Source: The Engineer

Antibiotic resistance is as big a threat to our way of life as terrorism and climate change, according to commentators who this week helped put the growing ability of bacteria to survive drug treatments back on the agenda.

And it’s not just antibiotics that are becoming increasingly ineffective: drugs for fighting fungal infections and viruses including HIV, hepatitis B and flu are also encountering growing resistance.

The obvious upshot of this could be that infections now thought of as easily treatable return to being lethal even for fit and healthy patients, while diseases such as tuberculosis, which have become relatively rare in the West and are gradually being tackled in the developing world, grow back to their former prevalence and deadliness.

But drug resistance could also have major implications for medical technology. We’ve come to assume that the development of surgical techniques, implants and internal electronic devices will deliver ever-improving ways for people to maintain their health and fitness.

Anything that requires an incision into the body would become a lot more risky, however, if we cannot rely on drugs to fight off any pathogens that might enter the wounds.

Luckily, technology – and engineers – could also help provide some of the solutions to dealing with these problems, providing non-invasive alternative treatments, preventing people from getting as many infections in the first place, and even tackling some of the factors that are accelerating drug resistance.

For a start, improved diagnostics could help limit the overuse of antibiotics by targeting them more precisely, making sure the right treatment is used to attack specific bacteria in a more localised area of the body. And we could see more directed use of drugs, for example through antibiotic-laced cements for bone implants.

But telehealth technologies could also make a real difference. Drug delivery devices or even smartphone apps can monitor and log a patient’s use of drugs, remind them to finish the course of antibiotics and letting their doctor know if they aren’t doing so (a major factor behind growing drug resistance).

‘People modify their behaviour based on whether they’re being monitored or not,’ said Tom Oakley, head of drug delivery at technology developer Cambridge Design Partnership.

‘There are devices developed already where people can track how they’ve been getting on. And there’s an interesting idea for the future called gamification where you can gain points or even get money off for taking your drugs.’

Improving the robustness of medical technology could also contribute. Firstly, increasing life expectancy means we could see growing use of internal devices as people survive longer into old age and that these implants will need to last longer. Stronger materials and better design could help reduce the need to replace these technologies and so cut the number of operations and risk of infection.

Secondly, there’s a need to make medical technology more resilient to aggressive chemicals and higher temperatures as keeping them sterile becomes even more important.

‘Medical technology relies on being able to put things into the body that are sterile,’ said Andrew Diston, head of global medical technology at Cambridge Consultants.

‘The issue with implants and tools is occasionally you get infections however good you are at keeping them clean. So if antibiotic resistance gets worse, the standard of sterility needed will be higher.’

Another solution to this problem could be using more naturally sterilising materials in medical technology. For example, substances containing silver nanoparticles or that hydrophilic (water attracting) properties create an environment that is naturally toxic to bacteria.

However, there’s a problem when using the likes of silver nanoparticles in drug delivery devices, as Tom Oakley points out, in that no material from the technology is allowed to enter the body with the drug, less it affects its treatment performance.

Sterility and the efficiency of cleaning could also be improved with better bacteria-detecting tools that can instantly determine whether the pathogens have been killed and not just whether they are present (alive or dead).

Finally, technology can play a role in the creation of alternative treatments. The trend towards less invasive surgical procedures with smaller incisions or where doctors enter the body through natural orifices is already established and will become even more important as drug-resistance grows.

And the same goes for completely non-invasive tools that use ultrasound or electromagnetic radiation to target areas inside the body, particularly in cancer treatment where immune system repression will become less viable without antibiotics.

This kind of thinking can even be applied as an alternative to antibiotics themselves. By attaching markers to bacteria cells, it is possible to target and kill them with lasers, even from outside the body. Laser-activated dyes that produce bacteria-killing chemicals are another possibility.

While not likely to provide a widely usable replacement to treatments that use antibiotics, these kind of techniques at least show a way forward for doctors to become less reliant on the drugs in certain situations – which in itself could help prevent the growth of resistance.

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