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Point-of-care diagnostics needed to curb antimicrobial resistance

Huge quantities of antibiotics ‘wasted globally’, say experts

Jo Carlowe

Friday, 23 October 2015

Governments must promote the uptake of rapid point of care diagnostic tests to curb the threat of antimicrobial resistance, experts have said today. 

Rapid Diagnostics: Stopping unnecessary use of antibiotics, published today, is part of The Review on Antimicrobial Resistance, chaired by economist Jim O’Neill. In the report, experts say the supply of new medicines is insufficient to keep up with the increase in drug resistance as older medicines are used more widely and microbes evolve to resist them. 

The report further explains: “…the demand for these medicines is very badly managed: huge quantities of antimicrobials, in particular antibiotics, are wasted globally on patients who do not need them, while others who need them do not have access. Fundamental change is required in the way that antibiotics are consumed and prescribed, to preserve the usefulness of existing products for longer and to reduce the urgency of discovering new ones.”

A central part of the solution, say the authors, is “rapid point-of-care diagnostic tests” to solve the demand problem “which results currently in enormous unnecessary antibiotic use”. 

The review illustrates the problem by taking the example of the modern health system in the United States, where a study found that more than two-third of courses of antibiotics, were inappropriately prescribed to adults visiting their doctors with respiratory problems – amounting to 27 million courses of antibiotics wasted a year, in just one set of indications, in the US alone. 

Other “worrying” examples, included powerful antibiotics being used as a treatment for gonorrhoea, “where the world’s ‘last line’ treatment is given on a precautionary basis to almost all patients", even though 70-80% of cases in the UK would be expected to respond to older 'first line treatments'. As a result, cases of multi drug-resistant gonorrhoea are increasing, presenting a risk that untreatable cases will emerge. 

The report states that stewardship programmes to change prescribing habits of doctors and the expectations of patients can go some way towards addressing the issues of overuse. 

In addition, it says “new rapid diagnostics” are needed too, rather than “empirical” diagnoses.

“For material progress to happen over the next five years healthcare systems need to leapfrog to using rapid diagnostics wherever possible, before using an antibiotic,” states O’Neill. 

Katherine Murphy, chief executive of the Patients Association, has welcomed the findings.

“As Jim O’Neill’s report highlights, the Department of Health must promote the uptake of C-Reactive Protein as point of care test in GP practices and Community Pharmacies to reduce antibiotic prescribing in respiratory tract infections. The Department should also adopt the Antimicrobial Self-Assessment Toolkit) in all NHS Hospitals as a benchmark for the state of antimicrobial stewardship, and promote the adoption and early evaluation of Reactive Oxygen Dressings to help prevent surgical site infections.”

The Review on Antimicrobial Resistance was commissioned by the UK Prime Minister. It is supported by the Wellcome Trust and the UK Government, but operates independently from both. 

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