Antibiotics, discovered in the late 1930s, were seen as a magic bullet to treat all infections. For around 50 years they were used successfully to treat and control bacterial infections. However, inadequate control of their use and lack of understanding or monitoring of resistance has led to the emergence of highly resistant strains of bacteria - a problem that has been acknowledged for more than 30 years.
Just recently under the week long initiative - Protecting Health: Nursing and Midwifery Successes and Challenges - a key theme yet again was the growing problem of antimicrobial resistance and its link to healthcare associated infections. This follows hot on the heels of the report from the Chief Medical Officer for England, Dame Sally Davies, who suggested that the risk to public health of the rise in drug-resistant bacteria is equal to the risk posed by terrorism. A risk she believes needs to be on the Department of Health's Risk Register. Many key commentators, including the major Pharma companies, have welcomed her report but noted that antimicrobial resistance is actually a major global public health problem.
The debate is once again focussed on the need for more effective control over the use of antibiotics and more importantly, the need to find novel ways of funding the development of new antibiotics - a widely acknowledged and intensifying problem. Over the last 30 years very few new antibiotics have been brought to market mainly due to the "challenging environment for antibiotic discovery, development and commercialisation". The paradox of course is that should a new antibiotic be developed, recovering R&D costs would be severely hampered by the need to minimise prescribing to reduce the risk of further resistance.
The 1998 report by the House of Lords Select Committee on Science and Technology – Resistance to Antibiotics and other antimicrobial agents was a key initiative in the war against resistance and made a similar, well researched case for action. Actions included: the media campaign stating that "Antibiotics don't work on colds or most coughs and sore throats"; and an information prescription. Since then there have been numerous reports, guidelines and recommendations from, among others, the UK's Antimicrobial Resistance Steering Group, all aimed at raising the profile of this important issue. While they have had a positive impact on antibiotic prescribing in primary care, there hasn't been the same success in hospitals or in agriculture and farming. Clearly, simply presenting the evidence and producing guidelines are not enough.
There have been similar initiatives across the developed world to encourage the development of new antibiotics and reduce antibiotic usage – but again with limited success. In November 2011, the European Commission set out "concrete actions" to beat the growing threat of antibiotic resistance and in May 2012 the European Commission/ Innovative Medicines Initiative (IMI) launched a €223.7 million programme aimed at tackling antibiotic resistance and speeding up the delivery of new antibiotics to patients based on "co-funding clinical trials".
A key concern is in under-resourced countries where antimicrobial drug resistance is usually not monitored because of a lack of surveillance networks, laboratory capacity, and appropriate diagnostics. In these countries this accelerating problem accounts for a substantial number of deaths, with infants often paying the highest price. Drug resistance in hospital-born babies is estimated to cause an additional 96,000 deaths each year in southern Asia.
Globally there is a need for: accurate mapping of antimicrobial drug resistance, a new international research agenda; a map of existing networks and recommendations to unite them; and a communication plan for national, regional, and international organisations. There is an important role for health care professionals in ensuring their understanding of the challenges and the importance of conserving the antibiotics we have left by using them optimally. The process of developing new antimicrobials and new technologies to allow quicker diagnosis and facilitate targeted treatment must be accelerated. Given the enormity of the challenge this necessitates local, national and global action.
We know what to do, but what are the odds that this time the actions really will work? We have to hope for all our sakes that they will, as it's not just a problem for the under-resourced countries with 25,000 people across Europe dying each year as a result of drug resistant infections, at a cost of £1.5billion. Numbers that are likely to increase exponentially. More importantly, successful surgical interventions that we take for granted today, may well end up being just as high risk a procedure as before the discovery of antibiotics!
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