapy is not a new concept, its application in clinical practice for treating bacterial infections has not been fully explored, in part due to its specificity. More research is needed to establish its safety, efficacy, and broader applicability.  

With the current global trend of increasing antibiotic resistance, phage therapy is on the spotlight as a potential solution to the growing threat of superbug infections. Earlier this month, a report by the Science, Innovation and Technology Committee of the House of Commons pushes for solutions to maximise the potential of phages for treating bacterial infections. This is an important step that, hopefully, will eventually help address regulatory barriers and increase both public and private investment in phage research. 

In another development, a report from the Indian National Programme on AMR Containment under the National Centre for Disease Control, shows that more than 50% of inpatient antibiotic consumption for the period 2017 – 2021 from 10 sites spread across India fall under the “watch group” of WHO’s AWaRe classification. This classification categorizes antibiotics into three groups (Access, watch, and reserve), emphasizing the importance of their optimal use and potential for resistance. In this report from India, the yearly proportions of antibiotics that fall in the “access group” were just about one-third of all antibiotics consumed.  This is alarming because, antibiotics under the “watch group” are regarded as having high potential for resistance and therefore should be a key focus of stewardship programmes. This data highlights the need for greater efforts at country and regional levels to strengthen stewardship and monitoring, especially in low- and middle-income countries.