The journey to fighting drug-resistant infections from the palm of your hand: From local to global

The road to fight one of humanity’s greatest health challenges from the palm of your hand has been a long and winding one. The University of Calgary is the starting point of a free access mobile app to help countries around the world fight antimicrobial resistance.

It took almost a decade of research and collaboration with teams from across the country, including McMaster University and internationally involving the World Health Organization (WHO). Dr. John Conly, MD, a professor and infectious disease specialist at the Cumming School of Medicine and Alberta Health Services (AHS), along with a team at UCalgary and AHS, has facilitated the development of an app to provide expert local knowledge so that physicians and veterinarians can make the best treatment decisions in an attempt to curb antibiotic resistance.

Tackling Antimicrobial Resistance (AMR) is a high priority for WHO as it is one of the top 10 global public health threats facing humanity. AMR is made worse by the over-prescription of broad-spectrum and unnecessary antibiotics. Prescribing antibiotics correctly is complex and requires expert knowledge. However, easy access for doctors to that expertise has been difficult, particularly in resource-limited settings.

Where it started

In 2012, the app concept was created by two medical residents, Dr. Elizabeth Parfitt, MD, PGME’14, and Dr. Paul Campsall, MD, PGME’14. Together with Conly, a software development group and a multidisciplinary team from UCalgary and AHS, the app launched in 2014 under the name Spectrum MD. It was first used in Calgary’s adult hospitals, with Alberta Children’s Hospital following a few years later.

Spectrum MD (now Firstline) is unique in its ability to be customizable, providing local stats for specific locations by incorporating local sensitivity patterns to various types of bacteria.

The innovation and application led to the Canada Health Infoway and Accreditation Canada 2016 National LEADing Practice award.

“This national award made all of us truly realize what we had done as a group and that it could have global reach one day,” says Conly. “It reminded me of the inspiring quote by Margaret Meade, ‘Never doubt that a small group of thoughtful committed citizens can change the world. In fact, it’s the only thing that ever has’.”

Following the award, the app was adopted in centres across Canada and internationally including the United States and the European Union.

One Health approach

In 2019, co-creation of the first veterinary stewardship app began with the Canadian Veterinary Medical Association through the Major Innovation Fund launched by the Government of Alberta. The goal was to create a digital app for optimal veterinary prescribing of antibiotics. The Firstline – Clinical Decisions veterinary app was born.

“Two essential elements of antimicrobial stewardship are the overall reduction of antimicrobial use and targeting the use of antibiotics when use is needed,” says Dr. Herman Barkema, DVM, PhD, scientific director of the Alberta-wide AMR – One Health Consortium at UCalgary.

“The app is instrumental for reaching both objectives: it tells the veterinarian not only when and when not to use antibiotics, but also what the antibiotic of first and second choice should be.”

Taking on a One Health approach, the app offers point-of-care treatment recommendations and other reference material for a wide range of animal health conditions in a wide range of species. It’s an ideal tool for rural mixed-practice veterinarians who treat companion animals like cats and dogs, as well as cattle, pigs, poultry, horses, and other species.

Where are we now

With over a decade since the initial concept, the app is now called Firstline – Clinical Decisions. It has grown from an app used solely in Calgary to now being used in over 400 hospitals and health-care organizations, spread throughout 13 countries and adapted for eight languages.

With the addition of new standard clinical guidance in The WHO AWaRe (Access, Watch, Reserve) antibiotic book in December 2022, Firstline will contribute to combating global AMR by significantly improving antibiotic prescribing, resulting in better outcomes for patients.

In addition, the WHO AWaRe Antibiotic Book is now available on Firstline, free of charge in all countries. The partnership which has been established provides a historic opportunity to improve antibiotic prescribing, reduce antimicrobial resistance, and potentially save millions of lives.

“I’m so pleased to learn about the impressive Firstline app created by our UCalgary colleagues. The partnership with the WHO AwaRe antibiotic book makes a valuable tool widely accessible as clinicians work to address antimicrobial resistance,” says Dr. William Ghali, vice-president (research).

"UCalgary offers a robust innovation ecosystem where scholars are enabled to pursue real-world solutions, and the dedication of our research community results in global impact."