The COVID-19 pandemic reminded us that our knowledge of infectious disease keeps evolving, inviting us to rethink and improve our public health approaches.
In this context, one of the greatest health tools humanity has ever discovered, antibiotics, is already becoming less effective and our collective assumptions about the low risk of their use is the key contributor. While our knowledge of resistance to antibiotics has long existed, the first World Health Organization report was not published until 1998. Today, we have reached a critical juncture.
Antibiotics have changed the world and touched most of our lives, making an infected tooth or pink eye from a bacterial infection mostly just a nuisance. Of course, for more serious health threats such as sepsis, antibiotics are a literal lifesaver. Where will we be if we lose this medical tool? Bacteria, similar to viruses like COVID-19, continue to evolve to evade our treatments.
Many think of this threat as geographically or theoretically far-off, but Antimicrobial Resistance (AMR) has been around since the beginning of its use and is increasing in frequency, with infections from “superbugs” becoming more common. In fact, some are calling it the antibiotic apocalypse, and a recent Lancet study reported that 1.27 million people around the world have died from an antibiotic-resistant infection. Even here in the U.S. we are seeing more resistant strains of bacteria, often affecting those who are most vulnerable in hospitals and ICUs.
Anyone can become infected with resistant bacteria. AMR is medically democratic. Nature finds a way to survive, and if you overuse the treatment tools, they will stop working for you. If that happens to enough individuals in a community, it will stop working for your community as new colonies of these resistant superbugs thrive. This can translate into a global health crisis. That’s why there is a very real, personal, national and global call to action here.
In the U.S. we have three primary issues that we must work together to fix to try to stem the tide on AMR. None are simple, but all are solvable through education and the right tests at the right time.
Awareness
First, we need to broadly educate every person about what requires an antibiotic and what doesn’t. Only some infections can be cured with an antibiotic. Viruses and allergic reactions cannot. Fortunately, we now have tests that can help distinguish the type of infection and doctors and patients need to ask for a test to be sure that your condition requires treatment.
- The “Why not?” effect: Doctors always consider the possibility of a serious reaction to an antibiotic, but as a whole, antibiotics are generally safe, easy to obtain and affordable, leading us to have a “What can it hurt?” mindset.
- We must evolve: Don’t take antibiotics preventatively or without a test confirming you need them. If you do start an antibiotic before the test result comes back, and the results then do not show a bacterial infection, stop taking it. Just 20 years ago, it was common that antibiotics were given before and after surgery in the absence of an infection. Today, we either avoid antibiotics or frequently stop them within 24 hours. Our knowledge has changed and so too must our behavior.
Empowerment
Second, we must empower physicians and other prescribers to stop and take the time to ask a different first question: Not what treatment does this require, rather, does this require a treatment (with an antibiotic) at all?
- To know the answer with certainty requires a test. This takes time, and physicians as we know are overburdened. We also know that physicians don’t want to contribute to this growing crisis, nor hurt their patients in the long run.
- If the results of the diagnostic test show that an antibiotic would help, the next question is, which one? We ask physicians to be the most judicious and use the most specific treatment for the infection.
- If antibiotics are not indicated, the medical community can help educate patients as to why antibiotics won’t help and why the best practices have changed.
Policy
Finally, since reliable diagnostic results are the key to reducing the threat of AMR, we need to make sure the right policies, incentives and reimbursement is in place to make diagnostics part of the standard of care.
- This will help us create new practice norms, balancing the new requests of our healthcare teams and ensuring testing is affordable to patients.
- AMR is already costing unfathomable loss of life, as well as more than $5 billion extra healthcare dollars a year. We must establish policies that focus on prevention immediately.
Making diagnostics a critical piece of the care puzzle has an added positive outcome: It provides a new way to track illness and contagion so that we can be better prepared for the next pandemic.
The COVID-19 pandemic taught us the value of knowing our diagnosis with certainty, helping us determine the course of treatment, and reiterating the role of isolation, when necessary, in reducing the spread of disease. This certainty has a ripple effect of helping reduce the spread, and keeping the economy humming when more adults get to work, and more kids go to school.
There’s value in protecting people, and advances in diagnostics must be used to help change our behavior and ensure that our amazing treatments are used appropriately and remain potent.
Lee A. Fleisher, M.D. an anesthesiologist and former Chief Medical Officer at the Centers for Medicare and Medicaid Services. He is currently CEO of Rubrum Advising.
Vitor Rocha is the president of Cepheid.