Antimicrobial resistance: Innovation must go hand-in-hand with awareness

and the Wellcome Sanger Institute

Paul Chapman discusses antimicrobial resistance and how innovation must go hand-in-hand with awareness to combat superbugs.

A recent study from researchers at Glasgow Caledonian University warned that Scottish hospitals are at risk of a superbug outbreak – unless attitudes change towards screening.

Researchers pointed to concerns over a lack of awareness among health professionals and the public about the threat posed by CPE (carbapenemase producing enterobacteriaceae) and the ways in which it can be stopped.

CPE is a bacteria which lives harmlessly in the gut but is extremely dangerous if it gets into the bloodstream, urine, or surgical wounds and causes an infection.

Whilst greater education has a very clear and important role to play in combating so-called superbugs, much still needs to be done in the development of existing and new medtech. Quite often better point of care (POC) testing, in combination with new antibiotics, is the best form of attack.

Antimicrobial resistance (AMR) and the associated issues – an over-prescription of antibiotics, costs to an under-pressure health service, an unrealistic expectancy from the public, and the routine use of antibiotics in livestock farming – have, of course, been well publicised.

There is a great deal of work going into combating what is undoubtedly one of the key healthcare challenges of our time.

Pf Magazine recently interviewed Liz Cross who is taking huge steps in point of care diagnostics to reduce the unnecessary prescribing of antibiotics to address antimicrobial resistance.

Much commendation must go to those seeking to develop the next generation of antibiotics as the development of novel antibiotics is essential in providing a last line of defence against rapidly evolving pathogens. However, in aiming to reduce inappropriate prescription of existing antibiotics, we must also consider the importance of POC testing and more technologically advanced diagnostic tools.

At Marks & Clerk, we file a lot of patents in the diagnostics field and continue to monitor sector and political developments.

I was particularly interested by comments from the UK’s superbug tsar, Lord Jim O’Neill, who recently stated that drug companies are being too slow to develop new antibiotics.

However, while I agree with him, it is likely to take at least five to 10 years to bring a new antibiotic to market, even if drug companies are given an incentive to develop them. Perhaps then we need to focus more on what we already have.

Suitable POC diagnostics are important in terms of extending the period of time for which existing antibiotics will be effective and, in essence, for buying fresh time to develop new ones. Once we have new antibiotics, then hopefully existing diagnostics can still be used to maintain their longevity.

Doctors represent a vital frontline in this battle. Having recently been to the doctor myself complaining of a sore throat, I was encouraged to be told that she did not want to prescribe me antibiotics. However, at the same time, she had no real test to determine what was causing my infection.

She appeared to be relying on the fact that as I did not have a temperature, it was likely a viral infection. Notably, we also do not appear to have any suitable anti-virals that can be used in such a situation.

I was comfortable with the doctor’s assessment, but across the board, doctors are often put under severe pressure from patients to be prescribed something.

Having a suitable test which would clearly show I did not have a bacterial infection would undoubtedly have assisted the doctor in reassuring another patient and backing up their assertion that they should not be prescribing antibiotics.

Of course, in the scenario of an infection being more severe than a sore throat, it is of paramount importance to treat the patient quickly and sometimes the doctor has little option but to prescribe antibiotics, at least initially.

Moreover, doctors in other countries may not be as strict as my own doctor was, and I am sure that over prescribing antibiotics is still prevalent worldwide.

Providing medical professionals with the correct tools will help ensure that antibiotics are used only when appropriate and necessary.

With my work on the Longitude prize advisory panel, one thing which is becoming clear to me is the importance of the cost of any diagnostic test. Antibiotics can be ‘bought on the street’ very cheaply in some countries and so if a test is not cheaper than the antibiotics themselves, it may be difficult to adopt test use.

POC diagnostics and antibiotic development need to go hand-in-hand. A great deal of effort, time and resource is put into the research and development of both POC testing and diagnostic technologies to ensure medical professionals only give antibiotics when it is appropriate to do so, which will slow down antibiotic resistance from developing in the first instance.

Without POC diagnostics and antibiotic development, patients will continue to receive existing antibiotics unnecessarily, increasing the likelihood of AMR.

Essentially then, we need heightened innovation across the board – bolstered by the vital protection that intellectual property affords – but we also need major behavioural changes.

Only a carefully balanced approach that foregrounds these concerns can hope to go some way towards turning the tide and avoiding the nightmare superbug scenario.