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Antibiotics and Antibacterial drugs are among the most commonly used class of drugs in Pakistan and other countries like ours. Poor hygienic conditions, pollution, contamination, inefficient sanitation and overall living conditions lead to high incidence of infections. The use of antibiotics has to be there to control infections.
Pakistan is among high antibiotic-usage countries. According to statistics, antibiotics sales were reported to be over ninety billion rupees for the 12 months period ending on June 2018. Antibiotics share in the overall pharmaceuticals business was about 24 percent, thus making it the largest group of drugs.
A lot of debate has always been around about misuse of antibiotics in Pakistan in two ways. One, unnecessary use in simple infections which may be tackled by the body’s own immune system. Two, use of more potent and stronger antibiotics where a less potent drug could be enough. The denominator for both is the same. The patients want relief as quickly as possible, and the physicians comply to either please them or impress them with their capability.
The implications of the above tendency are that bacteria become resistant to antibiotics early and that the choices of last resort when nothing else works become more and more limited.
Despite the growing resistance and other issues, the large pharmaceutical companies stopped investing in new research on antibiotics long time back. The reason was that the antibiotic prices were lower and though more units would sell but per unit profit would be small. The big Pharma diverted their resources to much more lucrative areas such as HIV, Cancer and rare diseases. If you try to remember when the last major new antibiotic was launched, you would probably think of twenty years ago. In fact, after Quinolones, no new group of antibiotics has been launched; that was thirty years ago. There have been a few isolated drugs which came on the market in this period.
USFDA approved 55 new drugs in 2018 till 30th November; only five are antibacterial. You can see the pace of progress in this area from this fact.
Lately, it has been reported that some smaller companies have taken up the challenge of developing new antibiotics, and that they are making good progress. It is encouraging to know. However, the problem is two-pronged. The big Pharma does not want to invest in antibiotic research because the Return On Investment (ROI) is not good; they would not want to launch it either because the price is small and a huge number of units must be sold to generate reasonable volume.
Big Pharma is now addicted to highly-priced products which would generate big revenue. Sovaldi was priced at 100 US Dollars Per Tablet in the US. Gilead gave huge discount to third world countries with high incidence of Hep C; 90% in Pakistan – 99% in Egypt.
Novartis has recently won European approval for its blindness fighting gene-therapy approval. They have indicated that the list price in US will be USD 850,000 for single therapy.
With such things in pipeline, who cares for the peony antibiotic pills which sell for a few cents?