The National Institutes of Health have given Duke researchers a grant that could be worth up to $11 million over the next six years.
Dr. Vance Fowler, an associate professor of medicine at Duke University Medical Center and the primary investigator for the project, said the research addresses the issue of antibiotics and resistance.
“We’re sort of in the worst possible storm in regards to antibiotics because the need is growing and the number of available antibiotics is dwindling,” he said. “While there are a number of reasons for this, one big factor is that big pharmaceutical companies are getting out of the development because it is not sufficiently profitable.”
Fowler hopes to prove that using his algorithm, doctors will be able to determine the amount of antibiotics a specific patient will need, instead of the current system which he believes overprescribes the method to treat intravenous infections.
Although antibiotics have worked well in the past, their utility is diminishing because they are being used too often, Fowler added.
“Tens of thousands of kilograms of this is being used in the United States of America and in Western Europe,” he said. “Subjecting the bacterial population to 20,000 kilograms of these antibiotics raises significant concerns as the bacteria population will eventually evolve to develop resistance.”
In order to test his hypothesis, Fowler will run a six-year trial that will be located in five sites in the United States and one in Spain. The trial, which he hopes to start next year, will enroll 600 volunteer patients with identified bloodstream infections who have signed an informed consent document to be treated either normally or algorithmically to test which is more effective.
His research focuses on a specific infection most commonly caused by an infected IV catheter, which is the leading cause of blood stream infections in hospitals. These infections, he said, can range anywhere from clinically insignificant colonization all the way to life threatening. The patients he is concerned with are those who have come into the hospital for treatment and while in the health care system have developed an infection through an IV catheter.
“Currently, there is no standard way to treat these patients,” he said. “We want to use an algorithm that we have developed to define treatment decisions based on a search criteria that helps clinicians make decisions on when to stop treating the infections with antibiotics.”
Fowler added that this algorithmic approach will provide a non-inferior standard of care while reducing the total number of antibiotic days in treating the blood infection.
“The reason NIH is paying $11 million is because there is no way to figure out who to treat and who not to treat,” he said. “We are figuring out a way to do just that.”
Sophomore Brandon Pierce said he believes the grant is appropriate for this research, especially given that the grant will be received over time as specific milestones are met. He added that it is a valuable investment that may yield long-term benefits.
This development will not only lower the total cost of antibiotics, but will also reduce global selection—giving bacteria less of a chance to evolve and develop a resistance to treatment. Fowler believes that if this method is shown to be a good standard of care, it will rapidly be adopted by practitioners everywhere, reducing the use of antibiotics.
“It seems that there have been discrepancies in providing treatment for this blood stream infection,” said junior Mays Ali. “This research, if successful, will lead to better and more standardized patient care.”
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