Why less is more in antibiotic prescribing
Antibiotic Resistance Reducing demand for antibiotics through better diagnostic support is the only way to avoid an antibiotic ‘apocalypse’, says top Government advisor Lord O’Neill.
Government advisor Lord O’Neill has urged global leaders to take a demand reduction approach to tackling the challenge of antimicrobial resistance (AMR). Calling on policy-makers to think more widely than bringing new drugs to market, he said: “Experience shows us that new drugs will eventually become victim of drug resistance. The only way is to reduce demand for antibiotics in the first place.”
How can we reduce demand for antibiotics?
In Lord O’Neill’s view, one of the most effective ways to facilitate demand reduction is to expand the use of diagnostic testing. Some self-testing equipment bought over the counter or point of care tests used by healthcare professionals in the community are already marketed in the UK to help front line patients and practitioners to distinguish between a range of viral and bacterial infections, and to identify specific microbes and their antibiotic resistance characteristics. Experts consider this a win-win policy: patients gain from more rapid use of effective antibiotics and society gains from less indiscriminate use of antibiotics, a major factor driving the emergence and spread of AMR. But better tests are needed and those that exist already are often under-used, as it can be cheaper to pay for an antibiotic ‘just in case’ than to pay for a diagnostic test.
Improved use of diagnostics is just one aspect of campaign to tackle AMR. In a review published earlier this year, Lord O’Neill makes 10 recommendations to tackle AMR – a phenomenon likely to bring on an ‘apocalypse’, according to England’s chief medical officer Dame Sally Davies. By reducing doctors’ prescribing, curbing use of the drugs in farm animals and incentivising drug companies to invent new antibiotics, the world will avoid a return to the days when conditions such as ‘the old man’s friend’ – pneumonia – and even childbirth, could end in death from infection. Encouraging Big Pharma to do its bit in drug development will be ‘pay or play’ policies that reward innovation and penalise non-participants, Lord O’ Neill says.
Halfing antibiotic prescribing targets by 2020
Endorsed by two prime ministers – and more recently, the G20 nations and UN assembly – the calls for action expressed by Lord O’ Neill have prompted the UK to mirror targets put in place in the USA to halve antibiotic prescribing targets by 2020. But, Lord O’Neill warns: “We will only achieve that if we have diagnostics to support that ambition.”
At the G20 summit in Hangzhou, China, in September, world leaders put AMR on the business agenda for the first time. In another first, at the United Nations General Assembly meeting in New York in October, a concerted ‘one health’ approach to combatting AMR was also adopted. Joining respected alumni such as HIV/AIDS, Ebola and non-communicable diseases, AMR becomes only the fourth health topic to be addressed by the Assembly in its 71-year history.
With the baton now passed to Germany, which takes on the presidency and will host the G20 summit in 2017, the hope is that the commitments made this year by global leaders will soon be realised. Lord O’Neill says: “The response to my report has certainly been encouraging. We have achieved a decisive environment in which to pursue action. But we must see the stage we are at now as only the end of the beginning. As pleasing as it is to see the report so well-acknowledged, the danger is that we think: ‘that’s it’. Policy makers need to ensure that action swiftly follows.”
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