Once while reporting on a medical meeting for new antibiotics, I met a physician/researcher who said “stay in the hospital long enough, and something bad will happen to you.” Now the prolific drug developer Bruce Montgomery and his Seattle-based startup have set their sights on making new antibiotics to fight one of those bad things that often happen to people in the hospital.
Cardeas Pharma, which attracted the first installment of a $7.5 million financing in December, is advancing into its first clinical trial this quarter with a new treatment for ventilator-associated pneumonias, Montgomery said in his first detailed interview about the company. Cardeas’s lead product candidate is an inhalable combination of antibiotics. They are designed to combat the lung infections people get in the hospital, often in intensive-care units, which can increase hospital stays by an average of seven to nine days, and increase costs by an average of $40,000 per patient.
While doctors have some traditional generic antibiotics they can already use on these patients, the drugs are given intravenously, and don’t often get absorbed into the lungs in high enough concentrations to wipe out tough-to-treat bugs like Pseudomonas aeruginosa and MRSA, Montgomery says. So Montgomery and his team, which have together developed inhalable antibiotics for other lung diseases at PathoGenesis, Corus Pharma, and Gilead Sciences, have set their sights on this growing problem that drives hospital administrators and insurance companies batty. Statistics are a bit hard to come by, but estimates are that 250,000 to 300,000 patients a year in the U.S. get ventilator-associated pneumonias, which raises the risk of serious complications and death, according to a 2006 review by University of Virginia researchers.
“If you can improve health outcomes and save the healthcare system money, that’s a great place to be. That’s where I want to be,” Montgomery says.
The basic concept at Cardeas, which Montgomery has never discussed publicly before, is pretty simple. The company is starting with a couple of generic antibiotics that have been around for decades—amikacin and fosfomycin—and adapting them into an aerosol form that’s designed to get them to penetrate deep into the sputum in the lungs where dangerous bacteria thrive.
By combining these drugs, Cardeas hopes to accomplish a couple of important things. First, since doctors often don’t know precisely what kind of infection they are dealing with (diagnostic culture tests in the lab can take a day or two), Cardeas wanted a combo that works against common classes of gram-negative and gram-positive bugs. Secondly, while bacteria always find a way to develop resistance to drugs over time, it is more difficult for bugs to develop resistance to two drugs as opposed to one, Montgomery says.
The first drug, amikacin, is commonly used by hospitals in the intravenous form to fight some of the nasty breed of multi-drug resistant gram-negative bugs like Pseudomonas and Acinetobacter baumannii.
The second drug, fosfomycin, is usually given as a single large dose for treating urinary tract infections. This compound, which can be used against tough to treat gram-positive bugs like MRSA, is largely “a forgotten drug,” Montgomery says.
Both of the compounds have been shown
