“It is a fact that the more an antibiotic is used, the more resistance you will see to that antibiotic. That’s why we need to think about how we use antibiotics, as well as when we use them.” That’s the view of Philip Howard, consultant pharmacist in antimicrobials at the Leeds Teaching Hospitals NHS Trust, and honorary senior lecturer at Leeds University.


Antimicrobial stewardship


The term ‘antimicrobial stewardship’ (AMS) is used by healthcare professionals to describe activities to reduce inappropriate antibiotic use: activities which not only reduce the overall amount of antibiotics in use – through better screening and more judicious prescribing, for example - but which also determine which antibiotics are used. This latter tranche of work aims to avoid the situation where an ‘old faithful’ antibiotic product becomes so over-used that it encourages resistant microbes to develop – and the usefulness of that treatment diminishes – even vanishes.   

Although headlines about hospital superbugs suggest that AMR is a hospital-only problem, there is a real need for all parts of the healthcare system to embrace the stewardship agenda. To illustrate the point, Howard points to the 11,000 British people who die each year from blood poisoning. Half of some blood infections seen in hospitals start with a common urinary tract infection caught in the community that escalated in seriousness as a result of resistance to the GP-prescribed antibiotic. He says: “Our hospitals are filled to bursting, but if we can prescribe the most effective antibiotic from the start, we could reduce those admissions – keeping patients in their own homes – and keeping people alive.”


Pictured: Fungal infection bone marrow


Financial incentives


Such is the recognition of the need for AMS that even in today’s cash-strapped NHS there are financial incentives in place across the service to kick start this agenda. For GPs, there are financial incentives to prescribe fewer antibiotics. In hospitals, a programme called Commissioning for Quality and Innovation (CQUIN) encourages hospital staff to refine their antibiotic choices through better use of diagnostic testing.  In total, CQUIN can contribute up to 2.5 per cent of a hospital’s annual income. “That’s a large amount of money, and in an NHS where every penny counts, anything that brings money in becomes a priority,” says Howard.

But more crucially, the funding that has followed programmes such as CQUIN and GP prescribing incentives has had a number of positive knock-on effects: firstly, it has enabled prescribers to afford newer, but more expensive antibiotics – and this has introduced diversity into prescribers’ antibiotic armamentarium and reduced worries about antibiotic obsolescence. Secondly, increasing demand for new antibiotic products has stimulated pharma industry product development, rekindling interest in what, to date, has been a dwindling field. This is very good news, says Howard: “Once a bug has become resistant, it is resistant. After that, the only way to move forward is to bring more antibiotics into use.”

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Basilea Pharmaceutica Ltd. is a biopharmaceutical company developing products that address increasing resistance and non-response to current treatment options in the therapeutic areas of bacterial infections, fungal infections and cancer. The company uses the integrated research, development and commercial operations of its subsidiary Basilea Pharmaceutica International Ltd. to discover, develop and commercialize innovative pharmaceutical products to meet the medical needs of patients with serious and potentially life-threatening conditions.

Basilea Pharmaceutica Ltd. is headquartered in Basel, Switzerland and listed on the SIX Swiss Exchange (SIX: BSLN).