Implementation of Rapid Point-of-Care Diagnostics to Address Growing Threat of Antimicrobial Resistance

Introduction

In a new report released by Lord Jim O’Neill, the UK Commercial Secretary to the Treasury and Chair of the Review on Antimicrobial Resistance, recommendations are listed out to combat the global risk of antimicrobial resistance (AMR).

Overuse of antibiotics, particularly the use of broad spectrum antibiotics in preference to targeted narrow spectrum therapies, has caused a rise in drug-resistant bacterial infections. This growing health problem has the potential to cause devastating global consequences and as a result, previously curable diseases have now become incurable.

AMR is already responsible for 700,000 deaths per year and the report alerts that AMR has the potential to cause 10 million deaths per year with loss in global productivity of nearly $100 trillion by 2050 if no measures are taken to stop its spread.1

Developments in diagnostic technology in the recent years have enabled rapid point-of-care diagnosis for various diseases. As a result, providers can instantly prescribe the right kind of therapy during a patient visit.

Rapid diagnostics to address threat of AMR

One of the key drivers of AMR is inappropriate prescribing within the community and in primary care because prescribing of antibiotics is largely taking place outside the hospital setup. The unwanted use of antibiotics in this setting must be immediately reduced so that our existing stock of antibiotics can be protected and preserved. To achieve this, one of the key strategies is to use rapid diagnostics.

Lord O’Neill’s breakthrough report is the first report focusing on how rapid diagnostics can or should help healthcare providers to avoid prescribing unwanted antibiotics and to reduce the spectrum of antibiotics being used.

It urges the governments and regulators of high-income countries to promote the use of rapid point-of-care tests among primary and specialty care providers. Highlighting the significance of point-of-care diagnosis in stopping the spread of AMR, the landmark report urges these nations to make it mandatory by 2020 that prescription of antibiotics is either based on the information provided by diagnosis or based on by epidemiological data where no tests are available.

Other recommendations outlined in the report include creating a Global Innovation Fund for AMR to promote research on diagnostics, and implementing a diagnostic market stimulus system to extend access to and application of diagnostics in middle- and low-income nations.

Other strategies to implement rapid diagnostics

Beyond the recommendations described in Lord O’Neill’s report, the following are other strategies that can support the implementation of point-of-care diagnosis in healthcare settings all across the globe:

Stronger emphasis on use of existing diagnostics – Various diagnostic tools are already available for rapid and effective diagnosis of infections. It is essential to fully utilize these tools for immediate gains. Although new diagnostics will enhance the diagnostic toolkit of prescribers, a large amount of money and time needs to be spent for development and commercialization of new tools. Immediate action needs to be taken to minimize antimicrobial usage all across the world. This can be quickly achieved when existing diagnostics are effectively utilized.

Restructuring financial incentives – There is a vast difference in financial incentives provided for point-of-care diagnosis worldwide, and lab testing has been favored by reimbursement schemes in many markets. The absence of adequate reimbursements or other financial incentives is still a major obstacle to the widespread adoption of point-of-care diagnosis. Incentives to promote the adoption and use of rapid point-of-care diagnostics in primary and secondary care must include incentives to establish the infrastructure for rapid diagnostics that includes equipment procurement, training, ongoing quality control and validation, and maintenance. Certain diagnostic infrastructure and know-how need to be decentralized from the lab to the frontline.

Accelerated pathways for regulatory approval – The increasing regulatory burden in most nations increases the time needed for bringing new diagnostics to the market.

Global education and advocacy – Globally coordinated advocacy and education initiatives can help mobilize people, policymakers, and healthcare providers to take necessary measures for antimicrobial stewardship.

Research has revealed a high correlation between nations’ antibiotic prescribing rates and resistance rates.2 More actions need to be taken for widespread adoption of rapid testing among healthcare providers throughout the world so that the nature of a patient’s infection can be rapidly and accurately identified and precisely treated. Uptake of the recommendations outlined in the Review on Antimicrobial Resistance is the first step toward that direction.

Acknowledgements

Produced from materials originally authored by Kieran Clarke, Ph.D, Global Product Director, Pneumonia and Antimicrobial Stewardship, Alere.

References

  1. The Review on Antimicrobial Resistance. Tackling Drug-Resistant Infections Globally: Final Report And Recommendations. May 2016. Available at: http://amr-review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf.
  2. Goossens H, Ferech M, Vander Stichele R, et al. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 2005; 365(9459): 579-87

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Last updated: Mar 21, 2019 at 8:36 AM

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