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Diagnostic tools for superbugs… There’s an app for that

A report published by today by the Jim O’Neill Review, calls for new rapid diagnostics to stop unnecessary use of antibiotics and tackle superbugs. Here Dr Des Walsh, our Head of Infections and Immunity, describes efforts by MRC researchers to reduce the prescribing of antibiotics by making some apps for that.

The IAPP app

The IAPP app

Barely a week goes by without the global concern of antimicrobial resistance rearing its head in the media. The increasing problem of microorganisms such as bacteria, viruses and fungi evolving and becoming resistant to antimicrobial treatments is as old as our ability to fight them. And yet, a solution remains elusive.

MRC researchers are both helping to better understand microorganisms to identify their weaknesses, and developing alternative treatments such as vaccines and bacteria-eating viruses.

They are also working hard to ensure that the dawn of a post-antibiotic world never arrives by focussing on arming doctors with the right tools to diagnose when antibiotics are and aren’t necessary.

We live in a culture where a number of myths surround antibiotics. Getting them from the doctor feels like ‘proof’ that we’re really ill and makes us believe that there’s something we can do to feel better. NICE recently revealed that nine out of 10 GPs say they feel pressured to prescribe antibiotics and that 97 per cent of people who ask for them are prescribed them.

In reality, a quarter of the 41.6 million antibiotic prescriptions issued each year in England are given unnecessarily for illnesses like colds or ear infections caused by viruses, for which antibiotics won’t work. To turn the tide and extend the shelf-life of our current antibiotic stock, we all need to examine our own behaviour – as members of the public and as health professionals.

We need to be able to tell accurately whether an illness is due to a bacterial infection and if so which antibiotic to use – or we risk losing a raft of drugs that are crucial to prevent infections after serious operations like caesareans and transplants or to treat illnesses such as pneumonia or kidney infections.

So what is the answer? One solution that Professor Alison Holmes has come up with, as part of a project led and managed by the MRC on behalf of the UKCRC Translation Infection Research Initiative, are tools to support healthcare professionals in their antibiotic-prescribing decisions.

The Imperial Antibiotic Prescribing Policy (IAPP) smartphone app

This app helps professionals choose the most appropriate treatment to ensure antibiotics are prescribed appropriately. In its first three years, the app has been consulted more than 105,000 times. It has an average of 316 active users each month.

Eighty-five per cent of users responding to a post-implementation survey said that it added to their knowledge base and 96 per cent said it influenced their prescribing practice.

The ENhanced antibiotic-prescribing through a CBR-based Imperial Antibiotic Prescribing Policy (ENIAPP) smartphone app

Thanks to the success of the IAPP and a collaboration with Imperial’s engineering faculty, this app is being developed to support antibiotic-prescribing decisions. It uses an algorithm with patient case memory of antibiotic recommendations.

It currently has a case memory of around 2,000 patients and has been used in 200 clinical interactions. The project has recently been awarded funding for further development and implementation.

A screen from the On call game

A screen from the On call game

On call: antibiotics

This is an electronic prescribing game to support and encourage prudent antimicrobial use in acute care. The game allows doctors, nurses and pharmacists to manage virtual patients attending a simulated hospital. Racing against the clock and the increasing workload, players receive information about the symptoms experienced by patients and have to diagnose and manage the cases. To be successful, players have to appropriately use antibiotics and antibiotic-prescribing behaviours.

Since it was launched in 2012, it has been downloaded almost 5,000 times from more than 30 countries. The research team is currently applying for funding to tailor a version for members of the public.

The Point-Of-Care Antimicrobial Stewardship Tool (POCAST)

This tool is designed to be used by GPs on mobile devices and computers. It presents the evidence-based Public Health England (PHE) primary care guidelines on infections in a user-friendly way, meaning the GP can obtain information about treating a particular infection at the click of a button. The tool links to various resources, such as websites, to help diagnose and manage infections. In future it will also include local antimicrobial guidelines.

App-based tools are only part of the picture. There’s a new generation of diagnostic tools coming through the pipeline that we hope will help conserve and protect our narrowing list of effective antibiotics. There’s no doubt that these are desperately needed.

Des Walsh

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