Antimicrobial resistance – Are we losing the battle against bacteria?

By Dr Claire Thompson, RPS Deputy Chief Scientist

Meeting with world health officials in October, Prof Dame Sally Davies, England’s Chief Medical Officer, repeated her warning that if antibiotics lose their effectiveness it would spell the end of modern medicine.

It has been 18 months since Jim O’Neill made his final recommendations on how we can tackle antimicrobial resistance (AMR) globally.  These included the need to:

– Increase public awareness of AMR;
– Reduce the over/inappropriate use of antibiotics;
– Prevent the spread of infections;
– Increase research into new antibiotics by generating a $2bn Global Innovation Fund.

Since then, little has changed within the UK.

At the BioInfect 2017 event Jo Pisani, Pharma & Life Sciences Partner at PwC, gave her state of the nation address on antibiotics and was disappointed to see that little has changed in the pipeline of new antibiotics since the O’Neill reports. “The UK has opportunity to be world leader in antibiotic development, but with so few companies involved in antibiotic R&D, how do we advance the pipelines?” she said.

Source: Antimicrobial resistance: The state of the nation report on UK R&D. PwC. https://www.pwc.co.uk/industries/healthcare/insights/antimicrobial-resistance.html

Where are the new antibiotics?

At the moment, there are less than 100 scientists in the Pharma Industry who are working on new antibiotics. This is mainly due to the lack of reimbursement models for antibiotics.

There have been calls for new models and incentives for developing antibiotics, such as exclusivities on market entry akin to those which are in place for orphan drugs or paediatric medicines, but these are yet to come to fruition.

This means that organisations such as the AMR Centre, charities such as Antibiotics Research, and small companies like Auspherix are leading the charge in developing new antibiotic medicines.
In order to progress the development of new antibiotics, we need to stop focussing on what they are going to cost and start thinking of cost of not having them.

What are we doing to combat AMR?

The key to overcoming AMR is not just about new antibiotics; improving stewardship and raising awareness are imperative. As a profession, these are some of the activities we are involved in.

Public engagement and awareness
With 1.6 million pharmacy visits per day, pharmacists are perfectly positioned to talk with patients and the public about what antimicrobial resistance is, when antibiotics are required, and how to take them. The Test and Treat service at pharmacies is under-utilised. Currently, people aren’t aware of it and don’t know they can talk to their pharmacist.

Antimicrobial Stewardship Programme
In September, the RPS launched the Antimicrobial Stewardship programme  which contains reference, guidelines and support tools for pharmacists.

What impact can we have?

In 2016, Government set a challenge of reducing inappropriate antibiotic prescribing by 50% by 2020. Pharmacists are integral to this. As a profession, we still have some work to do to ensure that the public know that they can talk to pharmacists about health concerns and to get advice on medicines. But the impact we can have as pharmacists (on raising awareness and providing stewardship) and as pharmaceutical scientists (in developing new antibiotics) is enormous.

A tweet from the BioInfect 2017 summarised this perfectly “Great way to cut queues at your GP. Talk to your pharmacist and conserve our antibiotics”.

Contrary to the saying, resistance is not futile – it is rife. But the war on bacteria is not over! Please play your part.

Mother was right!

“Wash your hands when you come in”, “Make sure you wash before dinner”, “Show me your hands” – just some of the echos of my childhood which I’m sure many of you recognise.
Ahead of World Antibiotic Awareness Week  and European Antibiotic Awareness Day  I spent much of my time at the RPS researching, collating and checking resources to support antimicrobial stewardship for the RPS AMS Portal.
I learnt a lot and guess what – our mothers were right!  One of the simplest ways to reduce the use of antimicrobials is hand washing (or hand hygiene as it is referred to in healthcare settings).  Not just to remove visible dirt but to remove bacteria and viruses which could cause infections such as upset stomachs, coughs, colds or pneumonia. Washing your hands properly should take 20 seconds, as long as it takes to sing “Happy Birthday to you” twice.
Simple you think – but wait – the RPS Handwashing essential guide states that 84% of British adults don’t wash their hands for long enough and 65% of people don’t always wash their hands before eating. The infographic below has other figures which make uncomfortable reading.

I mentioned these gruesome figures one evening at home and an unexpected consequence was that my daughter, who teaches a Year 2 class, was interested in using this information at school in some way.  I suggested having a look at the e-bug resource (another resource found during my AMS research) and together with the ‘handwashing and mouldy bread experiment’ (look it up on youtube!) she formulated a lesson plan.  The children loved it – and it became a feature of their end of term assembly.
So, what started as a literature review style research project on antimicrobial stewardship and resistance ended up as a theme for a school assembly.  It illustrates that antimicrobial stewardship belongs to us all – organisations, health professionals and all ages of members of the public.  Now, during World Antibiotic Awareness Week, take some time to have a look at the AMS Portal.  This is essentially a signposting resource linking to antimicrobial stewardship resources under six key categories: strategy, policy and guidance; clinical and technical guidance, initiatives and campaigns, training and educations resources, journals; and organisations.  The AMS Portal focuses on GB resources for pharmacists and pharmacy teams although we recognise the need to signpost to worldwide information and resources from outside GB are also included.
Have a browse – you might even find yourself influencing another school lesson or even humming ‘Happy Birthday to you, Happy Birthday to you………………….’!

Why is handwashing important?

By Professor Ash Soni, President of the Royal Pharmaceutical Society

Every day we carry millions of bacteria, some of which are naturally found on our bodies and some of which are germs that can make us ill or infect others.

Every day we have contact with people who don’t always wash their hands after going to the toilet, or preparing food.

Our survey on handwashing shows 84% of British adults don’t wash their hands for long enough to clean them of bacteria which can cause infections such as upset stomachs or pneumonia, or viruses which can cause colds and flu.

Regular handwashing with soap and water is the single best way to protect yourself and others from infections. The recommended time to spend washing your hands is 20 seconds, as long as it takes to sing ‘Happy Birthday to you’ twice. Read more Why is handwashing important?

The rise of antibiotic resistant bacteria

Dr Jacqueline Sneddon

Dr Jacqueline Sneddon MRPharmS FFRPS
Project Lead for Scottish Antimicrobial Prescribing Group

Consider this scenario. Your younger child has been awake all night, crying with earache. They’re upset and tired, and so are you. Your older child had a flu bug last week, and you have already taken three days off work to look after them. You’ll take the little one to the doctor in the morning and get antibiotics to clear it up. You’ll probably have to pester the GP for them, but you’ll do it so your child feels better quickly and you can go back to work sooner.

In addition to being really worried about our little ones, as parents, we also have to cope with the guilt of being away from work for too long, and for many parents this is unpaid leave.
The sight of a poorly child is an upsetting one. The hope that antibiotics will reduce the time our children suffer with pain, sometimes means that exhausted and worried parents demand a prescription for antibiotics, even though the GP didn’t really think they were necessary. Read more The rise of antibiotic resistant bacteria

How can pharmacists fight antibiotic resistance?

jaynelawrenceby Professor Jayne Lawrence, Chief Scientist, Royal Pharmaceutical Society

Antibiotic resistance occurs when medicines are no longer effective in treating bacterial infections. This is potentially catastrophic, as much of modern medicine would become impossible without antibiotics.  Simple infections would become life-threatening and common surgery would become unsafe.  Antibiotics are not effective against viral infections, yet they are often used to treat them. Pharmacists are on the frontline of fighting antibiotic resistance, but how can we make a difference in practice? Read more How can pharmacists fight antibiotic resistance?

A global approach to antibiotic resistance

Picture Harpal Dhillon Chair RPS AMR groupBy Harpal Dhillon, Chair of the RPS Antimicrobial Expert Advisory Group

Bringing any new drug to market is a time consuming, costly and high-risk endeavour that typically takes 10 years, at an average development cost of about $1.3 billion U.S.

Even then, only one in five drugs tested in people is approved and reaches the market.  For antibiotics, the economic considerations are more challenging than for many other medical areas.  In addition to the unique scientific and regulatory challenges in antibiotic development, pricing and reimbursement do not reflect the true value of these life-saving drugs. Read more A global approach to antibiotic resistance

Funding new medicines

jaynelawrenceby Professor Jayne Lawrence, RPS Chief Scientist

Without pharmaceutical science, we would have no new medicines. Neither would it be possible to improve existing medicines, or understand how we could better use our existing medicines.

Those working in pharmaceutical science play a pivotal role in the discovery, design, formulation, manufacture, regulation and use of medicines with the ultimate goal of improving the health of patients.

The challenges and opportunities faced when creating new medicines, improving existing ones or ensuring the better, safe use of medicines are set out in New Medicines, Better Medicines, Better Use of Medicines, a new guide to pharmaceutical science published today by the RPS. Read more Funding new medicines