The antibiotic tightrope

You’ve got to take your hat off to those brave souls with ice cool nerves who cross canyons, waterfalls and other natural obstacles on the narrowest of paths possible. There’s something about a tightrope walk that lifts the human spirit and inspires us beyond the sheer insolence of personal risk taking. Determination, concentration, skill or unique challenge all come to mind. But without a doubt, there is a fundamental need for a finely tuned sense of balance.

Tightrope walker

The tightrope walker is a useful picture of what is missing in the growing clamour over what we need to do about antimicrobial resistance (AMR). At one extreme, we have an urgent need to reduce every imaginable measure of antibiotic use in order to slow the emergence of resistance. That is not a matter for debate. We are up the creek with only half a paddle. Unfortunately, the complete removal of all or any currently used antibiotic from clinical use is not an option. They are just too useful to us. How can we justify restricting antibiotic use where they are clinically indicated, let alone potentially life-saving?

There is really no dilemma for the clinician faced with a serious infection: the immediate needs of the patient will win out every time. The long term consequences of escalating AMR are a problem postponed. The expectation that there will be an effective antibiotic for every infection; a pill for every ill, has a pervasive effect on every medical engagement with infection. The most minor infection might just morph into something much more serious. Even when the odds are heavily stacked against that eventuality, it is often easier to weigh in with an antibiotic just in case. After all, we’ve all heard of cases that have gone badly for lack of an early intervention.

This is why the O’Neill report cites better diagnostic tests as the circuit-breaker in the fight against AMR. The report spells out in detail the rationale for early resolution of the physician’s dilemma with better point of care tests. Those tests must address a series of three questions front line clinical staff must answer when handling any infection:

  1. How sick is this patient
  2. Why are they sick
  3. And what do we need to do about it?

Or to put it another way; better tests are needed to take the guesswork out of prescribing antibiotics. Escalating AMR will make that balancing act all the more difficult, lie a tightrope walk on a windy day.

If you would like to help us make AMR history, go to the website and join the campaign.

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