Health services losing the war against antibiotic resistance

11 March 2013

The UK's Chief Medical Officer has highlighted the threat of antibiotic resistance and called for action to develop new drugs. Also, on health economists Richard Smith and Joanna Coast argue that antibiotic resistance “has the potential to undermine modern health systems". They believe that an increase in resistant organisms coupled with a big fall in the number of new antimicrobial drugs “suggests an apocalyptic scenario may be looming.”

Their warning comes as the UK's Chief Medical Officer, Professor Dame Sally Davies, launches the UK’s Antimicrobial Resistance Strategy and Action Plan, reflecting the need for a clear change in our understanding of and response to antimicrobial resistance by the public, NHS and government.

In launching the second part of her annual report [1], she said, "The big problem is that not only is antibiotic resistance rising, we are losing the war." Infections account for 7% of all deaths and cost the UK health services £30bn per year, she said.

In the report, which focuses on the threat of antimicrobial resistance and infectious diseases, she makes 17 recommendations, including:

  • a call for antimicrobial resistance to be put on the national risk register and taken seriously by politicians at an international level, including the G8 and World Health Organization;
  • better surveillance of data across the NHS and worldwide to monitor the developing situation;
  • more work carried out between the healthcare and pharmaceutical industries to preserve existing drugs and encourage the development of new antibiotics;
  • better hygiene measures should be used when treating the next generation of healthcare associated infections such as new strains of harder-to-treat klebsiella, this would build on the success of the NHS in cutting MRSA rates, which have fallen by 80% since a peak in cases in 2003.

Richard Smith and Joanna Coast writing in say that current estimates suggest that antibiotic resistance is a relatively cheap problem, but such estimates do not take account of the fact that antimicrobial medicines are integral to modern healthcare. For example, antibiotics are given as standard to patients undergoing surgery, to women delivering by caesarean section, and to those having cancer treatment.

“From cradle to grave, antimicrobials have become pivotal in safeguarding the overall health of human societies,” they write. Although it is difficult to forecast the likely economic burden of resistance, they believe that even the highest current cost estimates “provide false reassurance” and this may mean that inadequate attention and resources are devoted to resolving the problem.

For example, current infection rates for patients undergoing hip replacement are 0.5-2%, so most patients recover without infection, and those who have an infection have it successfully treated. But the authors estimate that, without antibiotics, the rate of postoperative infection could be 40-50% and about 30% of those with an infection could die.

While they recognise that this is a simplistic analysis, they say, “we use it as an example to illustrate and provoke, to emphasise the point that infection rates and their consequences in terms of health service costs and human health may be unimaginable.”

A change in culture and action is needed to plan for a future with more antibiotic resistance, they conclude. “Waiting for the burden to become substantial before taking action may mean waiting until it is too late. Rather than see expenditure on antimicrobial policies as a cost, we should think of it as an insurance policy against a catastrophe; albeit one which we hope will never happen.”

In an accompanying editorial, Professors Anthony Kessel and Mike Sharland say the new UK Five Year Antimicrobial Resistance Strategy and Action Plan “represents an important step in both recognising and responding to this significant threat”. The report will be published "soon", according to the Department of Health.

The problems are global and the terminology complex, but the importance is clear, they write. “A fundamental standard of the NHS should include basic high quality routine infection control and clinical care, as noted by the Francis inquiry. These standards of care are crucial to the prevention and control of all healthcare associated infections, including multi-drug resistant Gram negative bacteria."

Further information

1. Chief Medical Officer publishes volume 2 of her annual report:

2. The chief medical officer's Report Vol 2:


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