UK: Can New Diagnostic Tests Help Tackle Antibiotic Resistance?

Last Updated: 2 February 2016
Article by Karen Taylor

Antibiotics, first prescribed in the mid-1940s, have for many years been seen as the magic bullet to treat infections. However, as quickly as prescribing commenced, antibiotic resistance emerged. In recent years, serious concerns over antibiotic resistance have grown as inadequate control over their use and lack of understanding or monitoring of resistance has led to the emergence of highly resistant strains of bacteria. These concerns continue to amplify, as evidenced in a recent report by Lord Jim O'Neil, the Treasury Minister and former economist, who calls for more investment in rapid diagnosis of bacterial infections to prevent the misuse of antibiotics.1 This week's blog considers the progress in developing and using rapid diagnostic tests to support the prescribing of antibiotics.

There is considerable evidence of the benefits that antibiotics have brought to global health, with antibiotics estimated to have added, on average, twenty years to everyone's lives. On the other hand, the world now faces the prospect of increasing numbers of infections that have developed a resistance to most currently available antibiotics. Indeed, antimicrobial resistance currently claims at least 700,000 lives a year and, without the development of new medicines, could cause more than 10 million deaths a year by 2050, costing the global economy up to $100 trillion.2

In the UK, a survey commissioned by Public Health England to mark the November 2015 European Antibiotic Awareness day, found that 40 per cent of people are taking antibiotics for coughs or runny noses unnecessarily. The survey also revealed huge gaps in public knowledge on antibiotics, 90 per cent are unaware that drug-resistant bacteria can easily spread from person to person, 40 per cent believed they can treat viral infections and half believe antibiotics weaken your immune system.3

Since the House of Lords Science and Technology enquiry into antibiotic resistance in 2000, there have been numerous national and international enquiries and reports which have identified actions that are urgently needed to tackle the misuse and over-use of antibiotic prescribing. However, the misconception that antibiotics are a cure-all for all ills, has proved a very difficult myth to shift.

In 2013, the Chief Medical Officer for England, Dame Sally Davies, suggested that the risk to public health of the rise in drug-resistant bacteria is just as deadly as climate change and international terrorism.4 The ensuing debate, focussed on the need for more effective control over the use of antibiotics, as well as highlighting the need to find novel ways of funding the development of new antibiotics.

The issue is complex, especially given recent media headlines highlighting the distressing cases of babies and young children misdiagnosed as suffering from viral infections who subsequently died due to an aggressive bacterial infection. Inquests into these cases suggested that antibiotics may well have treated their condition effectively.

For more than a decade, GPs in the UK have been subject to numerous campaigns, incentives and penalties aimed at encouraging them to reduce the prescribing of antibiotics. However, most techniques that diagnose bacterial infections have generally taken days or weeks to show conclusively whether a patient had an infection that could be treated with antibiotics. In the meantime, and often under emotional pressure from patients, antibiotics have been prescribed "just in case". Indeed, various surveys in England have identified that nine out of 10 GPs say they feel pressurised to prescribe antibiotics, and around a quarter of the antibiotic prescriptions issued a year are given unnecessarily for illnesses like colds or ear infections caused by viruses.

But it doesn't have to be like this - one initiative that could help remove such uncertainty is the development of more effective and speedier ways of diagnosing the cause of infections. Not only would doctors benefit from having the right tools to diagnose properly , it would also reassure patients that the doctor actually knows that it is a viral rather than a bacterial infection and be able to agree on the appropriate treatment, curbing unnecessary overuse of certain drugs.  

Rapid diagnostics could also be used in clinical trials, to identify the right study patients, improve clinical care and stewardship, and help get drugs approved for limited populations, all of which would help reinvigorate the antibiotic pipeline and tackle multi-drug resistant infections.

A 2015 consensus report identified the UK as the European leader for research in point-of-care diagnostics. The report suggest that one reason why antibiotic prescribing in the UK remains considerably higher than in many other northern European countries is that needle-prick, point-of-care C-restive protein test (POC CRP)5, is currently massively under-utilised.6 The report suggests that if the test were used more widely it could slash antibiotic prescriptions for respiratory infections in primary care by up to 41.5 per cent, saving the NHS £56 million a year on prescription and dispensing costs alone. The report goes on to recommend that Clinical Commissioning Groups develop innovative ways to fund POC CRP testing. Indeed, both the National Institute for Health and Care Excellence and Public Health England have backed the use of POC CRP to help steer the correct course of treatment with respiratory tract infections.7

While rapid diagnostics appear to be the key, they have to be quick, cheap, accurate and accessible to all health settings if they are to be adopted more widely and slash the growth of resistance. 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.

If the world is to avoid the "apocalyptic scenario" of a post-antibiotic era, which the World Health Organisation says will happen this century unless something drastic is done; everything that can be done needs to be done. Neither the private nor public sector can succeed in the development of new antimicrobials and new technologies that allow quicker diagnosis and facilitate targeted treatment, without the other. Collaborations and partnerships between industry, government and academia will be needed if we are to accelerate development. Given the enormity of the challenge, action will also be needed at a local, national and global level.

Footnotes

1 Rapid Diagnostics. Stopping unnecessary use of antibiotics. Review of Antimicrobial Resistance Chaired by Jim O'Neil. October 2015. http://amr-review.org/sites/default/files/Paper-Rapid-Diagnostics-Stopping-Unnecessary-Prescription.pdf.

2 Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations. The Review on Antimicrobial Resistance Chaired by Jim O'Neill. December 2014

3 https://www.england.nhs.uk/patientsafety/amr/eaad/

4 Davies S, Grant J, Catchpole M. The Drugs Don't Work: A Global Threat. Penguin Specials 2013.

5 C Reactive Protein (CRP) is a major acute-phase plasma protein which is produced in response to infection or tissue injury. A recent Cochrane review concluded that a point-of-care biomarker ( CRP) to guide antibiotic treatment of acute respiratory infections (ARIs) in primary care can significantly reduce antibiotic use. See also: http://bmjopenrespres.bmj.com/content/2/1/e000086.full#sec-8

6 Ensuring the Rational Use of Antibiotics in Primary Care using C-Reactive Protein Testing. A Consensus Report. June 2015. See also: http://www.patients-association.org.uk/wp-content/uploads/2015/06/straight-to-the-point.pdf

7 NICE. Antimicrobial stewardship: Systems and Processes for Effective Antimicrobial Medicine Use. See also: https://www.nice.org.uk/guidance/indevelopment/gid-antimicrobialstewardship/documents

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