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. 2017 Aug 1;65(3):495-500.
doi: 10.1093/cid/cix320.

Challenges and Opportunities of Nontraditional Approaches to Treating Bacterial Infections

Brian N Tse  1 , Amesh A Adalja  2   3 , Christopher Houchens  1 , Joseph Larsen  1 , Thomas V Inglesby  2 , Richard Hatchett  4
Affiliations

Challenges and Opportunities of Nontraditional Approaches to Treating Bacterial Infections

Brian N Tse et al. Clin Infect Dis. .

Abstract

Due to increasing rates of antimicrobial-resistant infections and the current inadequacy of the antibiotic pipeline, there is increasing interest in nontraditional approaches to antibacterial therapies. We define "traditional" agents as small-molecule agents that directly target bacterial components to exert a bacteriostatic or bactericidal effect, and "nontraditional approaches" as antimicrobial therapeutics that work through other means (ie, not a small molecule and/or utilizes a nontraditional target). Due to their atypical features, such therapies may be less susceptible to the emergence of resistance than traditional antibiotics. They include approaches such as monoclonal antibodies, virulence disruptors, immunomodulators, phage therapies, microbiome-based therapies, antibiotic potentiators, and antisense approaches. This article discusses both the developmental and regulatory advantages and challenges associated with each of these technologies. By identifying existing regulatory and developmental gaps, we hope to provide a sense of where focusing resources may provide the greatest impact on successful product development.

Keywords: antibiotic resistance; antibodies; microbiome; nontraditional approaches; phage.

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Conflict of interest statement

Potential conflicts of interest. A. A. A. is a consultant for Merck and Roche, has lectured at Merck, and owns stock in Merck and Luminex. T. V. I. serves on the board of directors for Purthread, and has grants with Johns Hopkins University, the University of Maryland, the Robert Wood Johnson Foundation, the de Beaumont Foundation, the Open Philanthropy Foundation, US Centers for Disease Control and Prevention, Naval Postgraduate School, and US Departments of Defense, State, and Homeland Security. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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