Boston University School of Law’s Kevin Outterson* looks at how cost-saving measures are contributing to the rise of drug-resistant “superbugs” in the US and the steps that need to be taken to remedy the situation.

Globally, 700,000 people lose their lives to drug-resistant infections each year.

In November 2019, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma outlined her agency’s strategy for combatting drug-resistant bacteria, or “superbugs.”

The announcement is timely. Bacteria are evolving to resist our most powerful antibiotic treatments. Globally, 700,000 people lose their lives to drug-resistant infections each year. By 2050, that number could grow to 10 million.

Yet, as Verma explained in her announcement, “Our antiquated systems for reimbursing physicians and hospitals for antibiotic treatment have disincentivized both the development and use of new antibiotics.” To ignite the level of antibiotic development we need, U.S. policymakers will need to change the way we dispense and pay for antibiotics.

Most infections can still be treated safely and effectively with generic antibiotics. But even when they’re battling multidrug-resistant infections, healthcare providers tend to use older, sometimes toxic antibiotics, simply in order to save money.

Consider colistin, a commonly prescribed antibiotic that dates back to the 1950s.

The antibiotic, which treats certain types of drug-resistant infections, often spurs kidney damage. Some colistin treatments cause acute kidney injuries in more than 50 percent of patients, according to a recent analysis. The medicine is so toxic that if it were invented today, the Food and Drug Administration probably wouldn’t approve it for sale.

Despite these well-known health risks, and the fact that newer, less toxic drugs are available for infections being treated with colistin, doctors have administered colistin in well over 1,000 cases per year.

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