[Ip-health] FT: New diagnostic tools needed to stop antibiotic resistance

Thiru Balasubramaniam thiru at keionline.org
Sun Mar 4 21:48:06 PST 2018



For now, there is no global body that would help purchase and distribute
AMR tests outside the industrialised world. Coming years will call for
fresh financial as well as scientific progress to tackle antibiotic


Medical science
New diagnostic tools needed to stop antibiotic resistance
Rapid detection would reduce unnecessary use and make drugs effective for

Andrew Jack

At the Wallacedene clinic, a short drive from Cape Town’s bustling
waterfront full of tourists and richer citizens, dozens of South Africans
with tuberculosis sit patiently waiting for advice and support from nurses
and doctors.

They are at the centre of an epidemic of one of the world’s biggest
infectious disease killers and many struggle to find medicines that will
improve their health. The risks they face highlight the broader need for
affordable, reliable, accessible and rapid diagnostics to tackle a growing
global threat of antimicrobial resistance (AMR).

Most weeks, staff identify fresh cases of multidrug resistant TB. These
require complex and lengthy therapy with multiple medicines that bring side
effects still worse than the painful standard six-month treatment.

Even bedaquiline, one of the newest “salvage therapies”, used when other
drugs have failed, is not always effective. Doctors say local people who
were never previously infected are starting to contract directly strains of
TB that are already resistant to the drug, leaving them with no further

One of the biggest problems is a low rate of detection, with existing
diagnostics relatively slow, unavailable and expensive. That leaves people
untreated and enables the disease to spread more widely. Existing tests
that require hospital referrals and several days to process can often lead
to patients dropping out of the system altogether.

Doctors are now experimenting with new approaches to active case finding,
the systematic screening of people suspected of having TB, and taking
diagnostics into local communities and seeking out cases rather than
waiting for patients to approach the medical profession.

80% of healthcare decisions are influenced by diagnostics. Only 1% of
spending goes on them

There is an urgent need to develop more effective tools for diagnosing
illness. TB provides one of the more striking illustrations of this need,
but more generally drug resistance is growing, undermining the power of the
already limited range of antibiotics available to treat patients.

“Rapid diagnostics could transform the way we use antimicrobials in humans
and animals: reducing unnecessary use, slowing AMR and so making existing
drugs last longer,” wrote Jim O’Neill, the economist, in his 2016 report on
antimicrobial resistance for the British government. “I find it incredible
that doctors must still prescribe antibiotics based only on their immediate
assessment of a patient’s symptoms, just like they used to when antibiotics
first entered common use in the 1950s.”

Without good diagnostics, doctors cannot reliably identify treatments or
generate data to help track the spread of infection. Often they provide
inappropriate older medicines or else over-use innovative newer drugs,
failing to cure patients while worsening resistance.

Yet diagnostics remains the poor cousin of medicine, suffering from
under-investment in research and insufficient support to ensure that
treatments that are already available are widely disseminated and used
where doctors and patients need them.

“About 80 per cent of healthcare decisions are influenced by diagnostics,
but only 1 per cent of spending goes on them,” says Catharina Boehme, chief
executive of Find, the Geneva-based non-profit Foundation for Innovative
Diagnostics, which works with researchers and companies with a focus on
patients in poorer countries.

Find has helped support the development and application in South Africa of
GeneXpert, a test that confirms TB and the presence of the strain resistant
to the drug rifampicin. It is working on newer and more portable techniques
to help more effectively identify resistant TB.

Like many other diagnostics experts, Find say there is an urgent need to
develop a simple “triage” test that can allow doctors to distinguish viral
from bacterial infections in their patients.One of the biggest concerns of
the medical community is that viruses are treated with antibiotics — with
no positive effect on the patient, while also worsening resistance in the
wider community.

Ms Boehme believes that with sufficient support, efforts now under way to
develop triage tests could lead to promising results over the coming few
years. Yet the tests themselves will be of limited impact unless they can
reach patients in poorer countries.

For now, there is no global body that would help purchase and distribute
AMR tests outside the industrialised world. Coming years will call for
fresh financial as well as scientific progress to tackle antibiotic

Thiru Balasubramaniam
Geneva Representative
Knowledge Ecology International
41 22 791 6727
thiru at keionline.org

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