Top Priority Antibiotic Resistance

Antibiotic resistance has become a prominent topic in British politics. In 2014 the UK government launched the AMR review as a high-profile, high-level response to the serious concerns being raised about antibiotic resistance. 

The Review, led by former Goldman Sachs economist Lord Jim O’Neill, has focused largely on the issue as a global health crisis and has produced recommendations on how to tackle the problem at an international level. 

In a recent exclusive interview with the Bureau, Lord O’Neill said that the antibiotics crisis is a „more troubling train wreck“ than the global financial crash of 2008. He also floated the idea of an „antibiotics tax“, which was one of several options explored by the Review in their recent and final report.

The UK’s chief medical officer, Dame Sally Davies, has described the problem of antibiotic resistance as a „ticking time bomb“ that should be ranked along with terrorism on a list of threats to the nation.

In 2013 the Government launched the cross-party Five Year Antimicrobial Resistance Strategy. The Strategy is focusing on three strands: improving knowledge and understanding of antimicrobial resistance; conserving existing antibiotics; and stimulating the developments of new antibiotics.

High awareness after serious outbreaks 

The awareness stems partly from a series of serious outbreaks of MRSA in the mid-2000s. The outbreaks reached a peak in 2006 when MRSA caused or contributed to 1,652 deaths – five times the number in 1993 when records began. Several policy changes have tightened up on cleanliness in hospitals and the number of deaths has fallen in recent years.

New infection control guidelines for nursing staff in 2005 included screening hospital patients for MRSA, better hygiene practices and putting contagious patients in isolation rooms. 

Hospitals must now report the numbers of MRSA infections – and make these available to the public. Since 2012, when the number of MRSA related deaths was fewer than 300, the records have shown the number of MRSA infections each year instead of deaths. 

In addition the UK government has run several public awareness campaigns around the use of antibiotics, including telling people not to ask their doctors for antibiotics for a common cough or cold because antibiotics do not help fight viral infections. 

Incomplete reporting

The government publishes data for cases of the most common, and what it considers to be the most dangerous, infections.

Campylobacter is the most common food poisoning infection in the UK, thought to be responsible for at least 280,000 cases a year and around 100 deaths.

While antibiotics will work in many cases, a Bureau investigation in April this year found that resistance to one of the key antibiotics used to treat campylobacter infection – ciprofloxacin – is steadily increasing. In 2015, almost one in two of all human campylobacter cases tested in England for resistance to ciprofloxacin – one of several drugs doctors turn to when victims of the food poisoning bug develop complications – returned positive results.

Public Health England publishes annual, monthly and quarterly data on E. coli, C. difficile, and MRSA infections, but there is no information on what proportion of these cases are resistant to some or all antibiotics. This infection data is broken down either by hospital or by clinical commissioning group – National Health Service bodies responsible for the planning and commissioning of health care services for their local area.

Data collected by European Centre for Disease Prevention and Control, which analyses samples from participating hospitals, puts the UK in the lower average for the proportion of resistant strains of E. coli and Staphylococcus aureus or MRSA. 

Unclear trend in consumption

The most recent data shows that in 2013, humans were dispensed a total of 531.2 tonnes of antibiotics while total sales for animal use was 418.7 tonnes. When broken down to biomass, Human consumption of antibiotics was the equivalent of 135mg per kg of person, whereas sales of antibiotics for use in food producing animals equated to 55.6mg per kg.

This puts the UK at the mean of the continent: The European average was 116mg in humans and 144mg in animals according to a report by the European Commission from 2015 that analysed data from 2012. When it comes to total consumption, the UK came in at third place after France and Italy, mostly owing to its large populace.

In 2014, more than 37 million antibiotic „items“ were prescribed by doctors in general practice. An item refers to a single supply of an antibiotic on a prescription form – which tells us how many antibiotic prescriptions there were, but doesn’t indicate the length of treatment or dose prescribed. The three groups of antibiotics most frequently used in England that year were penicillins (45 percent), tetracyclines (22 percent) and macrolides (15 percent).

Although the number of prescriptions for antibiotics written by doctors has gone down in recent years, a report from Public Health England in 2015 found that the consumption of antibiotics had actually gone up 6.5 percent between 2011 and 2014. This suggests that longer prescriptions or higher doses of antibiotics are being prescribed by doctors, who prescribe around 74 percent of antibiotics to patients.

When it comes to transparency of antibiotic prescriptions in doctors’ offices, England is ahead of other European countries. The prescription data for every individual doctor’s office is public – and can for example be used for statistical and scientific analyses.

In hospitals antibiotic prescribing also increased significantly between 2011 and 2014, up 11.7 percent in hospital inpatients and 8.5 percent in outpatients. The Public Health England report also found that hospitals were prescribing the highest proportion of broad-spectrum antibiotics. This is problematic because, according to The National Institute for Health and Care Excellence, broad-spectrum antibiotics should only be used when infections are already resistant – if they are routinely prescribed, they increase the risk of MRSA and other resistant bugs.

As discovered by the Bureau, even the government only has a partial view of what is used by the farming industry. The Veterinary Medicines Directorate publishes an annual report on sales of antibiotics for use in animals, based on data from animal pharmaceutical companies. 

More transparency is required so we can see where the problem lies. In February the Bureau published an investigation which showed that the use of a critically important class of antibiotics called fluoroquinolones had increased by 59 percent in UK poultry farming between 2013 and 2014. 

The Veterinary Medicines Directorate data shows that total antibiotic sales (in a metric that allows for varying numbers of livestock over time) gradually increased between 2008 and 2014, while sales of antibiotics that are critically important in human medicines – like fluoroquinolones and 3rd and 4th generation cephalosporins – increased more sharply.

We are working on getting access to more detailed data so we can create a bigger picture of which antibiotics are being used and where, to better our understanding of the problem.

The authors are journalists at „The Bureau of Investigative Journalism“, a British independent not-for-profit newsroom, with whom we collaborate on superbugs investigations.