The Changing Landscape of Infectious Disease
In the last century, we have come a long way in our ability to treat infectious diseases. The twentieth century saw the development of penicillin and other antibiotics, the invention of the polio vaccine, and the development of medications to manage HIV. In the early 2000s, many scientists turned toward seeking cures for non-communicable diseases that were responsible for more than 50% of illness. However, it is necessary to continue to push forward in the development of new treatments for infectious disease. The phenomenon of antibiotic resistance underscores the need. We are starting to see some of these resistant responses in tuberculosis and malaria. Indeed, antibiotic resistance will be the cause of most deaths from infectious disease by 2050.
What we need to stop these diseases is drugs that target bacteria in new and different ways. Possibilities include: broad-spectrum antibiotics, genetic and genomic methods, and new strategies to permeate the cell wall. We also need to increase development efforts for rapid diagnostic tests (RDTs). Better RDTs would help healthcare providers avoid antibiotics for symptoms that do not require antibiotics and would allow use of narrow-spectrum antibiotics, which would likely be more effective than broad spectrum treatments. In order to use these medications, physicians need to know if a pathogen has a resistance component, which thus far is difficult to know without waiting days or weeks for additional diagnostic lab work. In addition to creating new drugs, we need to improve tests for resistant strains. Some researchers have been seeing positive results using RNA testing.
To combat drug resistance, changes need to take place at three levels. At the patient level, we need to change attitudes towards medication and increase compliance, because skipping doses can lead to drug resistance. At the physician or health practitioner level, we need education to change prescribing habits and decrease over-prescription. At the research and manufacturing levels, we need to develop new drugs and new methods of diagnostics that are quicker and more accurate and that allow us to check for resistant strains.