$17.1 Million Prize for Solving Antibiotic Resistance

Neil Osterweil

July 15, 2014

A prize originally awarded to the solvers of a problem that had plagued sailors since the dawn of history is now being offered to the scientists, researchers, or rank amateurs who can steer mankind through the increasingly treacherous shoals of multidrug-resistant bacteria.

The Longitude Prize 2014 challenges scientific professionals, backyard tinkerers, students, and entrepreneurs alike to come up with the solution to a simple but crucially important question: How can we prevent the continued rise of resistance to antibiotics?

The person or group who can create a point-of care test for bacterial infections that is "cheap, accurate, rapid and easy to use" and can guide clinicians in appropriate antibiotic selection will earn the £10 million (US $17.1 million) prize, backed by the Nesta foundation, Technology Strategy Board of the United Kingdom, and the British Broadcasting corporation (BBC).

"Point-of-care test kits will allow more targeted use of antibiotics, and an overall reduction in misdiagnosis and prescription. Effective and accurate point of care tests will form a vital part of the toolkit for stewardship of antibiotics in the future. This will ensure that the antibiotics we have now will be effective for longer and we can continue to control infections during routine and major procedures," according to the Longitude Prize Web site.

Time Is of the Essence

The Infectious Diseases Society of America (IDSA) recently issued a public policy statement encouraging development of improved diagnostics for infectious diseases.

"Despite dramatic advances in diagnostic technologies, many patients with suspected infections receive empiric antimicrobial therapy rather than appropriate therapy dictated by the rapid identification of the infectious agent. The result is overuse of our small inventory of effective antimicrobials, whose numbers continue to dwindle due to increasing levels of antimicrobial resistance," the statement says.

Angela M. Caliendo, MD, PhD, lead author of the statement and executive vice chairman of the Department of Medicine at the Warren Alpert Medical School of Brown University, Providence, Rhode Island, tells Medscape Medical News that the idea of a prize is intriguing.

"The clinical need is out there. It's not a gimmick, there's definitely a need for rapid tests that can drive decision making," she said.

The ideal test would not only allow clinicians to confidently identify or exclude a bacterial or viral pathogen but would also serve as a decision tool to help determine whether a patient needs urgent care or hospitalization, she said.

"You have to have a test that is very sensitive, with a very high negative predictive value," Dr. Caliendo said, "so that when you tell a physician that a test is negative, they know with a 98% certainty that you've ruled it out, because if not, you're not going to change their management, you're not going to change their use of an antibiotic."

Outside the Box

The prospect of a handsome prize may be just the thing needed to spark the interest of investigators or inventors who have unconventional ideas or approaches to this complex and challenging problem, agreed C. Buddy Creech, MD, MPH, associate professor of pediatric infectious diseases and associate director of the Vanderbilt Vaccine Research Program at Vanderbilt University School of Medicine in Nashville, Tennessee.

"We have limited resources at the local and federal level — at least in the US — that we can dedicate to all of the problems that affect humans, whether that's cancer, chronic diseases associated with aging, or infectious diseases," Dr. Creech told Medscape Medical News.

"We've done a great deal of work with those limited resources, but having this sort of bolus into the system I think is really smart. I think this is a moment that we'll be able to look back on and think, 'this is the moment where out-of-the-box thinking was rewarded.' "

However, solving the problem of rapid diagnostics will only address a single aspect of a larger, multifaceted problem, he emphasized.

"We've got overuse of antimicrobials, we've got very virulent organisms that cause devastating diseases in which you really don't have time to worry about resistance in an individual patient and you want to be able to cover them adequately for the infection they may have."

(A recent WebMD/Medscape survey found that clinicians prescribe antibiotics when they are not absolutely certain they are necessary 21.5% of the time.)

Dr. Creech continued, "We have the use of antibiotics in livestock, and we have the natural history of microorganisms that are built to develop mutations and therefore built to develop resistance over time."

There is a need for both rapid and accurate diagnostics to promote more judicious use of antibiotics, and for antimicrobial agents targeted more narrowly to specific pathogens, as opposed to broad-spectrum agents, Dr. Creech said.

For example, an agent targeted solely against Staphylococcus aureus would prevent other bacteria from developing resistance and could eliminate the risk for adverse drug-related events such as diarrhea associated with Clostridium difficile, he explained.

When Britannia Ruled the Waves

The original Longitude Prize was established by the British government in 1714 to solve the vexing and dangerous problem of determining longitude — the precise location of a geographic coordinate in an East-West orientation — within one half of a degree. The prize was a then-staggering £20,000, or nearly $2 million in today's money, according to the BBC.

Finding latitude (how far north or south of the equator a ship was) was a relatively simple matter, based on solar, lunar, and stellar observations, but determining longitude was a far greater technical challenge. Without an accurate reading of longitude, ships frequently went far astray of their destinations, costing their owners considerable time and money, and in the case of the British Navy, threatening the outcome of military actions.

The problem was solved by both a working-class clockmaker, who developed a highly accurate chronometer that told navigators the difference in time between their current position and that of the Prime Meridian in Greenwich, England, and by a group of astronomers who developed accurate tables and instruments for determining longitude by measuring the Moon's apparent motion relative to the stars.

Dr. Creech has disclosed receiving funding for vaccine research from Pfizer and Novartis. Dr. Caliendo is on the scientific advisory boards of Quidel, Roche Diagnostics, Roche Molecular, Janssen, and BioFire Diagnostics; has consulted for Biotrin/Diasorin; and has conducted clinical trials with Roche Molecular, Qiagen, and T2.

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