March 11, 2013

expert reaction to new report from the Chief Medical Officer on infectious disease and antimicrobial resistance

A report from the Chief Medical Officer, Prof Dame Sally Davies, warned of the dangers of antibiotic resistance, calling for a global initiative to tackle the problem.

Dr Michael Moore, Reader in Primary Care Research at the University of Southampton, GP, and Clinical Champion for Antimicrobial Stewardship for the Royal College of GPs, said:

“Antibiotics have come to be used more widely than was really needed for conditions such as common colds and infections that will get better naturally or respond better to other treatments. Patients have got used to this and both GPs and patients often worry about more serious infections; this can make it difficult for GPs to prescribe appropriately. Reducing unnecessary prescribing will need a partnership between patients and their doctors to understand when antibiotics are not needed and when to visit the doctor.

“The focus of research in Southampton has been to identify alternative strategies for GPs to use when faced with these tricky prescribing decisions. These might be through using clinical scores or near patient tests to identify those most likely to benefit from antibiotics, or improving consultation skills or identifying alternative ways of relieving symptoms.

“Antibiotics are still needed for serious infections; we need to make sure they are used appropriately to preserve essential antibiotics for the future.  We welcome this report which will highlight the dangers of overprescribing antibiotics. Patients need to be more aware of when antibiotics are needed and this report will help to get this message across.”

Prof Christopher Thomas, Professor of Molecular Genetics, University of Birmingham, said:

“Any reassessment of antimicrobial resistance that results in it being increased as a public health priority will help us not only enforce the immediate actions that can prevent the spread of resistance but also invest in research into new ways to combat the threat it poses. While better surveillance, hygiene and restricted use of antibiotics can slow the spread of resistance we also need new ways to kill resistant bacteria or reduce their carriage of resistance genes.  Novel approaches that might have appeared unrealistic a few years ago need to be explored if they hold a chance of helping us tackle this issue.  For example carriage of resistant bacteria by healthy individuals continues to rise, e.g. in old people in care homes and other institutions.   Novel approaches that can reduce such carriage could contribute significantly to tackling this threat”

Prof Laura Piddock, Professor of Microbiology and Deputy Director of The Institute of Microbiology and Infection, University of Birmingham, & Director, Antibiotic Action, said:

“I’m very glad that the Chief Medical Officer is recognising the antibiotic discovery void, which has been widely reported elsewhere in the last decade, and that she is now calling for politicians to treat this seriously. Equally it is very important that people use antibiotics properly, in order to preserve their utility. My colleagues and I applaud the activities and awareness-raising that she is undertaking on this issue.

“Antibiotic Action (antibiotic-action.com) has been calling for action since November 2011, and we are delighted to see this being highlighted in the public eye. We ask everyone to sign our petition to help raise awareness of this impending medical crisis.

“However, there are an increasing number of infections for which there are virtually no therapeutic options, and we desperately need new discovery, research and development; the UK is extremely well-placed to do basic discovery and research for new antibacterial molecules.

“I also welcome her call for this issue to be placed on the national risk register, as antibiotic resistance was highlighted in the recent global risks register discussed at the World Economic Forum in January, for which I was an expert adviser.”

Professor Nigel Brown, President of the Society for General Microbiology, said:

“Professor Dame Sally Davies rightly flags the issue of antimicrobial resistance to be of national and international concern. Urgent action is required by microbiologists and other scientists to identify and produce new antibiotics, and to tackle the problem of antibiotic resistance and its transmission.

“The Society for General Microbiology has brought these issues to the attention of its members in the November 2012 issue of Microbiology Today. Our members will be working on understanding infectious disease processes, reducing transmission of antibiotic resistance, helping develop new antibiotics and educating the users of antibiotics about these issues. The techniques of microbiology and new developments such as synthetic biology will be crucial in achieving this.”

Emeritus Professor Richard James, former Director of the Centre for Healthcare Associated Infections, University of Nottingham, said:

“Dame Sally Davies is to be congratulated in making clear the seriousness of the problem of antimicrobial resistance and proposing 17 recommendations to try to counter this threat.

“Anyone reading the report will realise that there are no magic bullets.

“The majority of the 17 recommendations relate to actions in the UK alone but there is acknowledgement of the requirement for the UK Government to campaign for this issue to be given higher priority internationally.

“If international agreement on the required global actions can be reached then a regular audit of the progress of each country could be carried out by the WHO.”

“My opinion:

“I would stress the importance of an integrated strategy that concentrated on the requirement for effective global action that included:

• Further measures to promote the development of new antibiotics by small biotechnology companies and universities, including alternatives – i.e. quorum sensing inhibitors, bacteriocins and vaccines. Antibiotic discovery is difficult, expensive and even if successful, is challenged by the rapid development of resistance. The use of antibiotics is the ultimate Darwinian selection.

• Improved surveillance of the spread of antibiotic-resistant bacteria is excellent in the UK/EU but needs improving in many other countries so that we can monitor the emergence of new antimicrobial resistance threats and monitor their spread globally.

• Effective antibiotic stewardship to prevent the overuse/misuse of antibiotics. Examples would include stopping over the counter sales of antibiotics in Southern Europe; reduce use in farming, including fish farming etc.

• Explore economic measures, such as a tax on antibiotic use, to prevent a “tragedy of the commons” scenario.

• Better education of doctors and patients on why antibiotic use should be restricted. It may be in the patient’s interest to be prescribed antibiotics but this could be detrimental to society.

• Improved infection control in hospitals to prevent the spread of antibiotic-resistant bacteria.

• Improved rapid diagnostic tests to inform antibiotic prescribing of infected patients.

• Acknowledgment of the interaction between social conditions and the spread of infection, i.e. TB spread amongst the disadvantaged in inner cities; urban populations in India that lack access to sanitation, Carbapenem-resistant enterobacteriacae in care homes in the USA.”