In late January, an 18-year-old woman from the state of Bihar in India won a court battle against the Indian government after a month’s-long struggle to be granted the right to receive treatment for XDR-TB: extensively drug-resistant tuberculosis. She and her family weren’t just asking for any drug. They were desperate to access bedaquiline, a highly restricted last-resort drug that is used to treat the most resistant cases of TB. Since being diagnosed at age 16, all other TB treatments had failed. In an effort to keep bedaquiline effective, the Indian government only allows access to specific patients in five cities.
Why would allowing wider use of a drug affect its efficiency? The answer is antimicrobial resistance (AMR), a phenomenon whereby infection-causing microbes learn to resist the drugs that are normally used to kill them. TB is one of the diseases most affected by AMR, but the list of infections and procedures made more dangerous is ever growing:
- Patients with malaria, HIV, gonorrhoea, sepsis, pneumonia, urinary tract infections (UTIs) can face an uphill battle as all these diseases have resistant strains.
- Infections that can arise during hospital stays for routine procedures like hip replacements and C-sections can cause serious health complications if doctors can’t treat them.
- Patients with weakened immune systems, like cancer patients receiving chemotherapy, will have a tougher time recovering from hospital-acquired infections if they’re caused by so-called superbugs that resist treatment.
AMR has been around for a long time and is a normal evolutionary process for bacteria, viruses and fungi. After succumbing to multiple attacks from drugs, they gradually learn to resist them. And we’ve been helping them.
Saving our antibiotics
If we are to slow drug resistance we need antibiotic stewardship from all levels: patients, doctors, nurses, community health workers, pharmacists, policy makers, food producers.
- At a patient level, we need to exercise prevention of infection through handwashing, immunization, breastfeeding and good behaviour, such as completing a full course of antibiotics, not demanding them if they’re not prescribed, and knowing antibiotics do not cure viral infections.
- When prescribing antibiotics we should avoid broad-spectrum drugs that don’t target specific pathogens and wipe out beneficial bacteria.
- At a research and development level, we need new antibiotics to become available and vaccine production to scale up.
- On a policy level, we need regulations on antimicrobial prescribing and consumption for animal and human health.
At the same time, we must not let regulatory frameworks and high costs impede access to medicines in the first place. Lack of access to and delays in accessing antibiotics still kill more people than antibiotic resistance.
A test worth taking
We also need good tests. Rapid, accessible, truly point-of-care diagnostics are key to guiding antibiotic treatment. Having a reliable and easy-to-use test that could be administered in doctors’ offices, hospitals, community health clinics, pharmacies and the home would give us the confidence to know when to use antibiotics, and crucially when not to use them.
Innovative initiatives like the £10 million Longitude Prize, which is looking to reward an inventor who comes up with such a test, recognise the importance of infection evidence to justify prescribing.
Data provides evidence and can spread awareness. Excellent resources like the Centre for Disease Dynamics, Economics & Policy (CDDEP) produce resistance maps for different bacteria, and the European Centres for Disease Control and Prevention (ECDC) publish an annual database of AMR rates across Europe.
To make this data more accessible, the Longitude Prize has twice now produced an interactive data visualization showing resistance rates from various bacteria to the antibiotics commonly used to treat infection.
The latest visualisation reveals the huge variation in resistance levels across Europe, and highlights the very high rates of resistance in some south and south-eastern European countries.
2016 Data visualisation (click to use)
This visualisation built on the first one we produced in 2015.
The medicines we choose to take now don’t affect us alone; they affect bacteria that travel around the world and pass their resistance to others. To prevent further cases like that from the young woman in India, where restricted access to antibiotics compounds the anxiety and danger of suffering from a resistant infection, we must all do our part to conserve our precious drugs for the future.
The Longitude Prize is housed at Nesta, a British innovation foundation
The Longitude Prize
Nesta’s data visualisations