Infectious diseases have plagued humanity since ancient times. While medical advances have led to treatments and cures for many infectious illnesses, new pathogens continue to emerge and evolve, posing ongoing threats to global health. Developing effective therapies against infectious diseases therefore remains a critical priority for medical researchers worldwide. In this article, we examine some of the major challenges in infectious disease therapeutics and highlight promising areas of ongoing research that aim to deliver new treatments and improve patient outcomes.
The Challenge of Antimicrobial Resistance
One of the biggest challenges facing infectious disease treatment is the growing problem of antimicrobial resistance. When bacteria, viruses, fungi and parasites evolve resistance to existing antibiotic, antiviral or antifungal drugs, previously treatable infections can become very difficult or impossible to cure. The overuse and misuse of antimicrobial medicines has accelerated the emergence and spread of resistant microorganisms. According to the World Health Organization, antimicrobial resistance is already responsible for around 700,000 deaths globally each year. If left unaddressed, resistance could undermine a century of medical progress and potentially cause ten million deaths annually by 2050. Addressing this serious and evolving threat requires coordinated global efforts to develop new antimicrobials, optimize antibiotic use, and limit unnecessary exposure and transmission of resistant pathogens.
Developing Novel Antimicrobial Agents
Given the risks posed by resistance, discovering wholly new classes of antibiotics, antifungals and antivirals with novel mechanisms of action is a research priority. While the traditional approach of screening natural products and mutagenizing existing compounds has yielded few winners in recent decades, new screening techniques and whole-cell phenotypic assays are showing promise. Innovative platforms like phage therapies and antimicrobial peptides are also attracting attention. Major pharmaceutical firms are collaborating with academic groups and biotechs through initiatives like AMR Accelerator to advance more candidates into clinical testing. Even so, developing each new drug is a lengthy, complex and costly process. Sustained investments will be needed to replenish depleted drug pipelines and ensure a steady flow of novel therapies.
Optimizing Existing Drugs
Alongside new drug discovery, optimizing currently available treatments remains an important strategy. Researchers are investigating ways to enhance the efficacy, safety and cost-effectiveness of existing antimicrobials through formulation modifications, drug combinations and repurposing for new indications. For instance, some groups are working to develop improved inhalable or injectable formulations of antibiotics to aid treatment of difficult-to-reach infections like cystic fibrosis or bone and joint infections. Combining antimicrobials can sometimes overcome resistance or act synergistically to achieve greater effects at lower doses. Meanwhile, repositioning approved drugs for new uses, an approach with a shorter development timeline, holds promise for identifying new antivirals, antiparasitics and antifungals. With continued innovation, more patients may benefit from cost-effective optimized versions of available drugs.
Improving Diagnostics for Targeted Treatment
Rapid, accurate diagnostic testing is critical for prescribing the right antimicrobial at the outset of treatment, minimizing unnecessary drug use while curbing resistance. New diagnostic platforms employing technologies like PCR, sequencing, microarrays and biosensors are shortening the timeline for pathogen identification from days to hours or even minutes. Improved diagnostics now enable rapid distinction of viral from bacterial infections without culture, guiding clinicians towards appropriate targeted therapy or watchful waiting. Further innovations may facilitate point-of-care species identification and rapid susceptibility testing directly from patient samples. This would allow initiating guided therapy much earlier when it matters most, improving outcomes while curbing further resistance selection. With the WHO target of diagnosing 65% of infectious diseases within one day by 2022, diagnostic advances will be integral to curbing the global burden of antimicrobial resistance.
Enhancing Host Defenses Naturally
Rather than solely relying on antimicrobial drugs, boosting the human body’s intrinsic defenses against infection is an attractive long-term strategy. Various immunomodulatory approaches are under study, such as vaccines to prevent infections, monoclonal antibodies for treatment, and immunostimulants to enhance host responses non-specifically. Probiotics, prebiotics and gut microbiome modulation hold promise for crowd-pleasing beneficial microbes in the gut or elsewhere while blocking bad pathogens. Technologies enabling rapid, large-scale screening of natural product libraries may uncover new candidates with immunomodulatory properties from diverse microbial and plant sources. With a deeper mechanistic understanding of immunity and its manipulable leverage points, supporting the body’s own defenses could complement drug-based treatments and help curb antimicrobial overuse driving resistance over the long run.
Conclusion
Developing effective therapeutics against infectious diseases remains a critical medical priority given the ongoing emergence and evolution of pathogenic threats alongside the scourge of antimicrobial resistance undermining existing treatments. While discovering wholly novel antibiotics and refining available drugs will continue playing major roles, broader strategies focusing on optimized combination therapies, improved diagnostics, and natural host defenses also hold promise. Through coordinated global innovation and partnership efforts across these many fronts, we stand the best chance of sustaining medically important antimicrobial efficacy for future generations in the face of ever-changing microbial adversaries. With sustained investments and collaboration among all stakeholders, better treatments and ultimately new prevention strategies can be realized to curb avoidable suffering from infectious illnesses worldwide.
