Antibiotic Stewardship Programs a Double-edged Sword for Tackling Sepsis

Wednesday, January 22, 2020 Drug News
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News earlier this week highlighted that new data have emerged suggesting that sepsis is a bigger killer than cancer. Sepsis has proven to be deadly, but perhaps its most pernicious aspect is that it results from myriad factors, including uncontrolled infection and inflammatory processes across multiple organs. Experts interviewed by data and analytics company GlobalData routinely expressed that development of rapid, accurate, sensitive and specific pathogen identification tools would be a key to decreasing the use of broad-spectrum antibiotics as first-line therapy and improving patient outcomes.

Michael Breen, Associate Director of Infectious Diseases at GlobalData, comments: “The best protection against sepsis is early antibiotic intervention. However, patients are frequently admitted to hospital once the stage has been set for sepsis, and downstream complications are driven by the patient’s own responses to the pathogen - sometimes irrespective of whether or not the infection has been addressed. Thus, while prevention is optimal, we must be able to address the human body’s own drivers of septic shock, and our present armamentarium for this is severely lacking.”

According to GlobalData’s databases, 1,259 marketed drugs, 230 pipeline agents and 1,066 clinical trials exist for sepsis, globally, with the vast majority being antibiotics. Data supporting early antibiotic administration indicate a very narrow time frame for administration of therapeutics, with this window being as low as one hour.

Breen continued: “These short administration windows are not unusual, as certain pathogens can progress rapidly, with no or minimal symptomatic presentation such as meningococcus. Alike bacterial meningitis, treatment may be readily available in the form of an inexpensive, likely generic antibiotic. However, in the age of reduced antibiotic use due to stewardship programs aimed at reducing drug resistance, use of early sepsis therapeutics may be stemmed.

“Antibiotic stewardship programs have proven useful in curtailing unnecessary antibiotic use, and accordingly, potential antibiotic resistance. With regards to sepsis, this is a double-edged sword; potentially slowing the administration of a potentially life-saving drug, but at the same time, reducing overall antibiotic resistance, increasing the chance of successful eradication of the pathogen.

“The industry’s investment in sepsis supports its awareness of the severe consequences of sepsis; however, commercialization of new agents is only part of the equation. Absent new therapeutics, the most promising steps are to more rapidly identify both patients who might be at risk for sepsis, and which antibiotics to give them. Aimlessly using antibiotics will certainly have negative consequences, particularly in terms of development of resistance, but we need to make sure we are not being overly cautious and delaying use of critical treatments.”

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