Contributed Commentary by Neil Polwart
August 29, 2017 | With the risk of anti-microbial resistance (AMR) ratcheting up news agendas across the globe, there’s a growing awareness among the general public that we’re rapidly reverting to a time when a simple cut could prove deadly.
The current AMR crisis stems from a number of factors, particularly the overuse of antibiotics in both human and animals, causing bacteria to become resistant to treatment. It is currently responsible for 25,000 deaths and €1.5 billion in economic losses every year in the EU. Experts have predicted that by 2050, drug-resistant infections could cause global economic damage on a par with the 2008 financial crisis.
It’s been cited as a threat greater than global terrorism and is a vastly complex challenge – the fact that only two new classes of antibiotics have been created in the last 50 years, give us some indication of the severity of the issue.
Although the looming threat of AMR is terrifying, as someone working at the intersect between cutting-edge diagnostics and smartphone technology, I’ve been heartened by the potential that new technology has to help us monitor and manage AMR.
Mobile Tracing
I’m particularly interested in the role that mobile technology has to play in improving traceability. From understanding where an outbreak started and where infected patients are located, to obtaining up-to-date information on the spread of resistant infection—technology can provide us with a coherent method of tracking and tracing AMR—something that’s currently sorely lacking. Antibiotic stewardship programmes are starting to gain traction in the US, but only really in acute hospital care settings.
Earlier this summer, the European Union launched a comprehensive action plan to tackle antimicrobial resistance and I was pleased to see that embracing new technology was a critical part of the planned strategy. It was heartening also to hear a number of speakers at the recent Next Generation Dx Summit* in Washington DC, discuss diagnostics supporting decision-making in this area, both in hospitals and at the pharmacy.
Lack of awareness is a key factor in the rise in antimicrobial resistance. According to the EU report, 57% of Europeans do not know that antibiotics are ineffective against viruses and 44% fail to understand that they are ineffective for treating cold and flu. This places pressures on clinicians to prescribe in inappropriate circumstances, furthering the AMR problem; although some researchers suggest that this problem is overstated and patients directed to appropriate care report positive feedback.
Although it’s clear no single action alone will provide an adequate solution—new diagnostic tools are key in stepping up the war against AMR. Connected mobile technology creates a rapid, reliable, and instantly shareable diagnostic solution—crucial for quickly differentiating between bacterial and viral infections and to identify AMR.
Technology’s potential to enable genuine Point of Care Testing (POCT) means that healthcare professionals can quickly identify those who are carrying an infection. This creates multiple benefits, including managing prescriptions, delivering tailored treatments for bacterial infections (removing the need for broad-based antibiotic treatment), and limiting infection outbreaks. POCTs can also be delivered outside of the laboratory—and are already helping to control and monitor the spread of infectious diseases like HIV, in rural communities.
Monitoring irresponsible prescription of antibiotics by medical professionals seems like an obvious first step on the journey to tackling resistance. I expect that within a decade, doctors will be required to centrally document and justify each prescription for the most crucial antibiotics and I’d be delighted to see legislation brought into place to effect this change. This is a key issue, particularly in countries where antibiotics can still be purchased over the counter.
Technology provides us with a way to prevent irresponsible dispensing—providing proof and accountability that will ensure only appropriate patients have been prescribed antibiotics. I’d suggest that similar traceability will be needed to support any use in food production, as the industry shifts from prophylactic to responsive use.
Experts are also starting to question the advice about always completing the course of medication and together with the possibility of “delayed” prescriptions, which you can only start if your symptoms don’t improve in a few days.
Shared Data, Shared Knowledge
These steps offer real changes to prescribing culture, however in order to understand their effectiveness, we will need new tools to track a large number of patients many of whom recover and have no natural reason to report their outcomes.
Data sharing portals can also be incorporated, meaning results are rapidly stored and shared. This would enable tracking of infection outbreaks and more proactive decision making during future epidemics.
As the European Commission and other global bodies move forward in developing new strategies to tackle this complex challenge, increasing a focus on innovation and collaboration will be key to ensuring we have a deepening pool of new and mobile technologies to draw upon in the battle to identify, track, and ultimately halt the spread of AMR.
*Next Generation Dx Summit; August 15-18, 2017; Washington D.C. The event was sponsored by Cambridge Healthtech Institute, the parent company of Diagnostics World News.
Dr. Neil Polwart, Novarum DX Founder and BBI Group Head of Mobile, has a PhD in Chemistry and around 15 years working in the diagnostics arena. He specialises in leading mHealth development, delivering connected health and true point of care technology solutions and has worked in the field of bio-sensors for nearly 20 years. He can be reached at npolwart@novarumdx.com.