Doris-Ann Williams MBE
Chief Executive, British In Vitro Diagnostics Association
Antimicrobial resistance has the potential to decimate the global population and poses an enormous threat to everyone on Earth.
There are many examples of antibiotic overuse, which have allowed bacteria to develop resistance to the antibiotics by mutating. They have the ability to evolve rapidly to survive and thrive.
Human health is a core example. Health systems differ around the world, both in the use of antibiotics and how far healthcare is developed, and the extent to which the bacteria is causing infection in different geographical locations.
Humans can spread antimicrobial-resistant bacteria by travelling abroad
Movement of people – as we travel by air, for example – exacerbates the problem, as antibiotic resistant infections can infect new populations of people. Tuberculosis (TB) is an example of this and some of the different types of bacteria causing TB have become very strongly resistant to nearly all antibiotics making treatment very difficult.
Detection of infection needs to be achieved as quickly and accurately as possible. In the developed world this must occur in both community and in hospital settings. There are a number of simple, rapid tests that should be more highly utilised to determine whether infection is caused by a virus or by bacteria, as only bacteria can be treated with antibiotics.
Antibiotics aren’t always the right medicine
People naturally want to recover from coughs and colds as rapidly as possible, so a healthcare professional may prescribe a course of antibiotics. But many of these coughs and colds will be due to a viral infection and so an antibiotic prescription is ineffective – having a test to demonstrate this will help family doctors explain this to patients.
Studies also show a significant number of physicians are likely to prescribe antibiotics to treat diarrhoea caused by rotavirus, due to the lack of capacity to establish a diagnosis. The fear of poor treatment outcomes for critical diseases and to prevent widespread deaths, can lead doctors to resort to blind prescription of multiple and broad-spectrum antimicrobials, which further impacts on resistance by the organisms.
In a hospital setting, it is even more critical to treat patients rapidly and with the right antibiotic to prevent sepsis and other life-threatening infections from gaining hold in the body and spreading among the other, vulnerable in-patients. Laboratory tests are becoming more rapid and sensitive to allow this. Some tests look for specific genetic material from bacteria so enabling the most effective antibiotic to be used.
Basic healthcare systems require simple, accessible tests
However, in many parts of the world, healthcare is much more basic than this and infection rates are already very high. People live in remote areas and even where there are hospitals, these often do not have the same equipment and specialists to support the highest level of healthcare. So, diagnostic tests for these regions need to be simple, compact and rapid, easy to perform and without requiring electricity or a water supply. They also need to be cheap but safe and reliable! These are not easy requirements to meet as developing the tests and making the format meet these demands takes time and money.
How mobile phone tech and drones can reach remote areas
Innovative uses of technology can deliver change in managing health, such as the use of mobile phone technology as one way of providing platforms for tests and managing results – even in remote regions – as huge numbers of these populations do have mobile phones. Another use of technology is to use drones to quickly deliver medical supplies – such as testing kits – where transport is an issue.
Funding is needed to ensure bacteria does not win the battle
There is a variety of initiatives to provide funding sources to support test development as well as to produce more anti-bacterial treatments around the world, such as the Longitude Prize in the UK, but meanwhile it really remains a struggle to get more diagnostic tools and wider usage of existing diagnostic tests in the different healthcare settings before the resistance levels are such that bacteria win the battle.