Tackling Antimicrobial Resistance

10th October 2019 | QuantuMDx Team

What is Antimicrobial Resistance?

One of the biggest misconceptions is that we’re becoming resistant to antibiotics. In fact, it’s bacteria that are becoming resistant to antibiotics.

Antimicrobial Resistance (AMR) develops when bacteria, fungi, or viruses are exposed to antibiotics, antifungals or antivirals.

AMR occurs naturally over time as microbes are constantly evolving. As such, their DNA has mutated, acquired resistance genes and they’ve evolved to survive.

AMR is also due to:

  • Over prescription of antibiotics (overuse and misuse) – prescribing for viral infections like colds and flu.
  • Prophylactic use of antibiotics in farming – particularly cattle – to prevent disease in healthy animals.
  • Patients not finishing their prescription.

The importance of antibiotics in medicine can not be overstated. As well as being used to treat or prevent bacterial infection, they are routinely used in medical interventions such as surgery, chemotherapy and stem cell therapy.

What is the size of the problem?

AMR is an increasingly serious threat to global public health. It already kills 700,000 a year.¹ By 2050, resistance to antibiotics could kill 10 million people each year ¹ – making antimicrobial resistance more dangerous than diabetes, tuberculosis and HIV/AIDS combined.

The cost of health care for patients with resistant infections is higher than care for patients with non-resistant infections due to longer duration of illness, additional tests and use of more expensive drugs. These extra costs could reach $1 trillion per year by 2050.²

Where are we now?

AMR is a global issue. It affects every country. 

  • There were 558,000 new cases of Multi-drug resistant TB in 2017. MDR-TB occurs when the bacteria that cause TB become resistant to the two most effective antimicrobial drugs used to treat the disease, Rifampicin and Isoniazid.¹
  • Extensively drug-resistant tuberculosis (XDR-TB) is a form of tuberculosis that is resistant to at least four of the core anti-TB drugs. It has been identified in 123 countries. An estimated 6.2% of people with MDR-TB have XDR-TB.¹

In the last 5 years, a total of 32 bacteria were identified by Public Health England as resistant to all antibiotics tested at the reference laboratory. These are called pan-drug resistant bacteria.³

Why not develop new treatments?

New antibiotics are expensive to develop – R&D costs can reach $300 million per drug, then a company must add another $3-4 million for approval fees.⁴

The process is lengthy too – all new drugs and treatments must be thoroughly tested before they are licensed and available for patients. It could 10 to 15 years or more to complete all 3 phases of clinical trials before the licensing stage.⁵

It has been more than 30 years since the last new class of antibiotics was discovered and came into routine treatment.

What can we do?

Antimicrobial resistance can be limited by:  

  • Preventing the infectious diseases
  • Applying antibiotic stewardship
  • Developing improved microbial diagnostics
  • Developing novel antibiotics and antimicrobial products
  • Developing alternative antimicrobial strategies.

However, AMR is a global challenge requiring a global response.

In April 2019 the UN Interagency Coordination Group (IACG) on Antimicrobial Resistance called for a co-ordinated, multi-sectoral “One Health” approach.

It recommended countries:

  • prioritise national action plans to scale-up financing and capacity-building efforts
  • put in place stronger regulatory systems and support awareness programs for responsible and prudent use of antimicrobials by professionals in human, animal and plant health
  • invest in ambitious research and development for new technologies to combat antimicrobial resistance
  • urgently phase out the use of critically important antimicrobials as growth promoters in agriculture

The UN IACG called for immediate engagement across sectors, from governments and the private sector, to civil society and academia.

The role of diagnostics – antibiotic stewardship

It’s widely agreed that we urgently need rapid diagnostics at the point care to: identify a pathogen and its drug resistance markers;  inform clinical decision making, and ensure patients are treated with the right drug regimen from the outset.

In the UK, the Longitude Prize has been launched – to invent an affordable, accurate, fast and easy-to-use test for bacterial infections that will allow health professionals worldwide to administer the right antibiotics at the right time.

We’re also playing our part. QuantuMDx is developing the Q-POC™ – a DNA/RNA analyser which compresses a molecular diagnostics laboratory into an affordable, simple-to-use and portable device.

 What can we all do as individuals?¹
  • Do not use antibiotics to treat viral infections, such as flu, the common cold, a runny nose or a sore throat.
  • Use antibiotics only when a doctor prescribes them.
  • When you are prescribed antibiotics, take the full prescription even if you are feeling better.
  • Never share antibiotics with others or use leftover prescriptions

Sources:

1. WHO 2. World Bank  3. Public Health England 4. Review on Antimicrobial resistance 5. Cancer Research UK

AMR Insights   SciDev.net