Antibiotic resistance is one of the primary public health challenges of our time.

Most people alive today take antibiotics and the changes they brought to modern life for granted. Before the 20th century, you were as likely to be “cured” by a faith healer or leeches as you were from any actual drug.

Antibiotics changed all that, ushering in an age where a simple scratch can no longer kill, and we’ve forgotten what life was like before they existed.

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But the quality of life that antibiotics have delivered to the world may not last forever.

In fact, the problem may be getting worse, as bacteria are in some cases mutating to become even more resistant to antibiotics, as researchers at Uppsala University in Sweden recently discovered.

“Tuberculosis (TB) kills at least 1.5 million people annually. A normal treatment requires four different antibiotics taken for several months. If one of the drugs does not work there is a great risk of a treatment failure. Unfortunately, antibiotic-resistant TB is now very common globally. For successful treatment it is important to quickly determine which antibiotics the TB bacteria is susceptible to. This diagnosis used to take several weeks, because TB bacteria grow very slowly. With the revolution in DNA sequencing it is nowadays possible to sequence the bacterial DNA and predict which antibiotics it will be susceptible to, all in a matter of a days.

“Recently, scientists at Uppsala University found that many clinical TB bacteria contained ‘frameshift mutations’ in a gene for making an essential protein (RpoB) that is the target of a very important TB antibiotic, rifampicin. This type of mutation should have killed the bacteria, but they were apparently alive and were recovered from TB patients receiving antibiotic treatment.”

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The fact is, every year in the U.S. at least 2.8 million people get an antibiotic-resistant infection — including tuberculosis, staph, gonorrhea and more — and more than 35,000 people die, according to the CDC

Synthetic dyes have been used to manufacture antibiotics since 1907.

Penicillin has been in the arsenal since 1942.

It just makes sense that legacy antibiotics are becoming less effective.

The more subtle challenge to addressing antibiotic resistance is the business model. It is becoming harder and harder to develop new antibiotics. The treatment period is typically a week, and in only a few years resistance emerges. At that point, it’s back to the beginning to find another solution.

So, an innovator has to pay off $1 billion of development cost with short dosage periods and short useful life.

Not good.

iSelect has passed on several drug-related approaches to this for this reason, but we’ve found others making headway.

We invested in Shield Bio for one. Shield uses third-generation gene sequencing to rapidly identify bacteria and choose the most effective antibiotic to treat it, all in one test. And, this is done while the patient is sitting in the doctor’s office.

Rather than creating a “superbug” antibiotic, by understanding the genetics of each particular person and the bacteria causing the infection, doctors are finding that long-forgotten generic antibiotics can often be just as effective. 

By diversifying the antibiotic solutions, we reduce the population’s resistance profile.

We still need to develop faster drug approval processes to reduce the cost of new antibiotics, but entrepreneurs will figure this out in time too.