Conclusions and recommendations
Communicating the danger
1. We
are convinced that greater public awareness surrounding the necessity
for stewardship of antibiotics is crucial in reducing pressure
on practitioners to prescribe antibiotics. We welcome the awareness
of the Government of the need for sustained campaigns to educate
new generations. However, the previous Strategy would appear to
have had insufficient impact in achieving a high enough public
awareness and the current Strategy has no definitive targets or
measures of success. We recommend that the Action Plan set challenging
targets for improvement of public awareness against which success
may be measured and reported. These targets should be re-evaluated,
and communicated to this Committee, once a rigorous evaluation
of the 2014 European Antibiotic Awareness Day has been conducted.
(Paragraph 16)
2. It is essential
that responsible antimicrobial stewardship is practised in the
animal sector. The Government should, in the Action Plan, outline
its plans to ensure that veterinarians, farmers and other animal
carers have a stronger focus on antimicrobial resistance. (Paragraph
60)
Antimicrobial resistance within the NHS
3. Given
the focus on antibiotic resistance since 2000, we found it difficult
to understand how the Government has failed to act decisively
to address the issue of inappropriate prescription of antibiotics.
We recommend that, as a matter of public interest, the Government
drives the development of clinically proven alternative, safe
and effective strategies to ease the demand placed on General
Practitioners by people with acute infections so that they can
develop an appropriate response to these requests without creating
further antimicrobial resistance. We support calls for better
education of medical students and greater focus on antimicrobial
resistance during clinical career development. It is essential
that the Government, as a matter of urgency, puts measures in
place to drastically reduce the unnecessary prescription of antibiotics.
(Paragraph 20)
4. It is inevitable
that strategic goals such as stewardship of antimicrobials will
get lost in the daily tactical decisions made by healthcare staff.
We consider it necessary that there are clear responsibilities
within all levels of the NHS for better antimicrobial stewardship
and we recommend that the Government outline, in its Action Plan
for the Strategy, how they will embed those responsibilities across
all roles within the NHS and how compliance with the Strategic
goals will be monitored and reported. We have concerns that the
implementation of new structures and chains of command may exacerbate
those difficulties in the short term. (Paragraph 23)
5. Diagnostics are
a key tool in limiting and targeting use of antibiotics. The Government
should indicate in its response to this report how it intends
to ensure better use of current diagnostic facilities, how it
intends to speed up diagnostic provision and how it will ensure
that the Catapult for Precision Medicine delivers diagnostics
for infectious diseases. (Paragraph 30)
6. We are concerned
that Infection Prevention and Control (IPC) does not appear to
be delivered in a coherent fashion within the National Health
Service. Our key concern is that the integration of antimicrobial
resistance measures will be more difficult in the absence of a
coherent IPC policy across the NHS. (Paragraph 33)
7. We acknowledge
the success that introducing Healthcare Associated Infection Targets
has achieved in reducing the incidence rates of infectious diseases
like MRSA and C. difficile. However, it is now time to design
a more sophisticated approach to infection prevention and control
that avoids undue reliance on particular antibiotics, thus exacerbating
the problem of antibiotic resistance. (Paragraph 36)
Dealing with the information gap
8. It
is essential that the Department of Health develop a system for
monitoring post-prescription behaviour of patients who have been
prescribed a course of antibiotics. That system should be outlined
in the Government's Action Plan for Antimicrobial Resistance and
should include data from community-based patients. (Paragraph
40)
9. The Government
recognises that there is a lack of information concerning environmental
drivers of antimicrobial resistance. We recommend that the Government
publish, in its Action Plan, a research programme that will recruit
expertise across the UK to fill the knowledge gaps on how antimicrobial
resistance exists and may be transmitted via environmental routes.
Hoping that research grant applications to research councils will
serendipitously gather this necessary information leaves too much
to chance. Research council funding should be, in this important
field of study, complementary to Government directed, and funded,
research programmes. (Paragraph 45)
10. There is circumstantial
evidence that antimicrobial resistance can be transmitted from
animal pathogens to human pathogens although the evidence base
is incomplete. The Government needs to ensure that this is addressed.
We recommend that this is an additional focus of research in the
action plan and that in the meantime, the Government takes action
to ensure the use of antibiotics in farm animals is strictly required
for therapeutic use. (Paragraph 51)
11. With regard to
the transmission of resistance from animal to human pathogens
it is clear that the Government does not hold and is not collating
the necessary information. The Action Plan should detail how the
Government intends to collect, collate and share this data and
have target dates for when this will be achieved. (Paragraph 56)
12. As the development
of new antibiotics and new technologies is dependent on private
enterprise working closely with academia, we were disappointed
to find that the membership of the Government's High Level Steering
Group for the Strategy did not incorporate voices from industry
or learned societies. We recommend that the membership of the
High Level Steering Group be expanded to include those voices.
(Paragraph 66)
Economics of new antibiotics
13. Antimicrobial
resistance has the potential to send medicine back to the early
20th century, severely limiting the use of what are now considered
basic and routine surgical procedures. The best current defence
against this scenario is a strong global pipeline of new drugs,
possibly using a range of solutions as described above. But that
is dependent on the infrastructure that provides financial incentive
to the industries that deliver these technologies including means
of compensating for the uncertainties inherent in research and
development. (Paragraph 82)
14. We agree with
the Prime Minister that, if there is no change to the economic
landscape for developing new antimicrobials, the pipeline of new
antimicrobials will run dry. We also agree that the Government
needs to work with researchers, investors, small and medium sized
enterprises, large pharmaceutical companies and other Governments
to urgently identify appropriate economic models that might encourage
the development of new antimicrobials. We hope that the review,
which will take almost two years to report back with recommendations,
will not delay work on any pricing alternatives that could be
agreed with the pharmaceutical industry over a shorter timescale.
(Paragraph 83)
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