New rapid diagnostic tools are needed to stop the unnecessary use of antibiotics and tackle superbugs, a government review has said.
Fundamental change is required to make a dent in the huge number of antibiotic prescriptions given mistakenly for viral infections, according to the report.
Creating more refined tests – which will allow doctors to identify in minutes the strain of bacterial infection present and the antibiotics to which it is resistant or susceptible – will allow more precise prescribing of narrow-spectrum antibiotics, it said.
Jim O’Neill, the economist and former chairman of Goldman Sachs Asset Management who is leading the Review on Antimicrobial Resistance set up by David Cameron in July 2014, said: “For far too long we have not recognised the huge cost to society of increasing resistance when we use antibiotics that we don’t need, such as taking antibiotics for flu, which have no effect except to increase the chances of superbugs developing.
“To avoid the tragedy of 10 million people dying every year by 2050, the world needs rapid diagnostics to improve our use of antibiotics. They are essential to get patients the right treatment, cut down on the huge amount of unnecessary use and make our drugs last longer.”
The review highlighted a study that found that more than two-thirds of courses of antibiotics in the US – equivalent to 27m – were likely to have been inappropriately prescribed for conditions that were not infections at all, or were caused by viruses.
The report, the latest in a series by the review – which will publish final recommendations in spring next year, suggested that rapidly advancing technology in the shape of computer learning and artificial intelligence could be put to good use in changing antibiotic prescribing.
But it cautioned that a step-change in behaviour is needed to alter long-established ways of using antibiotics.
One problem the review identified was that it is more expensive and more time-consuming for a doctor or a patient to use a diagnostic than to use a drug just in case it is needed, even if the wider consequences are negative.
For instance, in the UK, the world’s “last-line” treatment is given on a precautionary basis to almost all patients with gonorrhoea, even though 70% to 80% of the cases would likely respond to older, abandoned first-line treatments.
The committee also pointed out that drug companies have no commercial interest in the advent of rapid diagnostics, which would limit the number of antibiotics prescribed.
To bridge the mismatch between costs and benefits, it proposes a market-based revenue stream for developers of products that would top up payments to developers to make sure the commercial benefits and the needs of society are better aligned.
It also called for more money to be pushed into early-stage research, referencing its previous report, which proposed a global AMR innovation fund of around $2bn over five years to help boost funding for blue-sky research.
The report concluded by saying the long-term economic case for rapid diagnostics should be made, with healthcare systems playing an important role in this.
Dr Margaret Chan, director general of the World Health Organisation, said: “Antibiotics are rarely prescribed based on a definitive diagnosis. Diagnostic tests can show whether or not an antibiotic is actually needed, and which one. Having rapid, low-cost and readily available diagnostics is an essential part of the solution to this urgent problem.”
Source The Guardian