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Antibiotic-resistant infections and ‘last resort’ antibiotic use on the rise, says PHE
A new report published today by Public Health England has revealed that antibiotic-resistant infections of the bloodstream are increasing, as is the use of ‘last resort’ broad spectrum antibiotics.
According to the report, serious infections of the bloodstream, such as Escherichia coli and Klebsiella pneumoniae increased between 13.5% and 17.2% respectively. However, Streptococcus pneumoniae infections have reduced by 23%, possibly, say the authors, as a result of vaccination.
The English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) report, which covers the period between 2010 and 2014, also reveals a significant increase in the use of antibiotics carbapenems and piperacillin/tazobactam – the last line of antibiotic defence when all other treatments have failed - increased by 36% and 55% respectively. These antibiotics are used in intensive care situations, for example following transplant or in oncology units. Such broad spectrum drugs, known as ‘last resort’ antibiotics, treat a wide range of bacteria and are therefore particularly useful for doctors who are unsure what bacteria they are treating.
Dr Susan Hopkins, Healthcare Epidemiologist at PHE and lead author of the ESPAUR report says of the drugs: “Their use, while very small, has increased in the last few years. It’s quite challenging.
“We want hospitals to move away from these last resort antibiotics after two or three days of treatment to use more targeted antibiotics. There is a lot of work taking place to tackle antibiotic resistance and reducing prescriptions of antibiotics is just one strand of that work.”
The news coincides with the World Health Organization’s World Antibiotics Awareness Week (16 to 22 November), which aims to raise awareness of the problem of antimicrobial resistance and to encourage best practice among the public, health workers and policy makers.
Prescribing higher in poorer areas
Charity Antibiotic Research UK published overall antibiotic prescribing figures for the first time last week which revealed that prescriptions for antibiotics are more commonly issued in poorer areas, with prescriptions in Clacton-on-Sea - the UK’s most deprived area – at almost twice the national average. The charity also found that doctors prescribe 59% more antibiotics in December than in August, even though the majority of the illnesses treated are not seasonal. It found that prescriptions per head peaked in 2012 at 3.8 million, but have reduced by 5.6% since then as a result of various initiatives aimed at reducing unnecessary prescribing.
Dr Maureen Baker, Chair of the Royal College of GPs, says: "These figures show the lowest antibiotics prescribing rates in five years - and a huge drop from when prescribing peaked in 2012. This shows that healthcare professionals across the UK are taking our warnings seriously and working to address them.”
Dr Baker labels the problem of growing resistance as “a global threat” and describes the link to deprivation as “concerning”.
She adds: "This could quite legitimately be because people in high areas of deprivation present more frequently with conditions, such as Chronic Obstructive Pulmonary Disease, that need antibiotics - it is not necessarily indicative of inappropriate prescribing.
"GPs often face pressure from patients to prescribe antibiotics, particularly during winter months when more people are feeling ill, so the national significant drop in prescribing is positive and shows that the work the College and others are doing to support appropriate prescribing and urge healthcare professionals to say 'no' is taking effect.
"We all have a responsibility to reduce antibiotics prescribing even further and curb resistance to what are excellent and life-saving drugs when prescribed appropriately.”
Why are antibiotics becoming increasingly ineffective?
Antibiotics are a mainstay of modern medicine, used to prevent and treat bacterial infections which, left untreated, have the potential to develop into a life threatening infection.
Antimicrobial resistance occurs when bacteria naturally adapt and change in response to antibiotics, making the resulting infections very difficult to treat. However, experts agree that this process is rapidly accelerated by misuse and over prescribing of antibiotics – in both humans and animals. It is the bacteria that becomes resistant, not the recipient of the antibiotics and without effective antibiotics, even routine procedures and operations will carry a much greater risk of infection and even death.
The WHO warns that antibiotic resistance will also lead to prolonged illness, higher medical costs and increased mortality on a global scale.
What can I do?
PHE initiative Antibiotic Guardian urges people to stay informed and educate themselves and others about the correct use of antibiotics. The campaign aims to increase knowledge of the association between antibiotic prescribing and resistance, encouraging a change in behaviour.
It offers advice on treating seasonal illnesses, including coughs, colds and flu, which are caused by a virus which cannot be cured with antibiotics. While in some circumstances, particularly in those who have lowered immunity, a viral illness can result in a secondary bacterial infection, most GPs will advise rest and over the counter medications in the first instance.
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