By Professor Colin Garner, Chief Executive of Antibiotic Research UK, comments:
Today, patients undergoing routine treatments such as cancer treatment, organ transplantation and hip and knee replacements, are given antibiotics to prevent infection during these treatments. However, the frequency of antibiotic resistant infections is increasing, meaning that there are more and more deaths from antibiotic resistant bacteria. Sepsis is a common cause of death in the UK with over 37,000 deaths each year, more than lung cancer (35,000) and bowel cancer (16,000), and many of these sepsis deaths are due to untreatable antibiotic resistant infections. If there were no new antibiotics, then any infections become untreatable. The failure to develop new antibiotics is of great concern. Antibiotic resistance is life-threatening, with the young and old being most at risk of resistant infections.
The threat of the superbug is real and if we don’t act now, in as little as ten years, routine medical procedures will become life-threatening once more. Antibiotic prescribing levels, as well as the resistance to them, is a major concern and has recently been highlighted by the government. The Prime Minister addressed the topic back in September, having previously set up the UK Government Review on Antimicrobial Resistance, which is being headed up by the well-known economist Lord Jim O’Neill, to look into the causes of antibiotic resistance and why new antibiotics are not being developed quickly enough. Moreover, Public Health England’s second annual ESPAUR (English Surveillance Programme for Antimicrobial Utilisation and Resistance) report on antimicrobial resistance was also released at the start of November showing a rise in antibiotic resistant infections.
With this in mind, we need to understand the levels of antibiotic prescribing, the reasons behind prescriptions and ensure that unnecessary dispensing of antibiotics does not happen. Working alongside analytic database company EXASOL, we ran an analysis on over 602 million rows of prescription data for England. The results of this analysis uncovered positive and negative trends. We found that there has been an overall decrease in the prescription of antibiotics since 2011, which is great news. However, the results also found that despite this general downward trend, antibiotic prescriptions are still on the increase in the most deprived areas of England.
The analysis also showed a massive spike in antibiotic prescriptions in December, compared to August. Now many would put this down to more people being unwell during December with colds and flus, but this should not have any bearing on the amount of antibiotics being prescribed. Antibiotics are only effective on bacterial infections, meaning that they are completely ineffective on viral infections, such as the common cold and influenza. And as bacterial infections are not seasonal, there is no rational reason for why antibiotic prescriptions should increase so much during the winter months.
So, why is this happening? It is all down to awareness of the general public. Many people are still unaware that antibiotics won’t help you feel better if you have a cold or the flu, and this was underlined by a recent report by the World Health Organisation which found that 76 per cent of respondents thought that antibiotic resistance was when they became resistant to antibiotics, rather than the infective bacteria. However, when we are unwell and go to visit the doctors, we don’t like leaving without some sort of prescription to help us get back to health as quickly as possible. So the doctors prescribe antibiotics, despite their ineffectiveness, to satisfy patients. In fact, a recent study by researchers at King’s College London showed that patients were less satisfied with their GPs if they were not prescribed antibiotics.
Furthermore, a separate report showed that 97% of patients who request some sort of antibiotic prescription from their doctor will receive one. So not only is it about the general public having a better awareness about antibiotics, but doctors as well. Despite pressure to satisfy patients, doctors should also be more firm in refusing antibiotic prescriptions unless they are absolutely necessary. One method that might work to some extent is a post-dated prescription, when the patient will be able to pick up a prescription if they are still unwell a few days after having seen the doctor.
By using antibiotics when it is unnecessary to do so, we are just increasing the microbial resistance of the bacteria, which in turn leads to superbugs that are resistant to antibiotics. This would then mean that simple bacterial infections could not be treated with the available antibiotics in the future, and we would not have any medicine to cure them. We rely on effective antibiotics for much of modern medicine, not only in surgical treatments but also in childbirth for example; caesarean sections would become impossible and it would be so much more difficult to treat premature babies in High Dependency Units.
