What lessons can we take from the TB response to the rest of the AMR field?

AMR is widely recognised as a major threat to global health. Bacterial AMR was associated with an estimated 4.71 million deaths in 2021, of which 1.14 million were directly attributable to it. As multidrug-resistant pathogens continue to challenge healthcare systems worldwide, we can look to an infectious disease that we have made progress in– tuberculosis (TB). 

TB management has faced many of the same obstacles that we see in the wider AMR landscape today: delayed diagnosis, drug resistance, fragmented care pathways, and inequitable access to testing. However, over the past two decades significant progress has been made through investment in rapid diagnostics, decentralised testing, and global collaboration.

What lessons can the AMR field take from the TB field’s successes?

The Shared Challenges of TB & AMR Management

At their core, TB and AMR present a similar clinical dilemma: treatment decisions are frequently made before accurate diagnostic information is available.

For many bacterial infections, clinicians often prescribe empiric, broad-spectrum antibiotics while awaiting laboratory results. Although this approach is necessary given the limited information available to clinicians initially, it can contribute to the development of resistance as the treatment does not target the causative pathogen. The same challenge has historically existed in TB care, where patients could wait weeks or even months for culture-based results and drug susceptibility testing.

In both TB and AMR, delayed or inaccurate diagnosis can result in inappropriate treatment, poorer patient outcomes, continued transmission, and increased healthcare costs. Supporting clinical decision-making with fast, accurate, accessible diagnostics could help reduce these negative outcomes and curb resistance on a global scale.

Rapid Molecular Testing

One of the most important advances in TB control has been the development of rapid molecular diagnostics.

The introduction of molecular tests capable of detecting both Mycobacterium tuberculosis and resistance to rifampicin has transformed the diagnostic pathway. According to a 2025 Cochrane review, the Xpert MTB/RIF Ultra assay reduced the time to diagnosis and rifampicin-resistance detection from weeks or months to under two hours, enabling clinicians to make more informed treatment decisions much earlier in the patient journey.

However, over 15 years after the first Xpert assay was recommended by WHO, only 8 of 30 high TB burden countries have reported access of over half of their TB diagnostic sites to recommended rapid diagnostics tests. Some countries who have implemented rapid molecular diagnostics have seen reduced delays in treatment initiation but no reduction in treatment gap due to a lack of access to second-line treatments.

The parallel with AMR is clear. Rapid technologies capable of identifying pathogens and antimicrobial resistance markers could help move healthcare away from empiric therapies. However, most AMR pathogens are more complex than TB when it comes to genotypic prediction. Plasmid-borne genes, expression level, efflux, porin loss, and minimum inhibitory concentrations (MICs) near the breakpoint are all challenges that need to be overcome in order to deliver molecular diagnostics that surpass phenotypic antimicrobial susceptibility testing.

Faster diagnostic insights will enable clinicians to select the right therapy sooner, improving antimicrobial stewardship while helping to preserve the effectiveness of existing antibiotics. But this can only happen if the entire treatment pathway, from diagnostic technologies to treatment access, changes.

Decentralised Testing

Another major lesson from TB is that testing must be available where patients first access care.

Historically, many TB diagnostic services were concentrated in specialised laboratories, creating barriers to access and delaying treatment initiation. New guidance from WHO focuses on bringing tools like near-point-of-care nucleic acid amplification tests, tongue swabs, and sputum pooling, closer to patients to address persistent diagnostic gaps. In addition, campaigns to address the cost-prohibitive nature of instruments and consumables for molecular testing are aiming to improve access to rapid, accurate diagnostics for drug-resistant TB in LMICs.

This approach is equally relevant for AMR. Diagnostic testing that is technically accessible and cost-effective can be performed within community settings, outpatient clinics, urgent care centres, and smaller hospitals. This has the potential to shorten turnaround times and support quicker, evidence-based treatment decisions.

However, the complexity of the AMR pathogens causing infectious diseases and the limited availability of effective diagnostic technologies and pathways are major hurdles, which risk results being misread or misused in less specialised facilities at this point in time.

Collaboration Between Researchers, Healthcare Professionals, Policymakers and Funders

Progress in TB diagnostics did not happen through innovation alone. It was achieved through sustained collaboration across multiple stakeholder groups.

The Find. Treat. All. #EndTB initiative is one of WHO's efforts to combat drug-resistant TB. Run jointly with the Stop TB Partnership and the Global Fund from 2023-2027, it involves partnerships with countries, healthcare providers, researchers, civil society organisations, and industry partners to expand access to rapid diagnostics and more effective treatments.

Similarly, Cepheid's TB diagnostic innovations were developed through collaborations with organisations such as the Foundation for Innovative New Diagnostics (FIND), helping to accelerate the development and deployment of new technologies.

The fight against TB has demonstrated that no single organisation can solve the challenge alone. Change requires alignment between scientific research, healthcare systems, regulatory frameworks, and sustainable funding mechanisms. The same principle applies to AMR to ensure that innovative technologies are developed, evaluated, adopted, and made accessible at scale.

Conclusion

The global response to TB shows that progress against drug resistance is possible when collaboration, accessibility, and innovation are prioritised.

While AMR presents a broader and more complex challenge involving multiple pathogens and healthcare settings, many of the lessons already exist within the TB playbook. Rapid molecular testing can help guide earlier treatment decisions. Decentralised diagnostic models can improve access and reduce delays. Strong partnerships between researchers, healthcare professionals, policymakers, and funders can accelerate innovation and implementation.

TB diagnostics make a strong case for what we could be doing better to speed up the fight against AMR. At DRAIGON we’re developing faster workflows and diagnostics for AMR through AI-powered bioinformatics and WGS.

(Disclosure: DRAIGON is an EU-funded consortium working on AI-based prediction of AMR from genomic data; this article is written from that perspective.) Article also available on LinkedIn

Funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or European Health and Digital Executive Agency (HADEA). Neither the European Union nor the granting authority can be held responsible for them.