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Innovation for the development of novel diagnostic systems/technology to collect data on antibiotic dispersion and repurposing of old drugs to address antimicrobial resistance

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Background            

Increasingly, the development of antimicrobial resistance (AMR) and drug resistant infections is being recognized as a crosscutting threat to global health. High rates of resistant infections have been documented in healthcare and community settings, in all WHO regions, and against a broad range of microorganisms. Despite the global focus, considerable gaps remain in our understanding of burden and resistance patterns, including the burden of drug-resistant infections on children in the highest mortality countries in Africa and Asia.

However, what is clear is that AMR is not just a clinical or health services issue and to successfully mitigate it, we will have to simultaneously work across multiple fronts from generating new drugs, to designing ever more sensitive and accurate diagnostics and surveillance systems, to increasing awareness and changing patient and prescriber behaviour among many others.

Challenge

AMR is a complex problem with multiple interconnected drivers and therefore our focus is on high mortality and data-poor geographies, these approaches will likely require new concepts and approaches applied in a sufficiently robust way to lead to strategic guidance for decision-makers.

What we are looking for

We are looking for solutions to either of the following challenges:

  • Repurposing old antimicrobials to make them useful to combat infections today– Novel drug development is a long, expensive process and repurposing of old drugs is a recognised method to expedite the process of generating new drugs and drug combinations to combat the development of AMR. Therefore, we are interested in preliminary/early stage data and ideas for repurposing old antibiotics/antimicrobials that were removed from use either due to the development of resistance or being found to be inefficient or toxic then. Repurposing the drug in this case could mean the addition of an adjuvant, a non-antibiotic addition or the addition of a compound that would increase the effectiveness of the drug. We are looking to fund only preliminary studies in this area.
  • Developing simple, low-cost and rapid point-of-care diagnostic tests to differentiate between viral and bacterial infections to guide rational prescription of antibiotics at healthcare centres– Empirical treatment of illnesses with antibiotics, whether necessary or not, is a huge driver of antibiotic consumption. Empirical treatment occurs as we do not have accurate POC diagnostic devices that are readily available for doctors/ prescribers to base their decisions on. Additionally, patient expectations have been found to drive antibiotic prescriptions.
  1. We are looking for preliminary ideas and data to develop POC diagnostics that will provide the basic level of information to differentiate bacterial and viral infections at the doctor’s clinic/ healthcare institution. These would be over and above the current biomarkers used (C Reactive protein and procalcitonin). Novel ideas on use of new biomarkers to improve current bacterial/viral differentiation tests would be considered.
  2. We are looking for preliminary ideas and data to develop POC diagnostics that will provide the basic level of information to diagnose specific infectious conditions such as neonatal sepsis, VAP/HAP, infectious diarrhea, LRI, URI among others, that see high levels of resistance both in the hospital and community settings.
  • Environmental antibiotic pollution

Environmental resistance, or resistance that develops in the ambient environment is often ignored or less studied aspect which is important in the Indian scenario due to poor sanitation infrastructure, a lack of standards in effluent discharge for active pharmaceutical ingredients and lack of available treatments to remove Active Pharmaceutical Ingredients (APIs) from municipal wastewater.

Antimicrobials reach the ambient environment through effluent discharge during manufacture of APIs and during human and animal use and discharge.

Studies have demonstrated that the concentration of ciprofloxacin, a commonly used antibiotic, was 1000-fold higher than the level toxic to some bacteria. Pollution with waste from antibiotic manufacturing in the environment could also serve as an  important reservoirs of antibiotic resistance.

Antimicrobials, especially antibiotics, are not degraded within human or animal bodies and are often excreted in the same form with similar levels of activity. Household and hospital waste and wastewater often contains high levels of antibiotics, which once they reach sewage treatment plants, with the influx of bacteria from waste, become the perfect breeding grounds for developing resistance and transfer to pathogenic bacteria.

  1. We are looking for studies that will harness technology to collect data and investigate the levels of antibiotics/antimicrobials that are discharged from factories/big pharmacies around different settings as well as the levels in sewage treatment plants to analyze and understand the extent of the problem in India.
  2. We are looking for proposals that explored the safe levels of APIs that can be discharged into environment safely (there is some work already happening on this internationally).
  3. Proposals enumerating animal sources of antibiotics into the environment in India.

What we will not fund

  • Proposals seeking to apply existing tools and technologies in ways that do not transform available technologies
  • Incremental improvements to conventional diagnostic solutions or typical disease surveillance.
  • Ideas not directly relevant to low and middle income contexts.
  • Proposals involving clinical trials in human volunteers or patients (note: use of existing datasets or other outputs from clinical trials may be considered, so long as the proposed approach is feasible within the time and financial envelopes provided).
  • Approaches that represent incremental improvements to conventional solutions (e.g., research of current methods for vaccine discovery, development and delivery intended to expand, improve or integrate existing technologies or tools);
  • Solely behavioral change/educational initiatives (e.g., training programs, scholarships, education programs);
  • Solely infrastructure or capacity-building initiatives;
  • Approaches that present unacceptable downstream safety risks (e.g., as a barrier to product development)

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