3^rd World Congress and Exhibition on Antibiotics and Antibiotic Resistance July 30-31, 2017 Milan, Italy

Antibiotic resistance refers specifically to the resistance to antibiotics that occurs in common bacteria that cause infections. The easy access and effectiveness of Antibiotics led to overuse in live-stock raising promotes bacteria to develop resistance. This led to widespread problems with antibiotic resistance. World Health Organization (WHO) classified antimicrobial resistance as a serious threat and no longer a prediction for the future.  Antibiotic resistance is now among every part of the world and its affecting everyone irrespective to the age. When infections become resistant to first-line drugs, more expensive therapies must be used. A longer duration of illness and treatment, often in hospitals, increases health care costs as well as the economic burden on families and societies. To help prevent the development of current and future bacterial resistance, it is important to prescribe antibiotics according to the principles of antimicrobial stewardship, such as prescribing antibiotics only when they are needed.

Certain bacterial infections now defy all antibiotics. The resistance problem may be reversible, but only if society begins to consider how the drugs affect "good" bacteria as well as "bad". Historically, most antibacterials were used in hospitals, where they were incorporated into soaps and surgical clothes to limit the spread of infections. More recently, however, those substances (including triclocarbon, triclosan and such quaternary ammonium compounds as benzalkonium chloride) have been mixed into soaps, lotions and dishwashing detergents meant for general consumers. They have also been impregnated into such items as toys, high chairs, mattress pads and cutting boards.

Overall sales in the current antibiotics and new products market were nearly $40 billion in 2008. It increased to $41.5 billion in 2009. By 2015, it is projected to increase to $65.5 billion, for a 5-year compound annual growth rate (CAGR) of 9.6%. The largest segment antibiotic drugs market was nearly $36 billion in 2008; this further increased to $37 billion in 2009, this projected to reach $50 billion in 2015, for a 5-year CAGR of 5.9%. Sales in the bacterial vaccines market amounted to $3.6 billion in 2008 which increased slightly to $3.9 billion in 2009. This is projected to increase to $15 billion in 2015, for a 5-year CAGR of 31.6%.

In the past most drugs have been discovered either by identifying the active ingredient from traditional remedies or by serendipitous discovery. A new approach has been to understand how disease and infection are controlled at the molecular and physiological level and to target specific entities based on this knowledge. The process of drug discovery involves the identification of candidates, synthesis, characterization, screening, and assays for therapeutic efficacy. Evolution of an existing drug molecule from a conventional form to a novel delivery system can significantly improve its performance in terms of patient compliance, safety, and efficacy. These days, drug delivery companies are engaged in the development of multiple platform technologies to get competitive advantage, extend patent life, and increase market share of their products. Once a compound has shown its value in these tests, it will begin the process of drug development prior to clinical trials.

New diseases are arising worldwide and old diseases are re-emerging as Infectious agents evolve or spread, and as changes occur in ecology, socioeconomic conditions, and population patterns. Likewise, many diseases thought to be adequately controlled appear to be making a comeback. In developed countries, public health measures such as sanitation, sewage treatment, vaccination programs, and access to good medical care-including a wide range of antibiotics-have virtually eliminated “traditional” diseases such as diphtheria, whooping cough, and tuberculosis.

Antibacterial action generally falls within one of four mechanisms, three of which involve the inhibition or regulation of enzymes involved in cell wall biosynthesis, nucleic acid metabolism and repair, or protein synthesis, respectively. The fourth mechanism involves the disruption of membrane structure. Many of these cellular functions targeted by antibiotics are most active in multiplying cells. Since there is often overlap in these functions between prokaryotic bacterial cells and eukaryotic mammalian cells, it is not surprising that some antibiotics have also been found to be useful as anticancer agents.

Antibiotics, also known as antibacterials, are types of medications that destroy or slow down the growth of bacteria. In 1929, Alexander Fleming identified penicillin, the first chemical compound with antibiotic properties. Some of the common antibiotics are Penicillins, Cephalosporins, Carbapenems, Macrolides, Aminoglycosides, Quinolones, Sulfonamides and, Tetracyclines etc. General principles of antibiotic prescribing are use: First-line antibiotics first, Reserve broad spectrum antibiotics for indicated conditions only, prescribe antibiotics for bacterial infections if Symptoms are significant or severe.

The antibiotics market generated sales of US$42 billion in 2009 globally, representing 46% of sales of anti-infective agents (which also include antiviral drugs and vaccines) and 5% of the global pharmaceutical market¹. However, the antibiotics market is maturing; it showed an average annual growth of 4% over the past 5 years, compared with a growth of 16.7% and of 16.4% for antiviral drugs and vaccines, respectively.

The cephalosporin class of antibiotics is the largest in terms of sales, generating $11.9 billion in 2009, led by sales of the latest generation of drugs in this class (cefcapene (Flomox; Shionogi), ceftriaxone (Rocephin; Roche) and cefuroxime (Zinnat; GlaxoSmithKline). This class represents 28% of the total antibiotic market, and sales showed a growth of 3.4% over the past 5 years. With sales of $7.9 billion and 19% of the antibiotic market share in 2009, the second largest drug class is the broad-spectrum penicillins, which showed a growth of 5% between 2005 and 2009. The third largest drug class — the fluoroquinolones — had sales of $7.1 billion in 2009, accounting for 17% of the antibiotic market in 2009, and also showed an average growth of 5% between 2005 and 2009. By contrast, as generic versions of an increasing number of macrolides — which had $4.8 billion in sales in 2009 — became available, sales of this class declined by 5% between 2007 and 2009. Overall, the rate of patent expiry of leading antibiotics in the market is set to increase, with several of the current top-selling products facing patent expiry between 2010 and 2016. These include levofloxacin (Levaquin; Johnson & Johnson), moxifloxacin (Avelox; Bayer/Merck) and linezolid (Zyvox; Pfizer), which are expected to lose patent protection in 2011, 2014 and 2016, respectively.

Environmental microbes are a major source of drug discovery, and several microbial products (antibiotics, anti-tumour products, immunosuppressants and others) are used routinely for human therapies. Most of these products were obtained from cultivable (<1%) environmental microbes, and this means that the vast majority of microbes were not targeted for drug discovery. With the advent of new and emerging technologies, we are poised to harvest novel drugs from the so-called 'uncultivable' microbes. In this article, we propose how a multidisciplinary approach combining different technologies can expedite and revolutionize drug discovery from uncultivable microbes and examine the current limitations of technologies and strategies to overcome such limitations that might further expand the promise of drugs from environmental microbes.

Prescribing doctors are, increasingly, using clinical trial data as a major source of information for evidence-based medicine for the treatment of infectious diseases, as in other clinical disciplines. However, it may be difficult to extract from these data the information that is needed for the management of the individual patient. At the same time, clinical trial data have been used, apparently satisfactorily, in the process of drug registration, and the pharmaceutical industry has spent increasingly large sums of money to satisfy the needs of this process. In the face of all these problems, changes in the way antibiotic clinical trials are designed and performed are clearly necessary, although this must not tip the balance so far as to render them less useful for those who currently derive greatest benefit from them.

Antibiotics are among the most frequently prescribed medications in modern medicine. Antibiotics are useless against viral infections. When you take antibiotics, follow the directions carefully. It is important to finish your medicine even if you feel better. If you stop treatment too soon, some bacteria may survive and re-infect you. Do not save antibiotics for later or use someone else's prescription.

Nearly 2 million Americans per year develop hospital-acquired infections (HAIs), resulting in 99,000 deaths – the vast majority of which are due to antibacterial-resistant pathogens. Two common HAIs alone (sepsis and pneumonia) killed nearly 50,000 Americans and cost the U.S. health care system more than $8 billion in 2006. Based on studies of the costs of infections caused by antibiotic-resistant pathogens versus antibiotic-susceptible pathogens, the cost to the U.S. health care system of antibiotic resistant infections is $21 billion to $34 billion each year and more than 8 million additional hospital days. 

Regulatory affairs (RA), also called government affairs, is a profession within regulated industries, such as pharmaceuticals, medical devices etc. Regulatory affairs also have a very specific meaning within the healthcare industries (pharmaceuticals, medical devices, biologics and functional foods). Regulatory affairs (medical affairs) professionals (aka regulatory professionals) usually have responsibility for the following general areas: Ensuring that their companies comply with all of the regulations and laws pertaining to their business. Working with federal, state, and local regulatory agencies and personnel on specific issues affecting their business. i.e. working with such agencies as the Food and Drug Administration or European Medicines Agency (pharmaceuticals and medical devices)

Although the field of antibiotics is developing so rapidly as to render it almost kaleidoscopic, during recent months several topics of general interest have come into sharp focus. The subject of first consideration will include not only new drugs but also new forms of old drugs, as well as old drugs. Beyond this, I shall confine my discussion to two main items, bacterial resistance to antibiotics, and antibiotic toxicity. A variety of biological solutions have yet to be fully explored.

Antibiotics are commonly prescribed during pregnancy. The specific medication must be chosen carefully, however. Some antibiotics are OK to take during pregnancy, while others are not. Safety depends on various factors, including the type of antibiotic, when in your pregnancy you take the antibiotic, how much you take and for how long. Antibiotics generally considered safe during pregnancy: Amoxicillin, Ampicillin, Clindamycin, Erythromycin, Penicillin, Nitrofurantoin. Although there's no direct proof that these antibiotics cause birth defects, additional research is needed. In the meantime, use of these medications is still warranted in some cases.

The global systemic antibiotics market was valued at $39.6 billion in 2013 and is expected to reach $41.2 billion by 2018, at a CAGR of 0.8%. Since, 2005 this market is seen to grow at an annual rate of 6.6% until 2011. There are many companies manufacturing antibiotic these days and there are many other antibiotics present in the market such as aminoglycoside antibiotics and it covers about 79% of the global demand. Moreover, the other antibiotics such as penicillin have 8%, tetracyclines 4%, erythromycin 7%, streptomycin 1% and chloramnphenicol has 1 % market.

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Antimicrobial prophylaxis is commonly used by clinicians for the prevention of numerous infectious diseases. Optimal antimicrobial agents for prophylaxis should be bactericidal, nontoxic, inexpensive, and active against the typical pathogens that can cause surgical site infection postoperatively. To maximize its effectiveness, intravenous perioperative prophylaxis should be administered within 30 to 60 minutes before the surgical incision. Antimicrobial prophylaxis should be of short duration to decrease toxicity and antimicrobial resistance and to reduce cost.

Antibiotics must be used judiciously in humans and animals because both uses contribute to the emergence, persistence, and spread of resistant bacteria. Resistant bacteria in food-producing animals are of particular concern. Food animals serve as a reservoir of resistant pathogens and resistance mechanisms that can directly or indirectly result in antibiotic resistant infections in humans. For example, resistant bacteria may be transmitted to humans through the foods we eat. Some bacteria have become resistant to more than one type of antibiotic, which makes it more difficult to treat the infections they cause. Preserving the effectiveness of antibiotic drugs is vital to protecting human and animal health.