A collaborative project on artificial intelligence could aid antibiotic prescription and potentially solve the miss or over-prescription issues.
by Akshay Saigal and Dr Andrew Kwa
Antibiotic resistance is one of the biggest threats to global health, food security and development today. It can affect anyone, of any age, in any country, and especially in underdeveloped countries.
Antibiotics are medicines that inhibit the growth of or destroy bacteria. They are often prescribed to treat bacterial infections. For instance, in a fever, which can be an indication of infection, many will request for antibiotics without knowing that antibiotics are not useful against viral infections and this forms the common bulk of community infections.
“All antibiotics are commonly prescribed, especially those that can be taken orally and topically,” said Dr. Andrea Kwa, assistant director of pharmacy (research) and pharmacy clinician-scientist at the Singapore General Hospital (SGH). She explained antibiotic resistance occurs naturally and slowly, but misuse of antibiotics in humans and animals will greatly accelerate the process.
A growing number of infections such as pneumonia, tuberculosis, and gonorrhoea are becoming harder to treat as antibiotics used to treat them become less effective. Antibiotic resistance leads to longer hospital stays, higher medical costs and increased mortality.
As antibiotic resistance grows, the antibiotics used to treat infections do not work as well or at all. The loss of effective antibiotic treatments will not only cripple the ability to fight routine infectious diseases but will also undermine treatment of infectious complications in patients with other diseases.
Many advances in medical treatment—joint replacements, organ transplants, cancer therapy, and treatment of chronic diseases such as diabetes, asthma, rheumatoid arthritis—are dependent on the ability to fight infections with antibiotics. If that ability is lost, the ability to safely offer people many life-saving and life-improving modern medical advantages will be lost with it. Antibiotic resistance is putting the achievements of modern medicine at risk. Organ transplantations, chemotherapy and surgeries such as caesarean sections become much more dangerous without effective antibiotics for the prevention and treatment of infections.
Former UK Prime Minister David Cameron once said, “If we fail to act, we are looking at an almost unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine”.
The unabated rise in antimicrobial resistance (AMR), emergence of extensively drug-resistant (XDR) pathogens and the dearth of new antibiotic development has become a global health threat. A growing problem of nosocomial antibiotic-resistant bacteria infections had been fuelled by the lack of new effective antibiotics now and for the next 10 years.
The Centers for Disease Control and Prevention estimates that each year, at least two million illnesses and 23,000 deaths are caused by antibiotic- resistant bacteria in the U.S. alone. In addition, reports on AMR commissioned by the UK government and supported by the Wellcome Trust from 2014 to 2016 have estimated that mortality and morbidity attributable to an increase in AMR will rise.1 10 million more people are expected to die every year than would be the case if resistance was kept to today’s level as compared to 8.2 million more people dying from cancer every year in 2050.2
In U.S. and Europe, antibiotic prescriptions can be made without an in-patient visit (e.g. over the phone, electronic health record). “It is worse in Asia. In many developing Asian countries, generic antibiotics can be bought at any pharmacies or drug stores,” Dr. Kwa commented.
According to the U.S. Centers for Disease Control and Prevention, 30 to 50 percent of antibiotics are over-prescribed in outpatient scenarios due to the manual risk assessment of infections and a lack of visibility on the medical history of patients while evaluating patients at the first touch point.
“The prescription of antibiotics globally, including in Singapore, is largely reliant on the doctors’ clinical experience and sharp diagnostic sense. This could potentially give rise to inconsistent practice and patient outcomes, especially in local hospitals with high patient volume, where we need to diagnose fast,” said Dr. Kwa.
AI to the Rescue
A potential solution? Dr. Kwa shared SGH is collaborating with DXC Technology to launch a new project currently being developed, called the Artificial Intelligence (AI) Aid for Antibiotics Prescribing.
Using data analytics and advanced algorithms, DXC and SGH are working on an AI solution that can guide a doctor in prescribing antibiotics. Akshay Saigal, director Labs, DXC Technology, Asia, explained the AI will manage data associated with complex diagnoses and healthcare strategies, while considering patient demographics, clinical standards, treatment and investigation history. It then derives an effective and intelligent treatment regimen, allowing for more personalised treatment and reducing the possibility of miss or over-prescription of antibiotics.
This solution was recently recognised as one of the most impactful projects, by the Ministry of Health, Singapore at the “National Health Tech Challenge” awards.
What This Means for Patients and Physicians
The AI Aid for Antibiotic Prescription solution enables physicians to be better informed when prescribing antibiotics, in real-time, bringing about the better management of patient health, reduction in hospital stays and decreased healthcare costs for patients.
Besides increasing healthcare costs, AMR, or the growing resistance of micro-organisms like bacteria and viruses, is a major cause for concern for the healthcare industry on the whole. This brings about the major need for precision medicine prescribing. [APBN]
- Wellcome Trust. Review on Antimicrobial Resistance. Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations. Wellcome Trust; 2014 [Available from: http://www.jpiamr.eu/wp- content/uploads/2014/12/AMR-Review-Paper-Tackling-a-crisis-for-the-health-and-wealth-of- nations_1-2.pdf
- Boucher HW, Talbot GH, Bradley JS, Edwards JE, Gilbert D, Rice LB, et al. Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis. 2009;48(1):1-12.
About the Author
Akshay Saigal, director Labs, DXC Technology Asia
Dr Andrea Kwa, assistant director, Pharmacy (Research) and Pharmacy Clinician-Scientist, Singapore General Hospital