To curb antibiotic resistance, experts say creation of new drugs alone won’t suffice — broader availability of diagnostic tests to help doctors prescribe antibiotics more precisely will be equally crucial.
It might be difficult to imagine a time when simple infections like strep throat or appendicitis were deadly, or when routine surgeries such as gall bladder removal or knee replacements were high risk. But before the introduction of antibiotics, which help prevent and treat these infections and aid therapies for diseases like cancer, that was true. And if scientists, healthcare providers and policymakers aren’t able to stop the spread of antibiotic resistance — when bacteria adapt and cease responding to antimicrobial drugs — experts fear the return to such an era.
Already, by 2050, scientists predict antibiotic resistance will annually kill 10 million people worldwide, according to an article published in November 2013 in PLOS Medicine.
Common causes of antibiotic resistance
Drivers behind antibiotic resistance include overuse of antibiotics in animals, inappropriate antibiotic use in humans, such as using antibiotics for viral rather than only bacterial infections; using antibiotics for too long; and easy access to antibiotics without a prescription in low- and middle-income countries that leads to overuse, says Mark Miller, corporate vice president of medical affairs and chief medical officer at the biotechnology firm bioMérieux.
“This is a natural evolution that has been occurring since the development of the first human antibiotic in the mid-1940s,” Miller says. “Whenever an antibiotic gets introduced, the trillions-plus of exposed bacteria can develop resistance through genetic mutations.”
Because bacteria will always adapt, this resistance isn’t reversible, but progression can be slowed by reducing exposure of antibiotics in humans and creating new antibiotics. Equally, if not more, important is the expansion of diagnostic tests that help physicians identify the best and safest treatments, says Daniel Feinstein, MD, FACP, director of the medical surgical intensive care unit at Cone Health in Greensboro, North Carolina.
Preventing antibiotic resistance
Diagnostic tests can help physicians identify infections quickly to prevent unnecessary prescriptions and diagnose the infecting bacteria so that narrow-spectrum antibiotics, rather than broad-spectrum drugs that can contribute to antibiotic resistance, can be prescribed. “Diagnostics that can provide faster results, more complete information, and are easy to use would further reduce overall antibiotic prescribing and increase the appropriateness of antibiotics that are used,” Miller says.
One test from bioMérieux, VIDAS® B•R•A•H•M•S PCT™, detects an elevated Procalcitonin (PCT) biomarker signaling a bacterial infection within 30 minutes. “What this means is that when PCT is used according to the simple guidelines, we can anticipate huge reductions in antibiotic use and much more appropriate use of antibiotics in respiratory infections and sepsis with no safety concerns at all,” Miller explains. Feinstein notes that research suggests more than half of unnecessary antibiotic prescriptions for respiratory illnesses like pneumonia could be prevented with the use of PCT.
Another test, the BioFire FilmArray® BCID Panel, can identify within one hour 18 different bacteria and five fungi commonly to blame for the potentially fatal syndrome septicemia. Called “multiplex testing,” the BCID Panel has the ability to do not only that — it can also show if the bacterium involved is antibiotic resistant itself.
With broader availability of diagnostic tests, Feinstein believes rates of illnesses that stem from overuse of antibiotics, such as Clostridium difficile— which is a dangerous infection commonly contracted in hospitals — can be reduced.
In the meantime, patients can take matters into their own hands, he says: “Your physician is there to take care of you, but you also need to ask those questions: ‘Why do they think you require the antibiotic?’ And ‘Is it possible for the course to be shorter?’”