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?

Help to stop antimicrobial resistance!

Dr Jacqueline Sneddonby Dr Jacqueline Sneddon, Project Lead for Scottish Antimicrobial Prescribing Group, part of Healthcare Improvement Scotland

Dr Jacqueline Sneddon highlights opportunities for community pharmacy teams in Scotland to support European Antibiotic Awareness Day (EAAD) 2016 and contribute to the fight against antimicrobial resistance. Read more Help to stop antimicrobial resistance!

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

Antimicrobial resistance – how you can make the difference

nealpatel2

By Neal Patel, Head of Corporate Communications, RPS

This week the Royal Pharmaceutical Society hosted a national Antimicrobial Summit in partnership with the Royal College of Physicians, the Royal College of General Practitioners and the Royal College of Nursing, and in collaboration with Public Health England and the Department of Health.

This event recognised the fact that antimicrobial resistance is everyone’s problem and will require collective as well as individual action to meet the public health challenge resistance poses. Read more Antimicrobial resistance – how you can make the difference

Drug-resistant TB

Toby Capstickby Toby Capstick, Lead Respiratory Pharmacist & Member of the British Thoracic Society MDRTB Clinical Advice Service

Last night’s  Inside Out report for BBC One London Tackling drug-resistant TB in London described how tuberculosis is on the increase in London. A serious concern is that an increasing number of patients are being identified with strains of TB that are resistant to the most effective antibiotics used to treat the disease.

Rates of TB in the UK as a whole have remained relatively steady since 2005. They had risen over the previous two decades, in contrast to most other developed countries where TB rates had remained stable or had fallen. Public Health England reported that there were a total of 8,751 cases of TB in the UK in 2012, and resistance to at least one antibiotic was found in almost 1 in every 13 people diagnosed with TB. Read more Drug-resistant TB