Comment

A smarter approach to tackling AMR

Antimicrobial resistance (AMR) is estimated to cause 700,000 deaths each year globally. This could rise to 10 million by 2050 if we do nothing. Better stewardship, new diagnostics, and effective health education is crucial to tackling this growing threat, writes Professor Jonathan Ross, sexual health lead at the National Institute for Health Research (NIHR).

AMR is one of biggest threats we face. Chief medical officer Dame Sally Davies called it “a ticking time bomb.” Whether it’s tuberculosis, malaria, or STIs (e.g. ‘super-gonorrhoea’), the excessive and inappropriate use of antibiotics is leading to drugs previously used to treat infection no longer working.

In 2017, there were some 420,000 diagnoses of STIs in England, with young people most at risk. Left untreated, STIs can have serious consequences for people’s health, causing infertility, pelvic inflammatory disease, and harm to unborn babies. Moreover, the Family Planning Association estimated that the treatment of STIs cost the NHS approximately £620m in 2014.

Tackling AMR is a priority for global health, which is why the government’s 20-year vision to contain and control AMR by 2040 is welcome. But what happens when the antibiotics stop working? In short, we need to be smarter with our treatment. This relies on clinical research and on better stewardship, improved diagnostics, and effective health education.

Tackling AMR in sexual health is as much about preventing the spread of infection as it is about treating the likes of chlamydia, gonorrhoea, and syphilis. If we prevent the spread of infection, we ultimately use less antibiotics.

Firstly, we must work to reduce the transmission of infection. Fewer STIs means less need for treatment. Right now, a five-year research programme funded by the NIHR is looking at reducing the time taken to identify, test, and treat the sexual partners of those who have tested positive for chlamydia. Following a telephone consultation, a ‘testing and treatment’ pack is delivered by the patient or by post. A faster diagnosis makes it easier to treat the infection and prevents new infections.

Secondly, choosing the right antibiotic is crucial. Traditionally, this is done by sending a sample to the lab for analysis and waiting for guidance on which antibiotic will work best. But this takes time and doctors will usually give a ‘best guess’ antibiotic, only to refine it once the results are in. This can lead to the wrong antibiotic being given, thereby adding to the problem. This is where new point-of-care tests have an important role to play by helping provide more rapid and accurate diagnosis and ensure the right treatment.

Thirdly, we must preserve and reserve the effective antibiotics we have. Can we recycle some of the older antibiotics instead of simply prescribing the newest? If so, this would allow us to hold back the latest antibiotics for when we really need them. In the case of  gonorrhoea, many current antibiotics are ineffective. NIHR-funded research is looking at the use of older antibiotic gentamicin to treat gonorrhoea. Lab tests suggests it could be used to treat the infection, and has been used successfully as a treatment in some developing countries.

Fourthly, do we need to use antibiotics at all? In the case of bacterial vaginosis, research is underway to compare the current antibiotic treatment with a topical gel alternative. Such alternatives to treating STIs would go a long way to reducing unnecessary use of antibiotics.

Finally, let’s not forget education. We know that people who have had one STI are at higher risk of a second, third or fourth. One particular study is looking at the use of carefully worded text messages sent to individuals who have had an infection giving sexual health education in an effort to reduce the risk of another STI.

There is no doubt that clinical research and the NIHR has an important role to play in tackling the growing threat of AMR. Indeed, the success of the government’s plan depends on it. We need the NHS, academics, and industry to work together, as well as today’s research community and the next generation of researchers to be fired up to take on this important challenge. The clock is ticking...

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