Antimicrobial resistance poses ‘catastrophic threat’

Chief Medical Officer in England calls for politicians to treat the danger seriously

Global action is needed to tackle antimicrobial resistance, which in 20 years could see anyone dying following minor surgery, says England’s Chief Medical Officer Professor Dame Sally Davies.

Dame Sally’s warning coincides with the publication of the second volume of her annual report, which details the burden posed by antimicrobial resistance and infectious diseases, and calls for politicians to treat the danger as seriously as MRSA.

The report highlights a ‘discovery void’ with few new antibiotics being developed in the past two decades, even though a new infectious disease has been discovered nearly every year for 30 years.

In addition to encouraging development of new drugs, the report warns that looking after the current arsenal of antibiotics is equally important. This means using better hygiene measures to prevent infections, prescribing fewer antibiotics and making sure they are only prescribed when needed.

Antimicrobial resistance poses a catastrophic threat

Davies also states that more action is needed to tackle the next generation of healthcare associated infections, including new strains of pneumonia-causing klebsiella.

Some 17 recommendations are made as part of the report, including:

  • A call for antimicrobial resistance to be put on the national risk register and taken seriously by politicians at an international level, including the G8 and World Health Organization;
  • Better surveillance data across the NHS and worldwide to monitor the developing situation;
  • More work carried out between the healthcare and pharmaceutical industries to preserve existing drugs and encourage the development of new antibiotics; and
  • Building on the success of the NHS in cutting MRSA rates, which have fallen by 80% since a peak in 2003 through better hygiene measures.

“Antimicrobial resistance poses a catastrophic threat,” says Dame Sally. “If we don’t act now, routine operations like hip replacements or organ transplants could be deadly because of the risk of infection.”

She wants to see more government action and to encourage more innovation in the development of antibiotics.

Stephen Whitehead, Chief Executive of the ABPI said: “Dame Sally Davies is right to raise her concerns about antimicrobial resistance and its impact on medicine and patient care. Antimicrobial resistance is a serious and growing problem. There are however pharmaceutical companies actively involved in researching and developing new antimicrobial medicines. One successful initiative – the Innovative Medicines Initiative (IMI) – has brought together several pharmaceutical companies and the public sector to invest €223.7m in developing a programme to tackle antimicrobial resistance. But more still needs to be done and we believe that for there to be a continual supply of effective antibiotics, a comprehensive review of the R&D environment and good stewardship are required urgently.“

The Health Protection Agency (HPA) welcomed Dame Sally's call to put antimicrobial resistance on the national risk register. Figures from the HPA's Antimicrobial Resistance Reference Laboratory revealed that in 2003 three samples tested positive for antibiotic resistance compared with 800 in 2012.

It is this dramatic rise in the numbers of cases that warrants active intervention not just from Government but also from healthcare institutions, the pharmaceutical industry, patients and the general public to address this very serious problem, the HPA said.

The HPA works with colleagues from around the world advising on infection control and sharing data on strains.

This is not a clinical issue but a societal one and we must change our attitude towards antibiotics

Professor Anthony Kessel, Director of Public Health Strategy and Medical Director at the HPA, said: “We are very pleased that the Chief Medical Officer is giving the issue of antibiotic resistance her full attention. This is not a clinical issue but a societal one and we must change our attitude towards antibiotics. They certainly have their place for treating bacterial infections but too often are given for viral illness which contributes towards the problems we are facing today. This will require more awareness raising and education both for clinicians and the public on how they use the antibiotics that we have.

“The HPA has been working very hard on this issue for some time and has committed great resource to devising strategies and advice on treatment, infection control and patient management. We cannot eliminate this problem but we can put in successful strategies to manage it and minimise its impact and keep our antibiotics safe for the future.”

The Department of Health will soon publish its five-year UK Antimicrobial Resistance Strategy, setting out how it will meet the challenges outlined in the Chief Medical Officer’s report.

The strategy and action plan will champion the responsible use of antibiotics – by ensuring NHS staff have the skills, knowledge and training to prescribe and administer antibiotics appropriately. Part of this will include reviewing and updating the curricula for medical undergraduates.

It also aims to strengthen surveillance – by improving the recording of data on the numbers of antibiotics prescribed and trends in antibiotic resistance, which will be used by clinicians to change patterns of prescribing. This in turn will help reduce the level of resistance and help ensure patients respond to treatments.

The national approach to tackling antimicrobial resistance should not just focus on humans

In addition, the Department of Health wants to encourage the development of new diagnostics, therapeutics and antibiotics, for example by continuing to support the IMI and other initiatives that encourage scientific research.

Dame Sally’s report makes further recommendations on tackling antimicrobial resistance, including:

  • Applying new infection control measures to home and community care settings, as well as hospitals;
  • The national approach to tackling antimicrobial resistance should not just focus on humans; the Department for Food, Environment and Rural Affairs should also closely manage the risk of antimicrobial resistance in animals;
  • Public Health England should also work closely with the NHS Commissioning Board to make sure that advanced testing facilities are available to treat infections brought into the country from abroad.
  • Further promotion of the benefits of vaccination and encouragement of vaccine uptake during pregnancy to prevent diseases such as flu and whooping cough should be undertaken; and
  • Directors of Public Health should work with schools to ensure the school nursing system is well placed to deliver new immunisation programmes.

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