Spellberg Brad, Gilbert David N, Baym Michael, Bearman Gonzalo, Boyles Tom, Casadevall Arturo, Forrest Graeme N, Freling Sarah, Ghanem Bassam, Hamilton Fergus, Luna Brian, Moore Jessica, Musher Daniel M, Nielsen Travis B, Nori Priya, Phillips Matthew C, Pirofski Liise-Anne, Shorr Andrew F, Tong Steven Y C, Lee Todd C, McDonald Emily G
Hospital Administration, Los Angeles General Medical Center, Los Angeles, CA 90033, United States.
Division of Infectious Diseases, Department of Medicine, Oregon Health Sciences University School of Medicine, Portland, OR 97239, United States.
Health Aff Sch. 2025 Jan 24;3(2):qxaf012. doi: 10.1093/haschl/qxaf012. eCollection 2025 Feb.
To combat antimicrobial resistance (AMR), advocates have called for passage of the Pioneering Antimicrobial Subscriptions To End Upsurging Resistance (PASTEUR) Act in the United States, which would appropriate $6 billion in new taxpayer-funded subsidies for antibiotic development. However, the number of antibiotics in clinical development, and US Food and Drug Administration approvals of new antibiotics, have already markedly increased in the last 15 years. Thus, instead of focusing on more economic subsidies, we recommend reducing selective pressure driving AMR by (1) establishing pay-for-performance mechanisms that disincentivize overprescribing of antibiotics, (2) focusing existing research and development funding on strategies that decrease reliance on antibiotics, and (3) changing regulation or law to require specialized training in antibiotic stewardship for a clinician to be able to prescribe new antibiotics that target unmet AMR need. To stabilize the antibiotic market, we recommend (1) establishment of an advisory board of clinical practitioners to more accurately target existing antibiotic incentives and (2) endowment of nonprofit companies that sustainably self-fund antibiotic discovery, creating a bench of molecules that can be partnered with industry at later stages of development.
为应对抗菌药物耐药性(AMR),倡导者呼吁美国通过《终结激增耐药性的开创性抗菌药物订阅法案》(PASTEUR法案),该法案将拨出60亿美元由纳税人出资的新补贴用于抗生素研发。然而,在过去15年里,处于临床开发阶段的抗生素数量以及美国食品药品监督管理局(FDA)批准的新抗生素数量已经显著增加。因此,我们建议,与其专注于更多的经济补贴,不如通过以下方式降低推动AMR的选择压力:(1)建立按绩效付费机制,抑制抗生素的过度处方;(2)将现有的研发资金集中用于减少对抗生素依赖的策略;(3)改变监管或法律,要求临床医生接受抗生素管理方面的专业培训,以便能够开具针对未满足的AMR需求的新抗生素。为稳定抗生素市场,我们建议:(1)设立一个临床从业者咨询委员会,以更准确地确定现有的抗生素激励措施;(2)资助那些能够可持续地自我资助抗生素研发的非营利性公司,打造一批可在后期开发阶段与行业合作的分子。