Drug resistance will impact healthcare at every level

Mark Miller

Corporate VP, chief Medical Officer, bioMerieux

AMR is a serious issue today in many countries, with a  potentially dire future impact if it is not quantified, prevented, restricted and discussed globally.

In trying to better predict and reduce the impact of AMR, there are four key areas of focus:

1. Innovative Diagnostics – We’re constantly developing faster and more accurate diagnostic tests as these provide high medical value information to clinicians. More efficient diagnostic stewardship is key to ensuring treatment is more focused and appropriate at an individual level.
    
2. Better education on AMR – A really core principle is spreading the message about AMR, especially in low and middle income countries (LMIC). Discussions need to be had with the healthcare professionals on the ground in those countries, since they are the people who can effect change. We don’t just aim at physicians, but we also aim at doctors, nurses, pharmacists and infection control professionals, who will inevitably be responsible for educating the public in the future.
    
3. Surveillance – Surveillance of both antibiotic usage, and suceptibility to antimicrobials on a global scale, is key to understanding how best to go about tackling it on a country-by-country basis. You need that information before you can really do anything effective. bioMérieux is proud to be the supporter of a project, Global-PPS¹, that contributes to monitoring the worldwide prevalence of antibiotic consumption and resistance rates and to implementing antimicrobial stewardship programmes in hospitals.
    
4. Assisting in clinical trials – Another important area is assisting pharmaceutical companies who are developing new antibiotics to join up the diagnostics with their antibiotic trials (so called supportive or facilitating diagnostic tests), making those trials more efficient. Essentially, this helps them ensure they are testing their drugs on the right patient with the targeted infection. Those companies can then validate their antibiotics in a better and more rapid way, and in a standardised improved patient population.

Challenges surrounding education and advocacy of AMR

The biggest obstacle is getting to the different groups who need that information, and you can’t use the same tool or approach to educate all of those whom we need to reach. With AMR, you can’t use the same approach with a hospital physician as you would with a general practitioner or a community pharmacist.

The additional problem is that there isn’t enough understanding and appreciation of AMR, or the enormous threat it poses, within the general public. They don’t understand the impact it’ll have on them individually, their family or society.

If AMR gets out of hand, it will leave a mark on all elements of healthcare. We may not be able to perform elective surgeries or treat cancers without the risk of resistant infections, and common infections could become lethal to large portions of the global population again.

This is the kind of menace and appreciation of danger that we believe needs to be transmitted at all levels of society. It can’t just be aimed at professionals.

How core is the surveillance of both drug usage and resistance?

We’re in a unique position in terms of providing surveillance, as we provide the diagnostic tests that can help collate that vital information.

It starts from the basic concept that knowledge is power. If you know what’s going on, then you can implement actions to address those issues. If you don’t, then you’re acting blind. Surveillance gives us the knowledge. In many countries, there is no knowledge of what’s going on. There are no records about antibiotic use or the amount of resistance. There are guesses about how bad AMR is, in both developed and non developed countries, but no concrete figures in many cases.

The key is to understand the extent of antibiotic usage, in both developed and lesser-developed countries, while also measuring the levels of resistance. We’re pushing for inclusion of resource-limited nations in our Global-PPS.

The information we collate is invaluable. Both the global surveillance work looking at antibiotic usage and the data regarding resistance generated by a web-based tool help build a clearer picture of the whole issue.

It’s then up to people to take that data and use it. Countries look to us to implement these initiatives and enable them to successfully monitor what the picture looks like in their region, which is vital. They can then harness that information and implement national action plans.

Rapid diagnostic tests are vital in reducing AMR

In my eyes, there are five key reasons why diagnostics play a substantial role in tackling AMR:

1. On an individual basis, diagnostics will tell a physician what infection is occuring and what the  patient’s pathogen is susceptible to. They can help determine if antibiotics are needed and then choose the right antibiotics and ensure more targeted use of those drugs against the infection.  
2. Diagnostics are the only tool that can supply surveillance data. This is pivotal in following the status and progression of AMR.   
3. Screening patients for carriage of drug-resistant pathogens so that they can be isolated in order to limit their spread.   
4. Diagnostics can differentiate viral infections from bacterial infections. By quickly determining that someone has a viral infection and doesn’t need antibiotics, you can reduce overall antibiotic use drastically.  
5. Diagnostics are used within antibiotic clinical trials to ensure that the recruited patients have the infection and pathogen of interest, rendering those trials more efficient, less expensive, faster and easier to analyze.  

Combined effort is key to tackling AMR

We think that AMR is the single biggest health threat that we face globally. A report in 2016 estimated that this is going to cost trillions of dollars in GDP loss, but it’s also going to cost hundreds of millions of lives.

It’s already at a frightening level in some countries where people are dying of untreatable infections. The reason people are not more alarmed is because many of those countries don’t keep good figures. AMR is here today, it’s not just a potential threat.

We believe that there is not enough awareness of this issue and its serious consequences at the political and public levels, and that’s where we want to play a part in making sure that appreciation of this issue increases rapidly in order to improve the situation as fast as possible.