Science and Technology - Seventh Report

---

Here you can browse the report together with the Proceedings of the Committee. The published report was ordered by the House of Lords to be printed 17 March 1998.

CONTENTS

	Paragraph
CHAPTER 1 INTRODUCTION	1.1
What is resistance?	1.7
Clinical resistance	1.10
Cross-infection	1.14
The international dimension	1.15
Hospital infection	1.16
Does antibiotic resistance matter?	1.19
Can resistance be controlled?	1.31
Acknowledgements	1.42
CHAPTER 2 PRUDENT USE IN HUMAN MEDICINE	2.1
Present use in the United Kingdom	2.3
Towards more prudent use	2.8
Formularies, policies and guidelines	2.10
Rapid testing	2.16
Prescription checking and control	2.19
Pharmaceutical licensing	2.23
Pharmaceutical salesmanship	2.24
Over-the-counter (OTC) antibiotics	2.26
Medical education: undergraduate, postgraduate and vocational	2.31
Continuing professional development	2.32
Audit and feedback	2.34
Educational outreach	2.35
Educating the public	2.36
Are antibiotics bad for you?	2.40
Compliance	2.46
CHAPTER 3 PRUDENT USE IN ANIMALS	3.1
Animal medicines	3.3
Growth promoters	3.5
Human health concerns	3.7
Salmonella	3.15
Campylobacter	3.18
Enterococci	3.20
E. coli	3.25
Swedish experience	3.27
US experience	3.30
Licensing regime	3.31
Aquaculture	3.33
Uses of antimicrobial agents on plants	3.34
Sheep: worms and scab	3.36
Antibiotic-resistance marker genes in genetically-modified organisms	3.42
CHAPTER 4 INFECTION CONTROL	4.1
Infection control in hospitals	4.2
Infection control teams	4.3
Contracting for infection control	4.7
Hygiene	4.9
Isolation	4.12
Overcrowding and "hot-bedding"	4.13
Agency staff	4.16
Screening	4.17
Training	4.19
Infection control in the community	4.20
Power to enforce treatment	4.26
Surveillance	4.27
Infection control in prisons	4.29
Costs and benefits	4.30
A national MRSA strategy?	4.35
CHAPTER 5 SURVEILLANCE	5.1
Duty to report	5.2
Scotland and Northern Ireland	5.7
Information technology	5.10
Linking and feedback: the ICARE model	5.11
Resources for the PHLS	5.14
Crisis in clinical academic microbiology	5.15
A national strategy for surveillance	5.18
CHAPTER 6 NEW DRUG DEVELOPMENT	6.1
How hard is industry trying?	6.2
Licensing: fast-tracking and "orphan drug" designation	6.5
CHAPTER 7 VACCINES	7.1
HIV	7.3
Meningococcus	7.4
TB	7.5
Streptococcus pneumoniae (pneumococcus)	7.6
Hospital infections	7.7
Barriers and bottlenecks	7.8
Surveillance for antigenic variation	7.10
Research	7.13
CHAPTER 8 ANTIVIRAL DRUGS	8.1
Prudent use of antivirals	8.4
Surveillance	8.6
Research	8.8
CHAPTER 9 INTERNATIONAL	9.1
World Health Organization	9.3
Malaria	9.6
New drugs	9.9
Prudent use of drugs	9.12
Infection control and vaccination	9.13
Surveillance	9.14
Research	9.15
CHAPTER 10 RESOURCES FOR RESEARCH AND DATA-COLLECTION	10.1
Research into different ways of using antibiotics	10.2
Research into strategies of professional and public education	10.3
Collection of prescribing data	10.4
Research into infection control	10.8
Collection of denominator data for disease surveillance	10.9
Surveillance beyond the hospital	10.11
Research into systems of surveillance	10.14
A funding gap?	10.15
CHAPTER 11 CONCLUSIONS AND RECOMMENDATIONS	11.1
CHAPTER 12 SUMMARY OF RECOMMENDATIONS	12.1

APPENDIX 1  Sub-Committee I

APPENDIX 2  Witnesses

APPENDIX 3  First visit to PHLS HQ

APPENDIX 4  Second visit to PHLS HQ

APPENDIX 5  Visit to King's College Hospital

APPENDIX 6  Visit to USA

APPENDIX 6 (contd.)  Visit to USA

APPENDIX 7  Some important antimicrobial agents

APPENDIX 8  Glossary

APPENDIX 9  Acronyms

References to evidence

Q refers to a question in oral evidence; p refers to a page of written evidence. All the evidence is printed in a separate volume, HL Paper 81-II, Session 1997-98.

---