Scientific discovery begins with basic research in the laboratory at "the bench." To improve human health, however, these discoveries must be translated into practical applications that reach the patient's "bedside." NIAID-supported research in antimicrobial (drug) resistance helps facilitate this translation of basic research discoveries from "bench to bedside."
Tests that determine exactly which microbe is making a person sick can take a long time—sometimes several days or weeks—to get results. This is because many of today's tests require the microbe to grow over a period of time before it can be identified. As patients often need treatment sooner, healthcare providers must provide drug coverage for a wide range of possible pathogens. They therefore may start with a combination of drugs, including broad-acting drugs that target multiple organisms. While this approach can effectively treat individual patients, using broad-spectrum therapies before the specific microbe is identified can contribute to drug resistance.
Multiple complementary strategies are needed to address the growing problem of antimicrobial resistance. For example, healthcare providers need faster ways to diagnose infections and evaluate whether a certain strain of microbe is susceptible to particular antimicrobial drugs. This information will help guide treatment decisions, including the use of narrow-spectrum drugs to effectively treat infection and minimize drug resistance.
To meet this need for better, faster diagnostics, NIAID supports research such as the following:
Along with accurate diagnosis, healthcare providers need information that will help them to prescribe the proper dose of a drug—one that is effective but limits the microbe's odds of developing resistance following prolonged exposure to the drug. The appropriate dosage requires a clear understanding of how the antimicrobial drug is broken down in the human body (the drug's pharmacokinetics) and how the drug affects the microbe it is targeting (the drug's pharmacodynamics). NIAID is supporting research in these areas in order to improve dosage recommendations and limit the development of antimicrobial resistance. For example, NIAID supports projects studying the pharmacokinetics and pharmacodynamics of drugs commonly used to treat TB, influenza, and malaria, as well as hospital-acquired infections caused by Gram-negative bacteria.
NIAID also supports efforts to collect this information for older antibiotics for which the most appropriate dose is unclear. As situations arise where commonly used antibiotics are no longer effective, healthcare providers are returning to some of the older antibiotics, such as colistin. Though resistance to colistin is still low, healthcare providers stopped using the drug many years ago because of its toxicity. Information from NIAID-supported studies helps inform the best ways to dose colistin to maximize effectiveness while limiting toxicity. NIAID also supported research re-assessing the effectiveness of currently available drugs against TB to understand how drug resistance develops even when multiple drugs are used at the same time. These findings can help healthcare providers determine appropriate treatment strategies for TB.
The number of new antimicrobial drugs has not kept pace with the rise of antimicrobial-resistant microbes. NIAID has a substantial research program to spur development of new therapeutics against drug-resistant viruses, bacteria, parasites, and fungi.
NIAID supports university-based scientists and researchers at biotechnology companies who are exploring new ways to treat infections with substances that make it difficult for microbes to develop resistance. For example, NIAID supported key foundational and preclinical studies of a novel monoclonal antibody for the treatment of Staphylococcus aureus.
Other NIAID-supported efforts to develop new or improved drugs include the following:
The more an antibiotic is used, the more likely resistance to that drug becomes. In the presence of an antimicrobial agent, microbes are either killed or, if they carry resistance genes, survive. Through this process, drug-resistant survivors will replicate and their progeny will quickly dominate the microbial population. The emergence and spread of antimicrobial-resistant microbes can be reduced by minimizing the unnecessary use of these drugs.
Well-designed clinical trials provide data that healthcare providers need to make treatment decisions. This research will lead to better healthcare practices and more refined therapeutic approaches, such as shorter treatment duration or alternative therapies that do not require antimicrobials to minimize the emergence of antimicrobial resistance.
The following NIAID-supported clinical trials are examples of how NIAID is working to reduce the risk of antimicrobial resistance:
The need for new drugs would be reduced if bacterial or other infections could be prevented through effective interventions, including vaccines. NIAID supports a variety of studies on potential prevention strategies, including the following:
NIAID has built a comprehensive set of product development services and research tools and technologies to facilitate efforts to develop the next generation of vaccines, diagnostics, and therapeutics. These services make needed expertise as well as standardized, high-quality research materials and state-of-the-art technologies available to eligible investigators worldwide at no charge. Information regarding these resources may be found at Microbiology and Infectious Diseases Resources.
A variety of NIAID preclinical services are available to advance research related to drug-resistant pathogens, including
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Last Updated May 30, 2014