The little machine that's helping doctors tell when antibiotics are NOT needed

Written by Tony Millett on .

Antibiotics, having revolutionised medicine in the twentieth century, now find it hard to keep out of the headlines.  One day it's their crippling cost to the NHS' finances (about £190 million a year), the next day they are being over-prescribed by doctors, and on very bad days it's reports that some ordinary bugs have developed resistance to antibiotics and they're not effective against new breeds of superbugs.

A little machine - pictured on the right - sitting on the bench in a local surgery could become an essential part of the struggle to keep antibiotics effective - and save the NHS some money.

It's the Alere Afinion blood testing system and it has been helping doctors at Great Bedwyn's Old School Surgery since October.  A grant from the Friends of Savernake Hospital and the Community enabled the medical practice to rent one of the machines and set itself up with the equipment needed to make each test.

The test is used for two main groups of patients.  First for those who come in with cold or flu-like symptoms and want - even demand - a course of antibiotics.  The machine will give a very fast read-out of the CRP (which stands for C-Reactive Protein) level in the blood.  

This tells whether the body is suffering from a bacterial infection or whether the condition is viral and will not be cured by antibiotics. Even before they know what is wrong with them, many patients expect antibiotics will cure them.

As Great Bedwyn's Surgery's Practice Manager, Keith Marshall, explains: "There's so much pressure on doctors to prescribe antibiotics, but the more you use them the less effective they become."

The Old School Surgery, Great BedwynThe Old School Surgery, Great BedwynThe second group of patients who will benefit from this new technology are those being tested for diabetes or who have diabetes and need to be tested regularly.  The system will measure the HbA1c levels which are the main indicator for diabetes - measuring how much sugar is attached to blood cells.  

Because our blood cells only last 12 weeks before they are replaced, doctors can use this test to gauge blood glucose levels over the 12 weeks leading up to the test.

The test involves blood from a finger prick being put via a capillary tube into the analysis machine.  Marlborough.News has seen the (anonymised) results of the 80 tests carried out by a nurse at the Old School Surgery between October and the end of January.  

These show that antibiotics were prescribed after only 15 tests.  Of patients tested at the surgery who had lasting coughs, colds and other conditions - which might normally have all attracted a course of antibiotics - 78.75 per cent were shown not to need antibiotics. Two patients were admitted to hospital following tests.

Will the Alere Alfioin system save the NHS money?  The machine costs about £700 a year to rent on a four year contract.  And the equipment for each test costs £4.  For diabetic patients the test is almost instant and saves the costs of blood samples being sent off to a lab.  

For tests to see whether antibiotics should be prescribed the calculation of costs saved is more complicated.  A week-long course of a basic antibiotic can cost as little as £1.20 (not counting dispensing costs.)  

Savings to the NHS will come as much from patients not needing appointments with a doctor as from avoided prescriptions.  But as Dr Hannah Graystone of the Old School Surgery puts it: "This machine is more about using antibiotics appropriately than about saving money."

She explained that it was originally installed as part of the surgery's preparation for the 'winter hit of coughs and colds': "We use it a lot - we've found it very useful."

So what is the likelihood of this machine and its instant testing system getting widespread use in primary care?  Such are the over-tight finances of the NHS that Wiltshire Clinical Commissioning Group were not able to fund its use in Great Bedwyn's surgery.   

If NHS England was really serious about limiting the use of antibiotics and so prolonging their usefulness in fighting patients' infections, they might think a bit harder about funding one of these systems in every one of England's medical practices.  

Bacteria developing resistance to antibiotics is not a new or even an unexpected phenomenon.  Alexander Fleming, who discovered penicillin (one of the first antibiotics), warned it might happen when he accepted his Nobel 1945.

When the system was first operational at the Great Bedwyn surgery it was featured in a report on ITV News.

The AGM of the Friends of Savernake Hospital and the Community is on 11 May - details here.