Antibiotic resistance costs lives. Can technology provide the cure?
Antibiotic resistance (also known as antimicrobial resistance) is a serious worldwide problem. 700,000 people die from drug resistant infections each year, and this number is only expected to grow. As well as loss of life, the global financial cost of antibiotic resistance could reach £69tr.
So what are organisations doing to solve antibiotic resistance? How can different sectors work together to find effective solutions? For Alistair Murray, Clinical Director at MRPharmS and cofounder of app based pharmacy Echo, it begins with awareness.
A resistant problem
By now, the significance of antibiotic resistance is clear. According to Murray, the World Health Organisation considers antibiotic resistance to be one of the biggest risks to global health. A large part of the issue is that, on top of being overprescribed, medication isn’t always taken as directed. Inaccurate use costs the NHS billions each year in waste, and as patients return to their pharmacists for more medication it becomes a vicious cycle.
With 15 years of experience as a pharmacist, Murray is all too familiar with this problem. In 2015, he cofounded Echo to remove the barriers to medication adherence using technology.
“Healthcare providers need to rethink their approach to dealing with people’s expectation for antibiotics when not indicated,” he says. “Sticking to local guidance when prescribing antibiotics has also been shown to be effective in combating geo specific resistance.”
Interestingly, you have to look beyond healthcare to understand why the problem of antibiotic resistance is so pronounced. In the agricultural industry, over use of antibiotics has made animals less responsive to treatments. In a 2015 government report, 72 per cent of the 139 research articles used identified a link between antibiotic consumption in animals and antibiotic resistance in humans.
There are a variety of ways that drug resistant disease could be passed on to humans, the most obvious of which is direct contact. However, resistance could also be passed on through the consumption of animals and animal products, and through animal waste in the environment. The answer, for Murray, is to stop the indiscriminate preventative use of antibiotics in farming, and only use antibiotics when there’s a clinically justified reason.
Responding to resistance
Up to now, there have been numerous attempts to alleviate antibiotic resistance.
“Technology can help at a number of different levels of complexity, from helping to build awareness around the issue, to helping design new precision therapies,” explains Murray. “Better and faster technology for genetic sequencing will help to identify new susceptible targets in bacteria, and there are lots of technologies that are scaling the discovery process beyond what would be possible using real life situations, such as computer modelling incorporating AI and machine learning.”
Other initiatives include nanomedicines that improve the precision of drug delivery, and synthetic biology, which has enabled the development of meatless meats. And, as data harvesting and analysis techniques become more sophisticated, in depth information about antibiotic resistance can point to the best course of action. That said, technological applications don’t have to be particularly cutting edge. Take remote consultations, for example.
“Remote consultations via video help protect patients who are susceptible to developing resistant strains of infections such as people with cystic fibrosis,” says Murray. “Stopping people all going to one place and potentially spreading germs around a waiting room can have a big impact.”
Another less simple solution is to debunk the perception of antibiotics as a silver bullet, and encourage behavioural change. When it comes to patients, this is where Echo steps in. Echo’s team of doctors, pharmacists, designers and developers work with users’ GPs, filling out repeat prescriptions and delivering medication for free using Royal Mail. Users receive reminders through the app when it’s time to take their medication, and when they’re running low. Echo’s Family feature lets users manage the repeat prescriptions of family members, too.
“Another key step is signing up to the antimicrobial stewardship principles associated with schemes like becoming an Antibiotic Guardian,” Murray adds.
The impact on industry
In light of the threat posed by antibiotic resistance, the healthcare sector has no choice but to change.
“One of the most effective initiatives is only prescribing and dispensing within local guidelines, including what to do if the first line of treatment doesn’t work,” suggests Murray. “As well as this, having a delayed, standby course of antibiotics to only start if symptoms get worse – with clear parameters of when to begin treatment – can also help in the effort to prevent antibiotic resistance. This has become more common with some chest and urine infections which often resolve without needing antibiotic treatment.”
The pharmaceutical industry has a fundamental role to play in how it creates medication, avoiding drugs that would be susceptible to existing resistance. But, says Murray, the sector won’t have to do it alone.
“The need for affordable and equitable access means that there’s a good chance that governments and charities will have to fund much of the R&D. There are moves into developing a broader range of treatments than just antibiotics, like looking at vaccines and monoclonal antibodies.”
In agriculture, antibiotics should only be used when absolutely necessary, and produce from farms that use antibiotics should be clearly labelled. Hopefully, a combination of sectors, organisations, and techniques will reverse the charge of antibiotic resistance.
Beating antibiotic resistance is reliant on wider awareness, behavioural change, and a range of complementary technologies. Developing new medicines, for example, will reduce the reliance on antibiotics… But this is far more likely to happen if there is collaboration between research labs, startups, and big pharma. The same is true for behavioural change. Clinics have to work with governments to move away from the notion that ‘antibiotics are best’, and they can do so through improving the accuracy of medicine use through platforms like Echo.
For Murray, the single most important thing that organisations can do to help to solve antibiotic resistance is to only prescribe and use antibiotics when there’s an evidence based reason to do so.
“I always comes back to the notion of helping people get the most out of their medicines,” he says. “Awareness and monitoring is the basis of improving things.”
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