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The Government’s announcement of a review of the economics of antimicrobial research is a welcome step in addressing one aspect of antimicrobial resistance.  However, current practice across both health and veterinary services is failing to prevent the inappropriate prescription of antibiotics. The Government needs to set clear responsibilities at all levels of the NHS and veterinary medicine to achieve better stewardship of the antimicrobial drugs vital in modern medicine, the Science and Technology Committee has warned.

• Report: Ensuring access to working antimicrobials
• Report: Ensuring accesss to working antimicrobials (PDF)
• Inquiry: Antimicrobial resistance (AMR)
• Science and Technology Committee

Andrew Miller MP, Chair of the Science and Technology Committee:

"Antibiotic resistance cannot be entirely prevented, but it is a problem made worse by inappropriate use and poor stewardship of antibiotics in healthcare and farming. We heard concerns, for instance, that antibiotics are often prescribed by GPs simply to achieve a placebo effect or placate patients with distressing symptoms. In farming meanwhile, we suspect that antibiotics may be routinely used on healthy animals.

"We’re pleased that the Prime Minister has taken the opportunity just ahead of our report launch to reaffirm his commitment to action on antibiotic resistance, but publishing strategies and announcing reviews is not the same as dealing with the problem. A two year review of the incentives needed to develop new antibiotics may lead to necessary action, but what we really need from Government right now is decisive and urgent action to prevent antibiotics from being given to people and animals who do not need them."

Antibiotics in healthcare

The MPs argue that it is essential that the Government puts urgent measures in place to drastically reduce the unnecessary prescription of antibiotics.  Better education of medical students and greater focus on antimicrobial resistance during clinical career development is also needed.

Fears were raised during the inquiry that major restructuring of the NHS may limit its ability to get to grips with growing antibiotic resistance in the short-term.  The Committee is concerned that the implementation of new structures and chains of command may exacerbate difficulties in limiting the unnecessary use of antibiotics. It recommends that the Government outline, in its Action Plan for its Antimicrobial Resistance 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.

Andrew Miller MP added:

"All levels of the NHS must be given clear responsibilities for stewardship of antibiotics and better monitoring and reporting put in place to bear down on unnecessary use of antibiotics."

Antibiotics in farming

There is circumstantial evidence that antimicrobial resistance can be transmitted from animal pathogens to human pathogens. The use of tetracycline antibiotics and penicillin in farming as growth promoters has been already banned, but the Committee is worried that the total veterinary use of tetracyclines has increased nearly tenfold and that of penicillin type antibiotics has increased nearly fivefold Since the Swann Report in 1969. The MPs are calling on the Government to takes action to ensure the use of antibiotics in farm animals is strictly required for therapeutic use and that more research is carried out on the link between animal and human pathogens resistant to antibiotics.

Andrew Miller MP:

"The link between human and animal pathogens antibiotic resistance has not been conclusively proven, but we believe the Government should be taking precautionary action to ensure that antibiotics are only being used on sick animals."

Public Awareness

The Committee says greater public awareness surrounding the necessity for stewardship of antibiotics is crucial in reducing pressure on practitioners to prescribe antibiotics. The MPs welcome the awareness of the Government of the need for sustained campaigns to educate new generations and the recent announcement by the Prime Minister. However, they point out that the previous Strategy appears to have had insufficient impact on public awareness and the current Strategy has no definitive targets or measures of success.  The report recommends that the Action Plan set challenging targets for improvement of public awareness against which success may be measured and reported. 

Potential delay while Prime Minister’s review is conducted

The Committee agrees with the Prime Minister that urgent work must be done with researchers, investors, pharmaceutical companies and other Governments to identify appropriate incentives to encourage the development of new antimicrobials. However, the review will take almost two years to report back with recommendations. The MPs warn that this must not delay work on any pricing alternatives that could be agreed with the pharmaceutical industry over a shorter timescale.

Background

Antibiotics are antimicrobial substances that target bacterial infections rather than infections caused by viruses and fungi. They are an essential tool in modern medicine as many procedures, such as chemotherapy for the treatment of cancer and invasive surgery, rely on the use of antibiotics.

In September 2013, the Department of Health and the Department for Environment, Food and Rural Affairs jointly published the UK Five Year Antimicrobial Resistance Strategy 2013 to 2018. This document set out action points in seven “key areas”: 

1. improving infection prevention and control practices in human and animal health
2. optimising prescribing practice
3. improving professional education, training and public engagement
4. developing new drugs, treatments and diagnostics 
5. better access to and use of surveillance data in human and animal sectors
6. better identification and prioritisation of AMR research needs to focus activity
7. strengthened international collaboration
8.