Opinion Piece: Dr Sanjay Sarin
and Dr Cecilia Ferreyra (FIND)
Tackling antibiotic resistance in primary healthcare
Antimicrobial resistance (AMR) is a global health emergency that has the potential to eclipse COVID-19 in terms of the number of lives lost and economic damage. At present, 700,000 people die of drug-resistant infections each year, a number that’s expected to rise to 10 million deaths a year by 2050 if no action is taken.
The spread of AMR puts the very foundation of modern medicine at risk – without effective antibiotics and other antimicrobials, even common illnesses like diarrhoea and pneumonia, and simple surgeries, could become deadly. Some infections, like gonorrhoea, have already developed into ‘superbugs’ that are extensively resistant to existing antibiotics.
Accessible, accurate, and affordable diagnostics are vital for the protection of our existing and new antibiotics and to prevent AMR. Healthcare workers need diagnostics to understand the nature of the infection affecting their patient (viral, bacterial, fungal, parasitic) and choose the most appropriate treatment accordingly.
But a significant challenge in primary care settings is that many illnesses present with non-specific, overlapping symptoms, and without diagnostic tests it can be difficult to determine the cause of something even as innocuous as a fever or cough. Not wanting to leave patients untreated, healthcare workers often resort to giving antibiotics “just in case”, even if infections may be potentially viral in nature. Unfortunately, this is a major contributor to the growth of AMR and jeopardizes the effectiveness of life-saving antibiotics.
Pharmacies have an important role to play in combatting AMR at the community level. Pharmacists are often the first port of call for people seeking health advice and can direct people to seek higher levels of medical care, offer a rapid test to confirm an infection, or recommend self-care options, where antimicrobials are not indicated. Access to diagnostic tests and simple decision algorithms in the pharmacy settings can support pharmacists in this antimicrobial stewardship by enabling accurate diagnosis and guiding the choice of treatment.
There is increasing recognition of the importance of diagnostics in preventing AMR, particularly in primary care where most patients present for initial consultation. In the case of sexually transmitted infections, the World Health Organization now advises use of a quality-assured rapid test to confirm or exclude chlamydia and gonorrhoea infection, where molecular testing is not readily available or affordable.
Recognizing the central role of diagnostics in combatting AMR, FIND, the global alliance for diagnostics, is working to identify practical solutions to tackle AMR. One key initiative that aims to provide better healthcare to people with acute febrile illnesses in primary healthcare facilities – the AMR Diagnostic Use Accelerator platform – has been designed to evaluate a package of social, diagnostic and clinical interventions to improve the management of acute febrile illnesses and reduce unnecessary antibiotic use in primary care across low- and middle-income countries.
As part of this work, in India, FIND and the Indian Council of Medical Research have collaborated to stimulate research on the impact of incorporating diagnostics into clinical algorithms, to improve care and adequate antibiotic treatment in patients with acute fever presenting to public and private outpatient settings. The appropriate use of antimicrobials is a significant issue in India, where antibiotics can be easily bought from community pharmacies without a prescription. In this setting, community pharmacists have the potential to play a key role in patient education around appropriate antibiotic use and broader antimicrobial stewardship.
It’s hoped that the findings from the AMR Diagnostics Use Accelerator will help inform changes to policies and practices around the use of diagnostic tools for acute febrile illnesses and adherence to prescriptions, both nationally and internationally.
The COVID-19 pandemic has underlined the importance of strengthening health systems and disease surveillance to prevent future global health emergencies. The same urgency needs to be given to AMR, as a “silent” pandemic that spreads largely unnoticed. As a result, AMR preparedness and antimicrobial stewardship practices need to be urgently stepped up in every national action plan. Leveraging the power of diagnostics and the expertise of pharmacists can help reduce the unnecessary antimicrobial use that drives AMR across diseases and ensure that patients receive better care in primary healthcare settings.
Dr Sanjay Sarin
Dr Sanjay Sarin is Vice President, Access at FIND. He has over 20 years’ experience in health policy, market development, and business management with specialization in the development of strategic initiatives for driving access in emerging markets.
Dr Cecilia Ferreyra
Dr Cecilia Ferreyra is Director of the AMR programme at FIND. She is a specialist in infectious diseases and has over 17 years’ experience working in low- and middle-income countries.
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