Invest in antimicrobial test-to-treat strategies

As the United Nations General Assembly’s high-level meeting on antimicrobial resistance (AMR) convenes in New York next week, we urge leaders to prioritize tackling a crucial blind spot: AMR test-to-treat data. Inappropriate antimicrobial prescription costs lives and puts advances in treatment at risk. Rapid tests and decision-support tools can aid clinical decisions on prescribing antimicrobials (J. Budd et al. Nature Rev. Bioeng. 1, 13–31; 2023). In 2019, the UK AMR national action plan committed to tracking the percentage of antimicrobial prescriptions accompanied by a diagnostic test or decision-support tool by 2024. Difficulties linking electronic patient records with prescription and laboratory systems mean that these data are not yet routinely available, but it remains a priority. Globally, diagnostic tests are underused, partly because just prescribing antimicrobials is a cheaper alternative. Better data spanning all health-care settings are needed to understand, for example, when prescribing continues without tests, and to inform and monitor interventions. More investment is needed in diagnostic roll-out trials, data capture, workforce education and behavioural strategies to implement evidence-based AMR test-to-treat guidelines.