Stepping up the fight against AMR

Source: NHE July/August 2018

Professor Mark Baker, director of the Centre for Guidelines at NICE, explains what the organisation is doing to support the fight against antimicrobial resistance (AMR) and the challenges that lie ahead.

The global risk of AMR is clear. It is already estimated that around 50,000 deaths per year in the EU and US alone can be attributed to resistant strains of bacteria. Without effective action, this number will grow rapidly and harm millions of people in the future. Clinicians and the public are becoming increasingly aware that we need to use antibiotics appropriately, only taking them when they are likely to work and for people who we know will benefit. We are starting to see some progress with reduced antibiotic prescriptions.

Since the UK AMR Strategy was launched five years ago, significant headway has been made to tackle the threat of AMR. NICE published a guideline on antimicrobial stewardship in 2015 which aimed to change prescribing practice to help slow the emergence of AMR and ensure that antimicrobials remain an effective treatment for infection. 

According to a recent ESPAUR report, prescribing behaviours are gradually changing and the number of antibiotic prescriptions is decreasing. Despite this essential progress, resistance to antimicrobials is still growing and remains one of global healthcare’s biggest challenges. There is much work to be done to educate the public about the proper use of antibiotics and to ensure that prescribers follow professional guidance. 

At NICE, we are developing a suite of evidence-based antimicrobial prescribing guidelines for managing common infections aiming to optimise antimicrobial use and minimise the risk of AMR. In January, we published a guideline on sore throat (acute) antimicrobial prescribing. The evidence we reviewed found that most sore throats will get better without antibiotics. However, research suggests antibiotics are still prescribed in 60% of cases. Instead of prescribing them, NICE advises helping people manage their symptoms with pain relief, such as paracetamol or ibuprofen. 

We also have a series of topics in development to support the appropriate use of antibiotics for urinary tract infections (UTIs), due to be published in October. Although the majority of UTIs will require antibiotic treatment, we need to be smarter with our use of these medicines. Our draft lower UTI guideline advises healthcare professionals to ask patients about the severity and regularity of their symptoms before prescribing antibiotics. This includes asking about the steps they have taken to manage their illness, for example using painkillers, and may involve asking the patient for a urine sample, using the results to identify which antibiotic will work most effectively.

Antibiotics are often assumed to be a quick fix when feeling unwell, and too many patients are asking for them. This perception has to change. Our guidance on changing antimicrobial behaviours in the general population aims to achieve this. It includes recommendations for making people aware of self-care options to manage their symptoms – from resting and drinking fluids through to educating pre-school and schoolchildren on AMR and personal hygiene to reduce the spread of infection.

While effective stewardship of antibiotics is vital and necessary in the short term, in itself it is not a long-term solution. We need also to support the development of new antimicrobial medicines. This is why the Department of Health and Social Care is working with industry, NICE and NHS England to develop options for new funding models for innovative antimicrobials that support responsible use and offer incentives to companies to develop these essential new medicines. 

We now have a growing range of strategies and guidance in place to tackle AMR use head-on. With around 700,000 people dying each year around the world due to antimicrobial-resistant infections, the scale of this problem cannot be ignored. Empowering patients and healthcare professionals to preserve these vital medicines and use them prudently is one of our most effective, immediate defences in the fight against AMR – but it is absolutely critical we combine that with the development of new antimicrobials.


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