In the antibiotics market, scientific knowledge on the human microbiome can potentially be used for communication purposes. In means of, that manufacturers can use these insight to differentiate their active substances portfolio against others and regulatory institutions could promote the use of narrow-band antibiotics over broad-band ones. The use of medical communications aiming at the illustrations of the effects of antibiotics on the intestinal flora, are the focus of this article. The consulting firm Homburg & Partner from Mannheim finds three approaches for Medical Marketing using scientific findings of microbiome research.
First, manufacturers of specific narrow-band antibiotics are able to differentiate themselves from competitors and justify their higher price.
Second, manufacturers of original antibiotics can differentiate themselves from generic suppliers through specific Medical Marketing.
Third, the findings of microbiome research promotes reconsidering the German healthcare system including the recommendations and budgets for antibiotics and therefore increase clinical and private budgets for the use of specific narrow-band antibiotics.
An example of the interaction between antibiotics and microbiomes is the intestinal gut wall. Especially antibiotics, among others pharmaceutical treatments, can result in a dysfunctional microbiome, also known as dysbiosis, and potentially lead to chronic intestinal diseases. Even a one-week treatment with antibiotics already reduces the diversity and density of a patient’s intestinal microbiome dramatically. This is highlighted by samples taken from the Yanomani, an indigenous group in the Amazonas region, who show a 40 percent greater diversity of the microbiome compared to western populations. Reason for the lower diversity in western population is the daily exposure to antibiotics through food.
Gastrointestinal antibiotics such as rifampicin, vancomycin and metronidazole are characterized by their broad range of applications against a variety of pathogenic bacteria. However, this ostensibly advantage is accompanied by damage and change in the physiological composition of the microbiome and a diversity reduction of up to 90 percent.
Overall, the human microbiome consists of the genes of all microorganisms living in symbiosis with humans. In every anatomical niche of the body, a form of microbiome has differentiated itself, whereas the majority of all micro-bacteria are found in the intestines. Recent studies show that the microbiome can be divided into three groups called enterotypes. In each of these three enterotypes bacterial type is dominant- Bacteriodesm, Prevotella or Ruminococcus.
The microbiome is the key to understand drug intolerances and autoimmune diseases. It affects lipo-metabolic disorders and is associated with diabetes, cardiovascular diseases and some further malignancies. Additionally, the microbiome affects the human psychological condition via the intestinal-brain axis and is associated with psychopathologies such as schizophrenia and depression. These far-reaching influences of the microbiome on human well-being could lead to future personalization of treatment and dosage of drugs. The assumption that the microbiome regenerates within a few weeks after antibiotic treatment has proven to be false. Rather, dysbiosis can extend from several months to a couple of years. In recent years, trying to do something good to the microbiome of the intestine has gained popularity but remains controversial. Probiotics, which have been associated with an improvement of the microbiome may show adverse effects depending on the individual enterotype.
Fig. 1: After an antibiotic treatment, the diversity of the micriobiom can decrease significantly.
Manufacturers of specific narrow-band antibiotics should be aware of the benefits their products offer in terms of the diversity of the microbiome, highly reduced dysbiosis and decrease of future complications. Therefore, a clear Medical Marketing which enables differentiation of the products from broad-band antibiotic competition as well a strong communication of these messages to the physician is recommended. To demonstrate the benefits of specific antibiotics, direct interaction with key opinion leaders (KOL) and antibiotic stewardship teams (teams to improve the antibiotics prescription guidelines) should be established. Explicit targeting of costly DRG-target disease (DRG = diagnosis-related case groups for billing clinical treatment), which allow for high medical treatment expenses, can also justify the higher costs of narrow-band antibiotics.
The approach would be different for manufacturers of established broad-band antibiotics. As in this market segment the majority of available antibiotics are open to generic competition and do not offer much opportunity for differentiation. Originators can however still use the insights on the interaction of broadband antibiotics with microbiomes to differentiate their original products from generic alternatives. The presentation of the antibiotic-specific interactions with the microbiome and the resulting differentiation criteria can be translated into Medical Marketing. In addition to generating new messages, originators can position themselves as first movers in microbiome marketing by focusing more on the interaction of active substances with the microbiome. Further, they have the opportunity to market their products with focus on individual enterotypes.
Microbiome research should initiate a paradigm shift in the administration of antibiotics. This is opposed by the existing flat-rate accounting procedure in the health care system. Since gastrointestinal infections are often seen as concomitant symptoms, the German accounting system merely provides a low extra budget, which does not cover the additional costs of specific antibiotics. Thus, this system favors the use of cheap broad-spectrum antibiotics over the use of specific narrow-spectrum antibiotics. This applies to both the clinical sector, where costs are regulated by the DRG system as well as the private sector, where the drug budget caps costs. Moreover, holistic therapy concepts with the addition of pre- and probiotics could establish themselves in the market in order to counteract dysbiosis caused by antibiotic intake. The strong use of pre- and probiotics can currently be observed in the OTC market and is based on self-payer products and pharmacy positioning on this subject. Such approaches are not yet in focus of pharmaceutical companies, but should be driven forward (as well as by the other health care players). For example, each package of antibiotics could be delivered with prebiotics. First movers of such therapy concepts could gain an impulse for their sales.