Monday, 21 July 2014

Ensuring access to working antimicrobials



The U.K. Parliament’s Science and Technology Committee has set up a review of antimicrobials.

The terms of reference of the committee are:

“Antimicrobial resistance is widely considered to pose one of the greatest risks to modern medicine faced by this generation. Without effective antimicrobials, chemotherapy for cancer and invasive operations would become increasingly dangerous due to the likelihood of infection. The Government appears to recognise this threat to society and we were pleased to see the production of its Five Year Antimicrobial Resistance Strategy. It is clear to us that there is no room for procrastination and, in this report, we urge the Government to take immediate and decisive action. Two weapons in our arsenal against antimicrobial resistance were repeatedly underlined to us: improved stewardship to extend the effective life of existing antimicrobials and increased innovation to develop new treatments.

For too long, antibiotics have been used as if they were a bottomless pit of cure-all miracle treatments. Antibiotics are ineffective against viruses and other diseases that are not caused by bacteria and the unnecessary prescription of antibiotics has contributed to the acceleration of antibiotic resistance. It is vital that the Government takes action to ensure that antibiotic prescribing is founded on good diagnoses. To achieve this, there is a need to develop cheap, rapid and accurate diagnostic tests and provide better clinical training. Furthermore, whilst prescribers must be the stewards of antimicrobials, the Government needs to ensure that clinicians are supported through rigorous public awareness campaigns.

Whilst efforts to protect existing antibiotics must remain a priority, policy must be evidence-based. There is a lack of data on the post-prescription behaviour of patients and we suggest that the Government develops a system for monitoring this. Furthermore, there is a lack of information and evidence on the link between resistance in animal pathogens, the environment, and resistance in human pathogens. The Government cannot rely on the notion that curiosity-driven research will provide the information it needs and must plan to fund the necessary research, directly.

As the list of resistant pathogens grows longer, it is clear that fresh new treatments are required. We were dismayed to find that, since the year 2000, just 5 new classes of antibiotics have been discovered and most of these are ineffective against the increasingly significant problem posed by gram negative bacteria. The ability for companies to re-coup the costs of their investments into antibiotics has become hampered by a global market that fails to provide financial incentives. Of the 18 to 20 pharmaceutical companies, who were the main suppliers of new antibiotics 20 years ago, just a handful of companies persist in this field. We urge the Government to undertake immediate scoping of pricing alternatives, and to demonstrate to us how they plan to incentivise organisations to invest in new antimicrobials on a global basis. The life sciences sector must be encouraged to re-engage in this field before the pipeline of antibiotics runs dry. In that respect we welcome and support the Prime Minister's commitment to review the economic issues surrounding antimicrobial resistance.”

For further details, see UK Parliament.

Posted by Tim Sandle