Resisting Resistance

In countries with unregulated antibiotic access, stewardship for the prevention of drug resistance development can be a challenge. But how can obstacles like physicians’ lack of time to conduct a full diagnostic workup, or the absence of resources that would allow the verification of bacterial infections before prescribing antibiotics, be surmounted? Researchers from the Oxford University Clinical Research Unit in Vietnam suggest introducing an affordable, five-minute C-reactive protein (CRP) test that could distinguish between viral and bacterial infections and prevent antibiotic overprescription (1).

“There’s no current standard of practice for diagnosing bacterial infections in the Vietnamese primary healthcare setting,” explains Nga Do Thi Thuy, first author of the study. “Doctors commonly prescribe antibiotics solely based on clinical examination, regardless of existing treatment guidelines.” This is partly because Vietnamese primary care providers often have only minutes in which to see each patient, so they can’t conduct thorough examinations. The problem of overprescription is compounded by the fact that most antibiotics are available over the counter, so many patients skip the visit to the doctor and simply buy the medications they think they need (2). Standard CRP testing, recommended in many western countries, is not available in Vietnamese primary healthcare – but the researchers hope that their new test will fill the gap.

Will rapid CRP testing be enough to solve the problem? “The key challenge is low compliance with the therapeutic algorithm,” says Do. “Improved education, and the associated increase in adherence to the algorithm, could be a solution.” He adds that a CRP test to be delivered in pharmacies selling over-the-counter antibiotics might also reduce the issue of patients’ purchasing drugs they don’t need. The setting still brings unique challenges to bear – like health centers prescribing antibiotics to get rid of old stock, rather than out of need – but as rapid diagnostics continue to be developed and improved, Do and his colleagues are optimistic that the fight against unnecessary antibiotic use can be won.