Viewpoints

Lord Jim O’Neill, the UK Commercial Secretary to the Treasury and Chair of the Review on Antimicrobial Resistance, recently released a report laying out recommendations to fight the global threat of antimicrobial resistance (AMR).

Overuse of antibiotics, especially of broad spectrum antibiotics rather than targeted narrow spectrum therapies, has led to an increase in drug-resistant bacterial infections. This emerging health issue is poised to have devastating global consequences, making it impossible to treat previously curable diseases. AMR already contributes to 700,000 deaths a year, and the report warns that it could cause 10 million deaths a year and $100 trillion in lost global productivity by 2050 if nothing is done to stop its spread.¹

In recent years, advances in diagnostic technology have made rapid point-of-care testing possible for many diseases – enabling providers to immediately prescribe the most appropriate therapy during the course of a patient’s visit.

The majority of antibiotics are prescribed outside the hospital setting, meaning one of the main drivers of antimicrobial resistance is inappropriate prescribing in primary care and in the community. In order to protect and preserve our current stock of antibiotics, we must urgently reduce the unnecessary use of antibiotics in this setting. The use of rapid diagnostics is a key strategy in achieving this.

Lord O’Neill’s landmark report is the first to focus on the role that rapid diagnostics can and should play in helping healthcare providers avoid prescribing unnecessary antibiotics and to narrow the spectrum of the antibiotics that are used. It calls for high-income countries’ governments and regulators to support the use of rapid point-of-care tests by primary and specialty care providers. Underscoring the importance of point-of-care testing in halting the spread of AMR, the report calls on these countries to make it mandatory that by 2020 the prescription of antibiotics be informed by diagnosis, or by epidemiological data where tests are unavailable.

More must be done to ensure that healthcare providers across the globe increase their use of rapid testing in order to quickly and accurately identify the nature of a patient’s infection and precisely treat it.

Additional recommendations include creation of a Global Innovation Fund for AMR to support research on diagnostics, and implementation of a diagnostic market stimulus system to increase access to and use of diagnostics in low- and middle-income countries.

Beyond the measures outlined in Lord O’Neill’s report, there are other strategies that can help drive the use of point-of-care testing in healthcare settings around the world:

• Stronger Emphasis on Use of Currently Available Diagnostics – There are already available a number of diagnostic tools that can help healthcare professionals quickly and effectively diagnose infections. These tools should be fully leveraged for immediate gains. While new diagnostics will improve the diagnostic toolkit of prescribers, it takes time and money to develop and bring new tools to market. There is an urgent need to quickly reduce antimicrobial usage worldwide. Utilizing currently available diagnostics will facilitate a fast start in achieving this.
• Restructuring Financial Incentives – Financial incentives for point-of-care testing vary widely around the world, and in many markets, reimbursement schemes have favored lab testing. The lack of adequate reimbursement or other financial incentives remains a major barrier to point-of-care test adoption. Incentives to facilitate the uptake and use of rapid POC diagnostics in primary and secondary care should include incentives to set up the infrastructure for rapid diagnostics, including equipment purchases, training, maintenance, ongoing validation and quality control (QC). There needs to be a decentralization of certain diagnostic infrastructure and expertise from the lab to the frontline.
• Accelerated Pathways for Regulatory Approval – The regulatory burden is increasing in most countries, slowing the commercialization of new diagnostics.
• Global Education and Advocacy – Globally coordinated education and advocacy efforts can help mobilize the general public, healthcare providers and policymakers to take actions for antimicrobial stewardship.

Research has shown a high correlation between countries’ antibiotic prescribing rates and resistance rates.² More must be done to ensure that healthcare providers across the globe increase their use of rapid testing in order to quickly and accurately identify the nature of a patient’s infection and precisely treat it. Uptake of the Review on Antimicrobial Resistance’s recommendations is an important first step.