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More Harm than Good?

“Resistance to antibiotics is now a very real and worrying threat as bacteria mutate to become immune to their effects” – Prime Minister David Cameron.

In Europe alone, approximately 25,000 people die, each year, from infections resistant to antibiotic drugs. The World Health Organisation has described the lack of new drugs capable of fighting bacteria as “one of the most significant global risks facing modern medicine”. This has been of great concern to the UK Government and there is a worry that we will be cast back into the dark ages of medicine, when easily treatable infections would kill you.

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Last year, the Prime Minister asked Lord Jim O’Neill to investigate how we would be able to accelerate the discovery and development of a new generation of antibiotics. The Review on Antimicrobial Resistance published its second report ‘Rapid Diagnostics: Stopping Unnecessary use of Antibiotics’ on 23 October 2015.

Increasing resistance to antibiotics

This report suggests that rapid medical tests are needed in order to identify the type of infection. It recognises that too many antibiotics are being giving out when they are actually not needed. This is a waste of money, but a greater concern is that it is increasing resistance to antibiotics. An example given is that strong antibiotics are prescribed as a precaution, when penicillin would have worked in that case. This is particularly important as it is only bacterial infections that respond to antibiotics.

The report outlines how current diagnostic tests take 36 hours to culture bacteria, confirm the infection and also show which drugs it will not respond to. There are already some rapid diagnostic tests, one example being CRP blood tests which can indicate if infection is likely to be bacterial. The Netherlands are noted for having a low antibiotic prescription rate and have been using such tests for many years.

Testing relatively advanced for the 'big 3'

There are more tests in development but more needs to be done in order to improve the evidence base for them, so that there is a higher uptake of them being used. Testing is already relatively advanced for the ‘big 3’ namely HIV, Tuberculosis and Malaria. There is less funding available for many bacterial infections as it is thought they are not as ‘news worthy’. Clinical trials play an important role in bringing new things to the market. Pharmaceutical companies are less likely to fund the testing as they will not make a profit from it. The report suggests that hospitals or networks of physicians should be able to become ‘test specialists’. Delays found in normal trials could be avoided and this would also reduce costs. It also suggests that insurers could play a role in supporting the uptake and helping to develop best practice guidelines.

If the tests are developed they would be able to quickly identify the type of infection and what it is resistant to. This would be an ideal position to stop unnecessary over prescribing and importantly prescription of the wrong antibiotic which could lead to symptoms becoming more severe and even more adverse consequences.

It is hoped that this is a positive step forward, but only time will tell!