WHO taps Firstline app to address global pandemic of antimicrobial resistance

The World Health Organization (WHO) announced a new partnership with Firstline, a clinical decision support platform, to deliver antimicrobial guidance to clinicians via an app.

Antimicrobial resistance (AMR) is more deadly than malaria and HIV/AIDS combined with an estimated 5 million deaths in 2019, according to a recent study published in The Lancet.

Most WHO clinician support comes in the form of dense, multi-hundred-page PDFs, but the global health organization wanted to ensure that the AWaRe Antibiotic Book was shared in a more dynamic format. By partnering with Firstline, antibiotic treatment guidance can be accessed in all countries through the Firstline app in primary care clinics and in hospital settings.

“Prescribing antibiotics is actually quite complicated,” Michael Long, Firstline chief clinical officer and co-founder, told Fierce Healthcare. “Healthcare providers have to take a multitude of different factors into account: pharmacology, microbiology, that particular infection, costs and so on. They frequently need to do this without diagnostic information and sometimes in a medical emergency. So, they need help. This WHO resource will help them to make evidence-based, appropriate prescriptions to treat common infections.”

Essential medicine lists have been disseminated by the WHO since 1977, but the partnership with Firstline marks a move in the creation of the first recourse to help prescribers diagnose infections and dose antimicrobials for the appropriate duration.

Drug-resistant pathogens, including multi- and pan-resistant bacteria (or superbugs), are untreatable with antibiotics and can lead to small infections becoming life-threatening. With few new antimicrobials being discovered and antibiotic shortages, the threat is mounting. 

The WHO reported that resistance against antibiotics used to treat common bacterial infections, such as urinary tract infections, sexually transmitted infections and some forms of diarrhea, has increased worldwide, indicating an increase in drug resistance.

The AMR pandemic has long been exacerbated by the over-prescription of broad-spectrum antibiotics. The threat further heightened when antibiotics were overused in the early stages of COVID-19 to incorrectly treat the virus, as, at the time, providers did not have guidance.

“When the professional prescribes the antibiotics, usually resistance is the last thing they have in their mind,” said Lorenzo Moja, M.D., secretariat of the Model List of Essential Medicines at the WHO Department of Health Products Policy and Standards. “So there was a need to push knowledge and information on resistance. Our recommendation is a benchmark.”

Firstline’s web and mobile app is free to download, available in six languages and can be used without internet access. This way, providers and prescribers in the global south can bring guidance to the most rural areas.

Guidelines are customizable with WHO AWaRe categorization of antibiotics, COVID-19 guidelines, antimicrobial formulary information and local antibiogram data. The app was designed to be as small and power-efficient as possible to account for usage in low-income countries.

While superbugs can present themselves locally within hospitals, Moja is clear that resistance spreads globally, and WHO’s guidelines provide a global baseline.

“In hospitals, you will have what we call targeted therapy, meaning you test before, this is usually in high-income countries, but when you go into low-income countries, you go with empiric treatments, clinical science, so you don't test,” Moja said. “And there it is very important to have recommendations that can be shared as a global tool to combat antimicrobial resistance.”

The WHO categorizes antibiotics into three categories with increasing levels of threat to increasing AMR: Access, Watch and Reserve. The WHO aims to have at least 60% of antibiotics considered "Access."

Firstline categorized antibiotics accordingly with "Reserve" warning prescribers the drug should be used as a "last resort" and only for life-threatening infections due to multidrug-resistant bacteria.

“The world needs action to protect antimicrobials or we risk a future where even seemingly trivial infections can result in death,” Long said. “The good news is that we can take action, that using this new guidance from the WHO on the Firstline platform is an action that healthcare providers all over the world can take today to do their part in fighting the spread of antimicrobial resistance.”

Usage of the app to avoid AMR and inappropriate antibiotic usage showed cost savings with reduced inpatient antimicrobial usage to be $403.08 per bed annually, according to an article published in PLOS One.

Firstline provides a wide range of medical guidance through its app, including COVID-19, mpox and pneumonia. Currently, the platform serves 400 hospitals in 13 countries. Hospitals can upload their guidance to be accessed by clinicians at the point of care or adapt guidance from other providers.