October 10, 2014

expert reaction to new report on antimicrobial resistance (ESPAUR)

Public Health England has published a report on the prescription of antibiotics in England, and levels of antimicrobial resistance. Data are available for the regions of England, allowing comparison of prescription procedures and health outcomes.

Prof Jodi Lindsay, Professor of Microbial Pathogenesis, St George’s, University of London, said:

“This is a very important report that provides access to information that has not been available before.  For the first time we are able to see substantial differences in antimicrobial prescribing between healthcare regions of the UK.  These large differences show that it should be possible to reduce prescribing in some regions without compromising healthcare. In addition, the data show the worrying result that antimicrobial prescribing overall has increased over the last four years, and we simply must work harder to decrease prescribing.  Finally, those areas that prescribe the most antimicrobials have the highest incidence of resistant infection and have the most work to do.  The team that has produced this report is continuing to generate more data, and in the future it will be very interesting to see data comparing individual healthcare trusts prescribing compared to a range of resistant pathogen rates.”

Prof Brendan Wren, Professor of Microbial Pathogenesis and Dean of Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, said:

“Like climate change we think that the problem of antibiotic resistance is too distant to be too concerned about. This study confirms that the antibiotic problem is with us now and every opportunity highlighted in the study to reduce antibiotic prescribing must be taken. Our dependence on antibiotics goes beyond solving a common infection; they are used in many treatments including cancer, transplants and childbirth. We must act now to preserve effective antibiotics.”

Dr Simon Clarke, Associate Professor in Cellular Microbiology, University of Reading, said:

“Antibiotic resistance is one of the most significant threats to global health that we face, now and in the future.  The numbers of antibiotic resistant infections continues to increase, almost in lock-step with increasing prescription of these vital drugs.

“Crucially, we see more resistance in geographical areas that have higher rates of prescribing.  Therefore it’s essential that we repeat the best practice used in areas where lower levels of resistance are reported.  Anything that can slow down the rise of antibiotic resistance while still giving them to people do actually need them, needs to be considered”

Dr Richard Seabrook, Head of Business Development at the Wellcome Trust, said:

(Richard Seabrook works in innovation and technology transfer at the Wellcome Trust, including managing funding for drug seeding, quite a few of which are antimicrobials)

“Today’s findings are further proof, if it were needed, that resistance to antibiotics is a serious problem in the UK, and that over-prescribing is a key issue. The nightmare of a world without antibiotics – a world where routine hip replacements and C-sections would no longer be possible without life-threatening risk – is not far away, and there is still a limited sense of urgency.

“A vital part of the solution is not taking antibiotics for granted. As well as tackling over-prescribing, patients need to actively take part in this struggle by carefully sticking to their prescriptions. We also need to recognise that misuse of this precious resource is worldwide and encompasses animal health and human resistance to parasites and viruses.”

Dr Kieran Hand, Royal Pharmaceutical Society spokesperson on antibiotics, and Consultant Pharmacist for Anti-Infectives, University Hospital Southampton NHS Foundation Trust, said:

“This analysis of GP and hospital prescribing and resistance data is a very positive step in understanding where improvements need to be made to tackle antimicrobial resistance.

“The UK has a world-class health service and it should be a matter of national pride that antibiotics are used proportionately and responsibly in the NHS. At present, there is clearly room for improvement and we owe it to future generations to protect these vital medicines.

“Specialist pharmacists in hospitals and pharmacist prescribing advisors in primary care have been successful in promoting a switch in choice of antibiotics away from cephalosporins and fluoroquinolones and this has coincided with a significant reduction in Clostridium difficile infections and a plateau in resistance to these drugs in common pathogens.

“We now need to move on to the much more challenging task of reducing inappropriate initiation of antibiotics in the absence of evidence of infection and to reducing course length. In particular, a focus on review of antibiotic prescriptions in hospitals at 48-72 hours will be critical to reducing unnecessarily prolonged courses.

“There is more scope for reducing unnecessary prescribing in primary care, where over 60% of patients with upper respiratory tract infection receive antibiotics. There is an important role for prescribing advisor pharmacists in Clinical Commissioning Groups to be trained to deliver educational messages to GP practices on how to safely reduce prescribing and to support GPs with benchmarking of prescribing data.”

Prof Kevin Kerr, Consultant Microbiologist / Director of Infection Prevention & Control, Harrogate District Hospital, said:

“This is a very important report which provides yet more evidence that we as a society are squandering an unbelievably precious resource. Resistance to antibiotics is rising inexorably and unless we face up to the seriousness of this problem now, the tide of multi-resistant superbugs, which at the moment is lapping around our ankles will rise even further. We all have a role to play in this whether we are patients, members of the wider public or healthcare professionals. This reports gives us an extremely valuable baseline against which we can measure the success – or otherwise – our efforts.”

* ‘English surveillance programme for antimicrobial utilisation and resistance (ESPAUR), Report 2014’ will be published by Public Health England at 00:01 UK time on Friday 10 October 2014, which is also when the embargo will lift. 

Declared interests

Dr Kieran Hand is a member of ARHAI (Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection), DH’s Committee on antimicrobial resistance.