646 WORD COMMENTARY ABOUT THE 2013 UK ANTIMICROBIAL RESISTANCE (AMR) STRATEGY
Professor Laura JV Piddock,
Director of Antibiotic Action, BSAC Chair in Public Engagement
and
Professor of Microbiology and Deputy Director of the Institute of Microbiology and Infection, University of Birmingham, UK
Following the 1998 House of Lords report ‘Path of Least Resistance’, a UK AMR strategy was published in 2000. Since that time considerable efforts in the UK have been extended to successfully reduce the number of infections by MRSA and Clostridium difficile. However, over the last decade there have been increasing numbers of infections in people by multidrug resistant Gram negative bacteria including Escherichia coli and Klebsiella pneumoniae. In parallel there has been a reduction in the number of pharmaceutical companies producing new antibiotics, and the new drugs that have reached the patient have been predominantly those active against Gram positive bacteria such as MRSA.
The publication of the 2013 UK AMR strategy seeks to address the issues currently facing doctors treating bacterial infections, particularly those caused by Gram-negative bacteria. The three strategic aims of the strategy are laudable. If delivered these will address the challenges posed by antibacterial drug resistance by improving knowledge amongst healthcare professionals and the general public so that current treatments are preserved and used appropriately, and by providing an environment for new research to understand resistance and for the development of new treatments for bacterial infections.
Implementation of the 2013 AMR strategy will require the education of healthcare professionals so that they have a good understanding of antibiotic resistance and best practices in the use of antibacterial drugs. This is essential for delivery of the strategy and has been lacking in many undergraduate and postgraduate medical curricula and will require involvement with the royal colleges and local deaneries.
The 2013 strategy also recommends a substantial and extended research effort to understand resistance, discover new treatments and enhance surveillance of antibacterial drug resistance. This will require significant new funding to ensure delivery and government commitment to research councils and other funding bodies to provide the breadth and depth of knowledge required to tackle and resolve the problem of antibacterial drug resistance.
Engagement with the general public, who are increasingly aware that antibiotic resistance affects everyone, is also to be strengthened. This is important because of the widespread use in domestic and industrial settings of antibacterial molecules which can select antibiotic resistant bacteria.
Post the 2000 AMR strategy, funding was made available to investigate antibiotic resistance in bacteria isolated from animals. It is recognised that the use of antibiotics to treat infections in animals is an integral part of veterinary medicine, especially in food producing animals and economic consequences of infection. However, due to the impact of antibiotic resistance upon human health alternative strategies for the prevention and treatment of infections in animals should now be actively sought. The 2013 AMR strategy should facilitate this. For instance, veterinary medicine is one area in which bacteriophage treatment could make a big impact. It is therefore encouraging that delivery of the strategy will be UK-wide and the responsibility of both the Department of Health and Defra.
BSAC has been actively working in many of the areas identified in the 2013 AMR strategy and will support its delivery and encourage the use of the strategy as an opportunity and catalyst for swift and decisive action. BSAC initiatives such as Antibiotic Action already engage professional and public audiences and will continue to do so. Furthermore, the BSAC National Point Prevalence Survey System will collect longitudinal data on antimicrobial consumption in UK hospital settings, extending on the Society’s role in coordinating collection and submission of data from ambulatory patients to ECDC.
BSAC is also the Secretariat for the All Party Parliamentary Group on Antibiotics, Chaired by the Shadow Health Minister, Jamie Reed, MP; Kevin Barron MP is Deputy Chair, Zac Goldsmith MP is Treasurer and Baroness Masham is secretary. The APPG on Antibiotics provides cross-party parliamentarians a forum in which they can hear evidence, contribute to debate and identify solutions that the UK can offer to the Grand Challenge of antibiotic resistance and will further support delivery of the 2013 AMR strategy.
NOTES:
The British Society for Antimicrobial Chemotherapy (BSAC) is an inter-professional organization with 40 years of experience and achievement in antibiotic education, research and leadership and is dedicated to saving lives through appropriate use and development of antibiotics now and in the future. BSAC publishes the Journal of Antimicrobial Chemotherapy, the leading international journal in its field, and leads Antibiotic Action, a UK led global initiative that seeks to ensure effective antibiotics are researched, discovered and developed for all who need them. The Society engages with a wide range of stakeholders to improve and promote understanding of antimicrobials, including peer organizations, parliamentarians, policy-makers, students and healthcare trainees, scientists, researchers and journalists. The establishment of the APPG on Antibiotics is a stated output of BSAC’s ‘The Urgent Need Initiative’, and follows the work undertaken by Antibiotic Action since its launch in November 2011.
For further information on BSAC and its activities please visit:
· BSAC www.bsac.org.uk
· Antibiotic Action www.antibiotic-action.com
Promoting the need for discovery and development of effective antibiotics for all who need them
· APPG on Antibiotics http://antibiotic-action.com/appg-on-antibiotics/
· Antibiotic Resistance surveillancewww.bsacrsurv.org
Monitoring resistance to antibiotics (antimicrobials, antibacterials) within the UK
· UK Outpatient Parenteral Therapy Initiative www.e-opat.com
Supporting the establishment of standardized OPAT services across the UK wherever the clinical need exists
· National Antimicrobial Stewardship Point Prevalence System www.nas-pps.com
N3 server system providing reference data on antimicrobial consumption in hospital settings
· National Susceptibility Testing Methodology www.bsac.org.uk
Providing antimicrobial susceptibility test reporting and testing guidance since 1999