UK and US take the lead in battling antibiotic-resistant bacteria
Interview by Steve Halasey
International concern for the emergence of antibiotic-resistant bacteria has given rise to renewed efforts to detect outbreaks involving such organisms and prevent their spread.
In July, British Prime Minister David Cameron commissioned an independent review to explore the economic issues surrounding antimicrobial resistance, and create a plan for encouraging and accelerating the discovery and development of new generations of antibiotics.1 And in September, President Obama issued an executive order creating a new Task Force for Combating Antibiotic-Resistant Bacteria—to be jointly chaired by the secretaries of the US departments of defense, agriculture, and health and human services—with a multiyear mandate to develop plans for detecting, preventing, and controlling antibiotic resistance.2
Meanwhile, a study carried out by University College London and Public Health England (PHE) has suggested that making such government-led efforts successful may be more difficult than it might seem. Published in the Journal of Antimicrobial Chemotherapy, the study revealed that the proportion of UK patients given antibiotics for coughs and colds has risen by a staggering 40% since 2000—in spite of clinical practice guidelines clearly arrayed against such prescribing practices.3
To find out more about how the issue of antibiotic resistance is playing out in the UK and elsewhere, CLP corresponded with Peter FitzGerald, PhD, CBE, founder and managing director of Randox Laboratories, Crumlin, County Antrim, UK.
CLP: Antimicrobial resistance has taken on additional urgency in the UK and elsewhere. How broad is the impact of the problem?
Peter FitzGerald, PhD, CBE: Across Great Britain, as an example, it has been estimated that each year one million people spend at least 1 week in the hospital due to respiratory infections. The use of better diagnostics would greatly improve treatment of this group and reduce unnecessary prescribing. Reducing the average length of such bed stays from 7 days to 5 days would save the UK’s National Health Service half a billion pounds annually.
CLP: Why have practice guidelines proven ineffective at controlling inappropriate prescriptions of antibiotics?
FitzGerald: The rise in antibiotic resistance has been fueled by patients’ inappropriate demand for antibiotics and general practitioners’ reliance on antibiotics. Public Health England has signalled that there is a need to “make improvements to antibiotic prescribing,” and with this there is certainly also a need to end the one-treatment-fits-all mentality. Through more accurate diagnosis, and more appropriate use of antibiotics, it is possible to improve treatment and reduce the effect of antibiotic resistance.
CLP: What lessons does the recent PHE study hold for the medical community at large, and particularly for those who are most engaged in implementing government responses?
FitzGerald: This study further validates our concerns and reinforces the pressing need for real action. Prime Minister Cameron has said that antibiotic resistance threatens to cast us back to the “dark ages of medicine.” But this doesn’t have to happen. There are solutions, beginning with new technologies to improve the range of available diagnostics.
Ultimately, such diagnostics will empower doctors to prescribe the appropriate treatment for individual patients at first presentation, rather than adopting a “one-treatment-fits-all” mentality, and thereby contributing to the overprescribing of antibiotics that is not only affecting the health of our country but the health of the global population.
CLP: Developing new antibiotics to replace those whose effectiveness has been lost is likely to take many years. What can health authorities do to improve the situation in the short term?
FitzGerald: In spite of previous research into the issue of antibiotic resistance, the UK’s Medical Research Council has concluded that no effective solutions have been found. But as the search for broadly applicable solutions is continuing, the UK’s medical community and “war cabinet on antimicrobial resistance” can still make progress by conducting a rapid appraisal of existing innovative technologies with the ability to tackle this issue on the front lines.
Health authorities would make a significant contribution if they would encourage the adoption of advanced diagnostics, and move practitioners toward the mentality of “no antibiotic without accurate diagnosis.”
CLP: Are there differences between the approaches of the task force created by President Obama’s executive order and the UK’s “war cabinet on antimicrobial resistance”? Can they work together?
FitzGerald: The difference between the UK and US strategies is that the UK’s strategy targets antimicrobial resistance—a broader approach tackling infections born of bacteria, viruses, parasites, or fungi. However, predominantly, one finds coherence between the UK war cabinet’s strategy and President Obama’s directive. Both place the conservation and stewardship of current antibiotic treatments at the heart of their approaches; both emphasise the need for a greater understanding of the threat we face; and both define the clear need for research and development into improved diagnostic technologies.
CLP: How do you think support for the development of next-generation diagnostics should be implemented in policy and action?
FitzGerald: The UK’s chief medical officer, Dame Sally Davies, has described antibiotic resistance as a “ticking time bomb” and “as big a risk as terrorism.” It is time for governments across the globe to unite—to close down scatter-gun approaches, provide resources for research and development, and adopt private-sector technologies with demonstrated value to the healthcare arsenal. In addition, a shift in mindset is essential. Public reliance on antibiotics must be broken, and the public must be reeducated through improved information campaigns. Meanwhile general practitioners must address their culture of prescribing antibiotics too readily. These efforts must go hand-in-hand.
CLP: Your company has a leadership position in this field. How do your recent products respond to such needs?
FitzGerald: We believe that the rapid, highly accurate diagnostic technology we are pioneering has a fundamental role to play in addressing this growing concern in the UK, the US, and across the globe.
First-time, accurate diagnosis is the key. We’ve recently launched the Randox Respiratory Array, which screens saliva, mucus, or sputum specimens from a patient, and can accurately identify up to 22 bacterial and viral respiratory infections at the same time. The test returns results to the doctor on the same day, enabling the doctor to promptly prescribe the correct antibiotic—not just any antibiotic or other form of medication that might be ineffective. Achieving a correct diagnosis the first time around will make possible much-needed progress in appropriate prescribing and treatment.
CLP: How would you characterize your call to action for the medical community?
FitzGerald: There is an onus on each of us to take charge of public health. As the UK has emerged as a principal force in the fight against antibiotic resistance, we have an opportunity to lead by example and facilitate a much-needed change in prescribing behaviors.
We are calling on the UK’s newly established “war cabinet on antimicrobial resistance” to engage the latest in diagnostic technologies as part of their weaponry and start tackling the issue on the front lines.
By utilizing existing resources and employing pioneering technology to inform diagnosis, we can significantly influence prescribing habits, while the medical and research community continues to wage war on one of the greatest threats to public health in recent history.
Steve Halasey is chief editor of CLP.
1. UK Department of Health. Prime minister warns of global threat of antibiotic resistance. Press release, July 2, 2014; available at: www.gov.uk/government/news/prime-minister-warns-of-global-threat-of-antibiotic-resistance. Accessed September 29, 2014.
2. Obama B. Executive order: combating antibiotic-resistant bacteria. Available at: www.whitehouse.gov/the-press-office/2014/09/18/executive-order-combating-antibiotic-resistant-bacteria. Accessed September 29, 2014.
3. Hawker, JI, Smith S, Smith GE, et al. Trends in antibiotic prescribing in primary care for clinical syndromes subject to national recommendations to reduce antibiotic resistance, UK 1995–2011: analysis of a large database of primary care consultations. J Antimicrob Chemother. 2014; first published online August 4, 2014; doi: 10.1093/jac/dku291.