Finding solutions to antibiotic overuse

Dr Verena Gantner

General Practitioner, Switzerland

Dag Berild

Consultant and Professor of Infectious Medicine, the University of Oslo and Oslo Metropolitan University

Antibiotic resistance is the climate crisis of medicine — the man-made depletion of a vital medical resource due to rampant worldwide overuse.

Norwegian researcher, Dag Berild, has been studying rational antibiotic use for 30 years and explains how C-reactive protein point-of-care testing, using devices is a simple step doctors can take to help curb this coming crisis.

Antibiotics are among the most valuable class of drugs ever discovered. They save countless lives every year and make many other procedures — such as transplantation, cancer therapy and surgery with prostheses — possible.

However, due to rampant worldwide overuse, there is a danger of losing this essential medical resource soon.

“Unfortunately, the world is headed into a post-antibiotic era because of the overuse of antibiotics,” says Dag Berild, Consultant and Professor of Infectious Medicine at the University of Oslo and Oslo Metropolitan University. “If this continues, we will not have antibiotics in maybe 20 or 30 years. The more you use it, the more you lose it.”[1]

We must stop prescribing antibiotics for viral infections

The primary problem, say Berild and other experts, is the practice of prescribing antibiotics for self-limiting viral illnesses — such as respiratory tract infections — rather than limiting their use to treating severe bacterial infections and disease.

“The most common reason for prescribing antibiotics in primary care is respiratory tract infections,” says Berild. “They account for more than 50% of antibiotic prescriptions, both in hospital and in general practice.”[1]

In a large portion of those cases, the infection is viral and will not respond to antibiotics. The patient will bear the burden of cost and may suffer side effects. The repeated overuse contributes to antibiotic resistance in their region.

“Countries that have a higher prescribing rate of antibiotics also have higher antimicrobial resistance,” says Dr. Verena Gantner, a general practitioner in Muri, Switzerland. “In Central Asia, we got used to seeing doctors prescribe antibiotics that were not needed — even more than in Europe. And patients pay for that.”[2]

Lord Jim O’Neill, a former chairman of Goldman Sachs and professor of economics at the University of Manchester, led the Review on Antimicrobial Resistance (AMR) on behalf of the British government.

O’Neil’s researchers concluded that if we don’t undertake big policy initiatives, by 2050 there could be 10 million people around the world dying from AMR-related illnesses. Among the most important needs is rapid and affordable diagnostics.[3]

Improving diagnostics in three minutes with CRP testing

Berild points out that rapid and affordable diagnostics do currently exist. “We use CRP point-of-care testing for respiratory infections in Norway,” says Berild. “This helps us discriminate between serious bacterial infections that need to be treated with antibiotics and self-limiting disease.”[1]

CRP uses a simple finger stick to test a patient’s blood for C-reactive protein (CRP), a marker for inflammation and infection that can reduce diagnostic uncertainty and over-prescription of antibiotics in patients with viral infections.

A high CRP result indicates a severe bacterial infection where antibiotic treatment would likely be beneficial, but a low value indicates a viral or self-limiting infection that would be better treated by other means.

“CRP is a very important biomarker,” says Dr Gantner. “The benefit of CRP point-of-care testing is that I can take blood from only a fingertip and have results in about three minutes. Then I can show the value to my patients and they are reassured they have only a viral infection.”[2]

Evidence shows that CRP point-of-care testing works on a broader level. Two large studies in 6 European countries found that combining CRP point-of-care testing and enhanced communication skills of health care professionals resulted in a relative reduction of antibiotic prescribing by more than 60%.[4][5]

“Very few new antibiotics have been developed in the past 30 years so, it is crucial that we preserve the ones we currently have” says Berild.[1]

“This is not just a medical issue, it’s an ethical one,” says Berild. “Our generation misused antibiotics and created this problem, so when our children and grandchildren need them, there will be no effective ones left.”[1]