A NEW generation of thinkers are required to find the solution to resistance to this vital drug, writes Till Bachmann
Imagine a world where doctors are unable to carry out simple operations without risking the patient contracting an infection that could kill them. Or where cancer treatments become impossible because weakened patients cannot survive everyday infections. Sadly, this is not an imagined world – it is happening right now.
Since the 1940s, antibiotics have been used to treat patients with infectious diseases – everything from a simple throat infection to helping chemotherapy patients survive common illnesses when their body’s resistance is weakened.
The threat now facing the world is from AMR –Antibiotic or Antimicrobial Resistance, where the drugs are no longer effective in combatting these bugs.
In large part this is because of inappropriate use of antibiotics, such as to help farm animals grow more quickly. Disturbingly, the global use of the antibiotic Colistin in agriculture grew to 12,000 tonnes in 2015. The potentially devastating consequences of this were highlighted recently in China, with the news that humans and animals have been diagnosed with infections resistant to Colistin. This is frightening. Colistin was regarded as one of the last-ditch antibiotics. Traditionally it has not been widely used in human medicine because of the kidney damage it can cause. But as other drugs became useless, it has become more popular.
The news that infections are now resistant to Colistin leaves doctors and vets with potentially very little in their armouries. Unless this situation is tackled, the projections are for 10 million deaths per year by 2050 – that’s a number higher than the current death toll from cancer.
Antibiotic resistance is a ticking time bomb affecting every country and individual on the planet and global action is required now. Policy makers are coming together on a global scale and several initiatives have been launched to increase public awareness of AMR.
Last month saw the World Health Organisation’s World Antibiotic Awareness Week, as well as European Antibiotic Awareness Day. But we need more. New drugs are urgently needed, as well as – crucially – a change in behaviour of prescribing and using antibiotics – addressing doctors, patients and animal health professionals.
To achieve this we need better tests. Generally, it takes two days to find out which bacteria is causing an infection and which antibiotic to use. As doctors cannot wait, they will often start treating patients with antibiotics based on experience and adjust the therapy in a trial and error way. New diagnostic tests for antibiotic resistance could speed up the process of identifying the bacteria and transform the way doctors make decisions.
This would reduce the emergence and spread of AMR and save lives. Developing new tests is an enormous challenge, both financially and from a technical and scientific perspective. These tests have to be rapid, easy to use and cost-effective, but also need to keep track of the constantly changing bacteria which are trying to evade being found and killed. Because AMR is a global problem, these tests need to work in a great variety of healthcare settings, ranging from most modern hospitals to rural environments with little infrastructure. As developing these tests is so demanding, several international prizes have been launched.
The UK Longitude Prize will award £10 million for a test that can determine if antibiotics are needed and if so which ones in less than 30 minutes. There have been two rounds of applications but so far no one has come close to winning the prize. We think that it is time to bring in the next generation to help solve this complex problem.
To do this, our team around Dr Shahida Syed and Dr Marie Ducrotoy at the Division of Infection and Pathway Medicine of the University of Edinburgh will launch an annual competition (AMR DxC - The Antimicrobial Resistance Diagnostics Challenge) in 2016.
This brings together young international teams with diverse expertise to discover the diagnostic answers we all so desperately need. Big ideas need to start small and we kicked off this initiative last month with the AMR DxC Autumn School at the University of Edinburgh. Leading experts from India, UK and the USA, were joined by 20 PhD students from UK and Indian universities.
The attendees were selected to cover a wide range of backgrounds including microbiology, healthcare, epidemiology, bioengineering, diagnostics, physics, and social sciences. The students brainstormed, discussed, and attended lectures to address the problem of AMR.
They developed remarkable and unconventional ideas on how new technology can advance diagnostics. The week culminated with presentations of these ideas by the students to the expert panel. In conclusion, we can take away two very powerful messages from the 2015 AMR DxC Autumn School.
Firstly, we need to connect the next generation of scientists to fight AMR. Secondly, the 2016 AMR DxC competition has a tremendous potential to come up with innovative ideas to make an impact on diagnostics. We are looking forward to November next year when the world’s next generation scientists and leading experts in the field meet again in Edinburgh and debate solutions for one of the greatest threats facing mankind.
• Dr Till Bachmann is Deputy Head, Division of Infection and Pathway Medicine, the University of Edinburgh