" 9 out of 10 GPs say they feel pressured to prescribe antibiotics": NICE, UK

Contributed by: Dr. Tamhankar & Siddarth David

On August 18, 2015, the National Institute for Health and Care Excellence (NICE) in the UK released its first guidelines on antimicrobial stewardship "Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use". https://www.nice.org.uk/guidance/ng15 The NICE is the statutory body in the UK that provides national guidance and advice to improve health and social care.

The Guidelines are designed to promote judicious antibiotic use by reviewing prescribing and resistance data and providing feedback, education and training to prescribers. The NICE reports that "9 out of 10 GPs say they feel pressured to prescribe antibiotics, and 97% of patients who ask for antibiotics are prescribed antibiotics”. The Guidelines have been aimed at health practitioners, pharmacists, nurses and provider organisations.

The current edition of the Lancet has an editorial on the strengths and weaknesses of the Guidelines.  http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)61522-7/fulltext?rss=yes The NICE guidelines are pioneering antibiotic stewardship in the UK, which is particularly significant given that the UK lags way behind countries like Sweden and Norway in implementing policies to address antibiotic resistance. The NICE Guidelines are a welcome step to global measures on antibiotic stewardship and hopefully would push other countries to take notice and follow with their own guidelines.

Shocking to know people don't know what does "antibiotic resistance" actually mean!

"People in UK have no idea what the term "antibiotic resistance" actually means", reveals a study commissioned by  Wellcome Trust.

Most people surveyed mentioned that they thought antibiotic resistance means their own body became resistant to the antibiotic. They did not know that it is the micro-organism that became resistant. This misconception is a serious issue as they then felt that antibiotic resistance is not their problem but someone else's.

This information is shocking coming from a developed nation like UK. This could only mean that the terms used by the media and the doctors to the public need more clarification and simplification to enable better communication and understanding of this pandemic issue. The situation in developing countries will be far worse. For a country like India, there is widespread 'know-do' gap that exists which needs to be bridged in healthcare and specially in the area of 'antibiotic resistance'.

Source: http://www.wellcome.ac.uk/About-us/Policy/Spotlight-issues/Antimicrobial-resistance/

TED Talk by Maryn McKenna: What do we do when antibiotics don't work anymore?

Source: TED - ideas worth spreading.

Crowdsourcing - borrowing the 'software' concept to antibiotics.

"Crowdsourcing" is a concept where a project is funded and contributed by many people around the world. In a similar twist to antibiotic drug discovery, the Community for Open Antimicrobial Drug Discovery (CO-ADD) was set up by scientists at the University of Queensland in Brisbane, Australia, in response to the growing problem of antimicrobial resistance.

CO-ADD is asking groups of chemists and scientists to send in their compounds they are researching / discovering to be tested against various bacteria and viruses. including resistant ones. The cost of screening will be met by CO-ADD and commercial rights are retained by the contributors. CO-ADD director Matt Cooper explains. 'They retain all rights to the compound … and can file patents or write grants [on the basis of assay results],' he says. 

The only catch is that the group contributing a compound for screening must agree to put the screening data into a public database 18 months after getting the results.

Source: Community for Open Antimicrobial Drug Discovery

WHO says a lot needs to be done by the countries to combat antibiotic resistance

"While there is a lot to be encouraged by, much more work needs to be done to combat one of the most serious global health threats of our time." - Dr Keiji Fukuda, WHO's Assistant Director-General for Health Security. Dr. Keiji Fukuda also added that antibiotic resistance is the single greatest challenge in infectious diseases.

A survey was completed by 133 countries in 2013 and 2014 which captured the individual Government's own assessment of their responses to antibiotic resistance issues especially to blood borne infections, tuberculosis and HIV related infections. The survey revealed an appalling truth that only 34 out of 133 participating in the survey had any national plans to combat antibiotic resistance to antibiotic agents.

The exact situation might be far worser considering only 8 nations of the 47 member nations participated in the survey from the African Region. The issues of antibiotic resistance is rampant in African region. 

The encouraging aspect of South East Asian region was that all 11 member nations participated in the survey of which 5 out of 11 nations had a national plan to combat antimicrobial resistance. 

One more challenge that was revealed was that health workers comply poorly with prescribing standards and guidelines.