Untreatable gonorrhea is now a reality—and a sign of a growing threat to public health. Last month, the World Health Organization reported that some strains of the sexually transmitted disease are completely resistant to antibiotics. That means that unless something changes, when the inevitable college student ends up at Student Health with that burning sensation, there may be no respite.  

Gonorrhea is just one of many infections, from E. coli and Salmonella to tuberculosis that are becoming increasingly antibiotic resistant. In fact, public health professionals fear a “return to pre-antibiotic” age, when deadly pathogens can no longer be controlled by drugs. We desperately need to develop pharmaceuticals that are less likely to be rendered ineffective.

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The paper disks have different antibiotics: Antibiotics in the discs in the culture on the left prevent bacteria from proliferating. Bacteria in the culture on the right are resistant to most of the antibiotics, via Wikimedia Commons

Fortunately, scientists are exploring new kinds of treatments that better target specific infections and work with, rather than against, nature. Researchers at the University of Massachusetts in Amherst, MA, for example, are aiming to prevent and eventually cure urinary tract infections caused by E. coli with a bacteriocin: proteins produced by bacteria that target closely related species. The beauty of specificity is that it leaves the rest of our microbiome intact, unlike the traditional broad spectrum antibiotic. And because many of the bacteria in our own microbiome have likely been lobbing bacteriocins at one another for eons – these are likely to be a relatively safe option with few side effects.

Another potentially promising and highly specific option is bacteriophages: viruses that infect bacteria. This so-called “phage therapy” has been used for nearly a century, particularly in Eastern Europe. But they are essentially unavailable here in the U.S., a casualty of poor practices by early twentieth century pharmaceutical companies, the advent of antibiotics like penicillin, and the Cold War. Desperate American patients with untreatable infections including MRSA are making their way across the ocean for a cure. And when a University of California professor suffering from a potentially lethal multidrug resistant infection received and was cured by phage here in the U.S., it became headline news. Like bacteriocins, phage are already part of our normal flora. These are just two hopeful examples of employing ecology for our own protection.

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Neisseria gonorrhoeae, via Wikimedia Commons

While these new options are promising, their greatest strength—specificity and the capacity to cure infection—means they will never become blockbuster drugs, which may make them less attractive to big pharma. There are also questions of how to regulate biologicals like phage, that don’t behave as typical pharmaceutical chemicals, and there is the high-cost of drug testing and trials which may be daunting for small-scale developers. 

Those working on these non-traditional solutions need support from our federal regulatory institutions, agencies that fund medical research and healthcare, and perhaps even big pharma. The recent workshop sponsored by The Food and Drug Administration (FDA), Center for Biologics Evaluation and Research, and the National Institutes of Health, National Institute of Allergy and Infectious Diseases, is a hopeful sign. But with antibiotic resistance on the rise, we need to move these natural solutions from the laboratory to the pharmacy now. The longer we wait, the closer we come to infections that are now curable turning deadly.