18 November 2013

NHS urged to tackle antibiotic resistance

The NHS is being urged to tackle the rise in antibiotic resistance by cutting back on unnecessary use of the drugs.

The NHS is being urged to tackle the rise in antibiotic resistance by cutting back on unnecessary use of the drugs.

The Department of Health has warned that there are few public health issues of greater importance than antibiotic resistance.

"The increasing threat from antibiotic-resistant infections is so serious that in 20 years' time we could be back to how it was in the 19th century when routine operations could be fatal as a result of everyday infections," said Professor John Watson, Deputy Chief Medical Officer for England.

Antibiotic resistance arises when bacteria evolve mechanisms to withstand the drugs which are used to fight infection. Recent decades have seen vast increases in the use of antibiotics across medicine and agriculture, and in the absence of adequate regulatory controls, patient awareness, and through inappropriate use, this has led to a huge global surge in antibiotic resistance.

In many countries, the rate of resistance has more than doubled in the past five years

The problem is compounded by a desperate shortage of new drugs to treat multi-drug resistant bacterial infections, with the pipeline for new antibiotics at an all-time low.

The European Centre for Disease Prevention and Control (ECDC), supported by the Department of Health, is using European Antibiotic Awareness Day, today, to raise awareness of the growing number of infections due to antibiotic-resistant bacteria.

The Department of Health - in their five year antimicrobial resistance strategy - calls on providers of health and social care services to improve their uptake of NICE guidance on the appropriate prescribing of antibiotics.

NICE's guidance has already had a big impact on reducing antibiotic prescribing rates for infective endocarditis - an infection of the lining of the heart caused by bacteria and occasionally other agents.

Since its launch, the guideline has helped to reduce prescribing of antibiotics for this condition by 78.6 per cent.

The guideline recommends that antibiotic prophylaxis should not be offered for all patients at risk of infective endocarditis undergoing dental and a range of other procedures. This is because there is insufficient evidence to support the use of antibiotics as a preventative measure to people at risk of infective endocarditis.

NICE's guidance on the prescribing of antibiotics for respiratory tract infections, an area where antibiotics are often over prescribed, states that a no-antibiotic, or delayed antibiotic strategy should be used to treat people with infections.

Healthcare professionals should reassure patients that this is because antibiotics will make little difference to symptoms, and may have side effects such as diarrhoea, vomiting and rash.

Prof Mark Baker, Director of the Centre for Clinical Practice at NICE said: “Respiratory tract infections are infections of the throat, sinuses, airways or lungs and are responsible for 60 per cent of antibiotic prescribing in general practice.

“We're working with healthcare professionals to ensure they are aware of our guidance on upper respiratory tract infection treatment which outlines the normal duration of symptoms and so called “red flag” symptoms which are signs that medical advice in the form of a GP consultation are required.”

Another area where NICE can help to cut down on antibiotic prescribing is around the treatment of babies with suspected early-onset neonatal infection.

Early-onset neonatal bacterial infection, infection that occurs within 72 hours of birth, is the cause of death for 1 in 4 babies who develop it, even when they are given antibiotics.

These infections are usually caused by organisms from the mother's genital tract, including group B Streptococcus (GBS), E.coli, Pseudomonas and Klebsiella.

NICE recommends that intrapartum antibiotic prophylaxis should be offered in a timely manner to women whose babies are at higher risk of infection. This includes women who have had a previous baby with an invasive group B streptococcal infection, or a group B streptococcal colonisation, bacteriuria or infection in the current pregnancy.

Babies with suspected early-onset neonatal infection should receive antibiotics as quickly as possible, within 1 hour of the decision to treat.

But antibiotic use should be minimised in babies who are suspected of having an early-onset neonatal infection, but subsequently do not.

A clinical knowledge summary - which provides summaries of the best available evidence and practical guidance on best practice - is available on chest infections and the use of antibiotics.