Challenges in identifying antibiotic resistance targets for point-of-care diagnostics in general practice

Mitsakakis, Konstantinos; Kaman, Wendy E; Elshout, Gijs; Specht, Mara; Hays, John P

Many countries produce national guidelines for the treatment of diseases often seen within primary care. Examples of such guidelines include the National Institute for Health and Care Excellence (NICE, UK) and The Nederlands Huisartsen Genoostchap (NHG, The Netherlands) [41, 42] . It is essential that POC diagnostic innovators who are thinking of developing antibiotic resistance diagnostics actually take note of these guidelines and develop tests for antimicrobial resistances that are based on the antibiotic-prescribing guidelines of the countries in which the device is to be sold. However, for the POC diagnostic innovator, developing different antibiotic resistance testing capacities for specific countries may not make financial sense unless those countries have standardized primary care guidelines available and large populations with access to primary care. Additionally, national guidelines for antibiotic prescribing are regularly revised, which means that POC diagnostic innovators must consider if the time required to develop, market and generate profit from a new antibiotic resistance test will fit within the regular cycle of national guideline revision. Of course, the revision of national guidelines does not mean to say that the actual choice of antibiotics to be used will be changed, but the POC diagnostic innovator should take this into consideration when weighing up the time from POC development to marketing. Finally, if a GP knows that a revision of antibiotic-prescribing guidelines is due in a few months, he may be less inclined to buy an antibiotic resistance diagnostic that may be 'out of date' within a few months. One possible solution to this problem is for POC diagnostic innovators to be aware of the problem and develop diagnostics that are easily and quickly adaptable to the rapidly changing 'ecosystem' of (inter)national guidelines and to the emergence of new antibiotic resistances.