European Antibiotic Awareness Day

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Dr Diane Ashiru-Oredope is the Pharmacist Lead for the Public Health England’s Antimicrobial Resistance Programme and chair of the UK-Antibiotic Guardian Campaign.

A mum of two little ones, she is an antimicrobial pharmacist by background and recently submitted her dissertation for an MRes in Public Health with the University of Manchester.

She chaired the subgroup of the recently updated national antimicrobial stewardship toolkit for secondary care – Start Smart then Focus and project led development of the ARHAI/PHE National Antimicrobial Prescribing and Stewardship Competences. She is also the deputy chair of the English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR).


Antimicrobial Resistance; Why is there so much focus on this?

The threat of antibiotic resistance is often perceived as a problem for future generations to tackle, however resistance is already affecting our everyday lives, now. Increasing numbers of people, for example, need more than one course of antibiotics for a urinary tract infection despite taking the course as prescribed by their GP. This is because the microorganisms that antimicrobials are used to treat are fighting back and developing systems to resist the effect of these vital medicines.

The World Health Organisation defines Antimicrobial Resistance (AMR) as the resistance of a microorganism to a medicine that was previously effective against it.

Resistant organisms like bacteria, fungi and viruses have developed the ability to withstand attack by antimicrobial medicines such as antibiotics, antifungals and antivirals, and therefore these medicines are not as effective as they used to be.

In addition, each intake of antibiotics destroys some of the ‘good bacteria’ in a person’s gut and these resistant microorganisms can be transferred from one person to another. Carriage of resistant bacteria may not be realised until the resistant bacteria causes an infection and antibiotics are not effective when you need them to be.

Medical students reading this will realise that effective medication will play a vital role in their future career as medical professionals, but why are the government, public health agencies and health care professionals so worried about AMR?

Sadly, this is because resistance is no longer a thing of the future; it is already here, now. It is estimated that 25,000 people die every year in Europe alone because of infections resistant to antibiotics; death rates from resistant infections in the United States are similar. Do you recall recent media coverage on resistant gonorrhoea and tuberculosis?

This spread of resistant bacteria is happening quickly. As you can see from the image below, in just five years, antibiotic resistance in the commonest bacteria causing sepsis in Europe has increased dramatically. If we continue with this trend, by 2025 Europe could have major problems with infections that have few or no antibiotics that can be used for treatment.

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Also, a recent review by eminent economist Lord Jim O’Neil has highlighted that if we do not take significant action now, by 2050, antibiotic resistance will kill more people than cancer.

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Penicillin was discovered in 1940, 75 years ago, and it has been 30 years since a new major antibiotic was discovered. Whilst we do need new antibiotics, and work is underway in this area, it is important that we learn how to preserve the antibiotics we use now (this is known as antimicrobial stewardship – AMS).

Over the last 60 years or so, antibiotics have significantly reduced deaths from common infections. In the early 1930s infections which we now considered trivial were fatal – having no effective antibiotics would be reminiscent of this time. Prior to antibiotics, 1 in 10 healthy young people died from pneumonia and skin infections; now, thanks to antibiotics this is only 1 in 100. Deaths from childbirth related sepsis was 3 in 100 prior to antibiotics and is now less than 3 in 100,000 births.

Beyond the treatment of infections we need to consider the implications to chemotherapy, transplants and other surgical procedures which rely on the use of antibiotics to prevent infections. Without effective antibiotics, these life-saving surgeries will become even more dangerous.

If you’d like to hear more about AMR in practice we recently asked seven healthcare practitioners (a paediatrician, critical consultant, sexual health doctor, obstetrician, general practitioner, ID consultant) why they are worried about antibiotic resistance. You can read their thoughts through this link here.

We cannot eradicate antibiotic resistance, but there are a number of actions that the public, all health and social care staff and students can take to help reduce the spread of antibiotic resistance.

 

What can you do?

1. Choose from one of the following healthcare student pledges on the #AntibioticGuardian website and become an Antibiotic Guardian

– The next time I see an antibiotic prescribed, I will ask the prescriber about the indication and duration, to understand if this is in accordance to local and national guidelines

– The next time I see that a recommended infection prevention practice is not being adhered to (e.g. hand hygiene, on-farm biosecurity), I will respectfully challenge my peers and healthcare workers/veterinarians

– I will use the e-Bug young adult peer education materials on drug-resistant infections, antibiotic use and vaccinations to educate and inform my peers. Available here.

– I will familiarise myself with PROTECT, the British Veterinary Society’s 7-point plan or similar guidance materials and resources regarding prudent use of antimicrobials within the animal sector and discuss them in my classes (veterinary students)

– I will ask my tutors to discuss in class the challenges of responsible use of antibiotics in various animal sectors, including companion animals

– If I’m prescribed antibiotics, I will take them exactly as prescribed and never share them with others

– For infections that my body can fight off on its own, like coughs, colds, sore throats and flu, I pledge to talk to my pharmacist about how to treat my symptoms first rather than going to the GP

– I will wash my hands after sneezing or coughing to reduce transmission of infection and antibiotic resistance

2. Talk to 5 people about antibiotic resistance and encourage them to become antibiotic guardians.

3. Read the Royal College of Physicians Top 10 tips for effective antibiotic prescribing. Available here

4. Use E-bug peer-education package, to help educate you and give you the tools to teach other students or members of the public. Available here

5. Look through the Antibiotic Guardian recommended CPD resources Available here

6. Look at the Antimicrobial Prescribing and Stewardship Competencies which have been developed by PHE for prescribers with the aim to improve the quality of antimicrobial prescribing and stewardship.

7. Familiarise yourself with antimicrobial stewardship principles.

– If you are going into general practice – read the TARGET toolkit, available here.

– If secondary care – read the Start Smart then Focus, available here

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