Viewpoints

Antimicrobial resistance (AMR) is a global healthcare and economic problem. Experts believe that we are on the cusp of a “post-antibiotic era,” in which once treatable diseases become much more serious, and even deadly, if significant action is not taken quickly and on a global level.¹

The latest data shows that up to 50,000 lives are lost annually due to antibiotic-resistant infections in Europe and the U.S. and at least 700,000 people die globally each year due to drug-resistant illnesses.¹ Without effective action, it has been estimated that AMR could kill up to 10 million people a year by 2050, with a cumulative cost to the global economy of £70 trillion.¹ This would mean the death of one person every three seconds from AMR.

Of the strategies proposed to deal with this threat, rapid diagnostic tests are increasingly recognised as a crucial component for optimising the prescribing of antibiotics and reducing their use.¹ There is a strong relationship between high prescribing and emerging resistance (Figure 1),² and the majority of antibiotics are prescribed in primary care.³

In the Nordic countries and the Netherlands, point-of- care C-reactive protein (CRP) testing has been used for a number of years to help guide who needs an antibiotic and who does not for respiratory tract infections (RTIs). RTIs are one of the major reasons people attend primary care (especially in winter) and often seeking an antibiotic prescription.⁴ However, antibiotic prescriptions for RTIs are often inappropriate because most RTIs are viral.4 There is limited evidence to support the use of antibiotics in acute bronchitis, sore throat, sinusitis and otitis media.⁴

Use of point-of-care CRP testing in primary care has been shown to significantly reduce antibiotic prescribing by up to 42% in lower respiratory tract infections.² CRP is a biomarker in blood which indicates the presence of inflammation; the amount of CRP in the body gives an indication of the severity of an RTI infection. Low levels of CRP are indicative of viral or self-limiting bacterial infections; high levels indicate serious infection.⁴ CRP testing must be included in the consultation to help antibiotic decision-making.

In the UK, Alere has been working with academics and healthcare professionals who support point-of-care CRP testing to enable adoption of the test in primary care. This led to the publication of the Straight to the Point! Consensus report,⁵ which summarises compelling evidence that point-of-care CRP testing helps differentiate self-limiting RTIs from more serious infections requiring antibiotics. Launched in June 2015, the report calls on healthcare policy makers, payers and general practitioners (GPs) to enable policies and support for uptake of point-of-care CRP testing in primary care.

Since the start of this high-level discussion, the National Institute of Health and Care Excellence (NICE) has included point-of-care CRP testing in the Pneumonia clinical guidelines⁶ and the Antimicrobial Stewardship guidelines.⁷ In addition, Public Health England (PHE),⁸ and the Royal College of General Practitioners (RCGP) TARGET Toolkit⁹ now include point-of-care CRP testing for RTI consultation.

In order to build awareness, a drop-in session was conducted in the Houses of Parliament in May 2016, where over 20 members of Parliament were tested for CRP (Figure 2). There is also potential for pharmacies to deliver the CRP test service for the GP and patients.

Rapid diagnostic tests are high on the patient safety agenda, but require widespread uptake and investment. They can improve diagnostic precision in the GP consultation, increase patient education, are cost effective, and importantly, reduce antibiotic prescribing.

The point-of-care CRP test is not the perfect bacterial/viral test, but it can and is making a significant contribution to the reduction in antibacterial use in primary care. Rapid diagnostic tests are high on the patient safety agenda, but require widespread uptake and investment. They can improve diagnostic precision in the GP consultation, increase patient education, are cost-effective, and importantly, reduce antibiotic prescribing.

In the recent report on Antimicrobial Resistance, Lord Jim O’Neill highlighted “we need to encourage more innovation and, importantly, must ensure that useful [diagnostic] products are used. I call on the governments of the richest countries to mandate now that by 2020, all antibiotic prescriptions will need to be informed by up-to-date surveillance information and a rapid diagnostic test wherever one exists.”¹