Aug 22, 2016

Resolving antimicrobial resistance

Antimicrobial resistance (AMR) is a term that has been in health news headlines over the last month and it is going to be a trending topic for some time.

We’re on the brink of a global crisis that not only concerns health, but everything from the economy to agriculture as Jim O’Neill, AMR expert and macro economist highlighted in his report last month1.

Last week, we saw some positive health PR for the NHS around the issue. The NHS has succeeded in reducing antibiotic prescribing by 1% nationwide, an ambition set out in April 2015. In fact they cut prescribing rates by a huge 7.3%2 – an achievement that HCPs, commissioners and the government should be proud of.

Success can be attributed to a variety of factors, one being the Quality Premium Initiative which financially rewarded CCGs for meeting their AMR targets2. This, launched alongside TARGET, (Treat Antibiotics Responsibly, Guidance, Education, Tools) supported HCPs to cut antibiotic prescribing3. AMR is a complex issue and while these measures have seen significant successes, there is still a long way to go.

Reducing antibiotic prescribing is not enough to tackle the global issue, and HCPs, in particular GPs, should not be solely responsible for providing the solution. Both the general public and the pharmaceutical industry have a role to play as well.

The public need to be better educated about the risks associated with antibiotic resistance. A 2015 survey found that a third of adults had taken a course of antibiotics in the past year, with around 60% taken for common conditions that typically resolve themselves5. While 86% of patients agreed that coughs and colds tend to get better on their own5, it’s clear that health communication needs to go beyond education and actually change the public’s perception of antibiotics.

There is opportunity for better communications; the survey found that only 8% of patients are informed about antimicrobial resistance5. It’s easy to say that doctors should be providing information on AMR but they’re already time and resource poor. So who should be, or who is able to, provide the much needed information?

While public health awareness is needed, there are issues that need action.

1. Reduce the demand

Reducing the dependence on antibiotics may help change demand for them. When the TARGET programme launched, 53% of patients expected antibiotics after visiting a GP for a cough or a cold and 93% of patients who asked for antibiotics were prescribed them3; so altering the demand could dramatically reduce prescription rates.

Increasing the uptake of vaccines could also help. The flu vaccine could potentially reduce the number of antibiotic prescriptions6. But this circles back to patient education and public awareness, something that the NHS can’t be expected to do alone.

2. Develop new classes of antibiotics

There have been calls this week to approve antibiotics that will fall into a ‘last resort’ category7. Dr Paul Hoskisson, a member of the Microbiology Society, suggests that a change in regulation may enable a new wave of antibiotics with stronger side effects to broaden the pool of antibiotics and slow the spread of AMR7. This could help reduce the use of broad spectrum antibiotics, which are linked to Hospital Acquired Infections such as C-Difficile6.

3. Cost increases – the elephant in the room

It’s clear that reducing the rate of prescribing is a crucial element of tackling AMR on a global level, but what effect will this have on the pharmaceutical companies that develop and manufacture antibiotics? A drop in prescription rates will result in less revenue, which may impact reinvestment in essential research and development of much needed, new antibiotics. No one likes increasing the cost of health care, but could increasing the cost of antibiotics be part of the solution?

Increasing the cost will not only help reduce prescription rates in a cash-strapped NHS, but also compensate for loss of revenue in the pharma industry if antibiotic prescribing drops a further 8% next year – enabling R&D into the very same area.

We have heard the advice that less is more across many industries…it may be time this is true for antibiotics as well.