AMR action plans - what are we missing?
AMR action plans - what are we missing?
The recent pandemic has bluntly exposed some of the gaps in our healthcare systems across Europe and one thing stuck with me the most: we were not prepared. In many ways, we can think of this as a test run of how the world responds to large-scale healthcare crises. There are more complex threats ahead, one of them being antimicrobial resistance (AMR). The topic has gained a lot of attention and awareness over the past years, but I continue to ask myself: are we on the right track to manage this public healthcare crisis in all its different aspects? Are we doing enough to slow it down? Are we ready to handle it?
AMR has global impact not only burdening healthcare systems (estimated 10 million deaths by 2050), but also the economy (1.5 billion EUR yearly) . We are in very diverse states of dealing with it, i.e. in most European countries, access to antimicrobial drugs is highly regulated, whereas the situation in Africa or India is very different. Medications in some of these places are available over the counter with no prescription, keeping resistance on the rise. And as we have learned the hard way, microbes do not care about borders.
AMR is a continuously increasing problem and therefore rightly stressed by many of the high-level organisations such as the United Nations , the WHO  and the European Union  with dedicated AMR calls to action or action plans. One objective they all have in common is the urge of increasing awareness and understanding of AMR and its consequences. In my perspective, this is the most crucial thing based on the recently published AMR preparedness index  and personal experiences. As professionals in the medical technology industry, we are exposed to these topics eventually, but the real challenge is to reach the general public with fact-based knowledge and engage them to comply with simple but important actions to support the combat of AMR. Another example that the COVID-19 pandemic has taught us – patient/public compliance is key, if not everything.
Status quo and where to go
Are the current AMR action plans even enough? Let’s take the example of urinary tract infections (UTI), which is one of the most common bacterial infections affecting around 150 million people a year . Adequate therapy decisions depend on high-quality diagnostics, yet up to 83% of suspected UTI patients are treated with antibiotics without urinalysis diagnostics . Recent reports show that the resistance rate to ciprofloxacin, an antibiotic commonly used to treat UTIs, varied from 8.4% to 92.9% for E.coli and from 4.1% to 79.4% for Klebsiella pneumoniae . Ultimately it can be assumed that UTIs are a major cause for unnecessary prescriptions, even though fast and innovative technologies to support the diagnosis have been on the market for years. However, the pace of implementation and adaptation of newer technologies is not keeping up with the rate of innovation.
These facts lead me to wonder if the implementation is properly reflected in the action plans and if there are better strategies to make changes in the healthcare sector. And taking a look inward, are we using our power and tools efficiently within the medical technology world to encourage and push change? And as individuals? I think one place to start could be for us to utilise the evolving digitalisation to foster change and quicker implementations of innovations.
- Factsheet_AMR (europa.eu)
- PROGRESS REPORT 2017 EU AMR ACTION PLAN Last update: Q4 2020 https://ec.europa.eu/health/sites/default/files/antimicrobial_resistance/docs/amr_2018-2022_actionplan_progressreport_en.pdf
- Stamm WE, Norrby SR (2001): Urinary tract infections: Disease paranormal and challenges. J Infect Dis 183 (Suppl. 1) S1–S4.
- Pujades-Rodriguez et al. (2019) Lower Urinary Tract Infections: Management, Outcomes and Risk Factors for Antibiotic Re-prescription in Primary Care. EClinicalMedicine 14:23-31