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Review urges tests before antibiotic prescriptions to combat resistance

Published 19/05/2016

There is a growing resistance to drugs
There is a growing resistance to drugs

Doctors should be forced to perform diagnostic tests on patients before prescribing antibiotics which are currently being dished out "like sweets" , according to a major review of antibiotic resistance.

Experts have warned that resistance to the drugs that are used to fight infections could cause a bigger threat to mankind than cancer.

Tackling antimicrobial resistance (AMR) is " absolutely essential ", said Lord Jim O'Neill as he published a global action plan to prevent drug-resistant infections and defeat the rising threat of so-called superbugs.

One of his proposals suggests that big pharmaceutical companies should "play or pay" - meaning they either join the search to hunt for new antibiotics or be forced to pay a fine. But those who do and find successful new treatments should be rewarded handsomely.

Another calls for better use of diagnostic tools to prevent patients being given antibiotics unnecessarily.

Health leaders from around the world have raised serious concerns about the growing resistanc e to a ntimicrobial drugs. These are the drugs which destroy harmful microbes. Antibiotics are the best known of these drugs, but there are others, such as antivirals, antimalarial drugs and antifungals.

Lord O'Neill likened AMR to "facing a growing enemy with a largely depleted armoury".

His new report warns that i f antibiotics lose their effectiveness then key medical procedures - including gut surgery, caesarean sections, joint replacements, and chemotherapy - could become too dangerous to perform.

Projections suggest that if nothing is done to control AMR, there will be 10 million deaths each year by 2050. Failure to act will also cost the world over 100 trillion US dollars in lost output between 2014 and 2050, the review suggests.

In the forward to a separate new report on AMR from t he Institute and Faculty of Actuaries, Professor Dame Sally Davies, England's chief medical officer, suggests that antibiotic resistance is responsible for around 50,000 deaths every year across Europe and the United States.

The O'Neill review, commissioned by Prime Minister David Cameron in 2014, sets out a series of measures aiming to tackle the threat of AMR, including:

:: Reducing the unnecessary use of antimicrobial drugs in healthcare settings.

:: Monitoring and reducing superfluous use of the drugs in farming.

:: Quicker prog ress to be made on b anning or restricting antibiotics that are vital for human health from being used in animals.

:: Better use of diagnostic tools to help reduce unnecessary use of the drugs.

:: A global public awareness campaign about the problem of drug resistance.

:: Increasing the supply of new antibiotic drugs.

The report points out that the process of determining whether or not a patient needs antimicrobial drugs, especially antibiotics, has not changed for decades.

"Rapid diagnostics would be able to reduce use of antibiotics by letting doctors know if a patient has an infection and if this infection is viral or bacterial, meaning that antibiotics will only be given out to patients who need them," the report states.

Lord O'Neill, said that antibiotics are treated "like sweets" as he called on governments across the world's richest countries to mandate that by 2020 antibiotics could only be prescribed following a rapid diagnostic test, wherever one exists.

He said that introducing this mandate will lead to advances in technology and diagnostic tools by opening a new market for them.

The review also points out that a new class of antibiotic has not been seen for decades because developing new drugs is an "unattractive" commercial proposition for pharmaceutical companies.

Lord O'Neill suggests that one way to encourage the development of new drugs would be to reward pharmaceutical companies that develop new drugs. These "market entry rewards" of around one billion US dollars each would be given to the developers of successful new drugs, subject to certain conditions.

The review also sets out how the proposals should be financed - through governments, international institutions and taxation on current antibiotic drugs. It also suggests that pharmaceutical companies who do not invest in research for AMR should be forced to pay an "antibiotic investment charge".

Lord O'Neill, chairman of the review on AMR, said: "My review not only makes it clear how big a threat AMR is to the world, with a potential 10 million people dying each year by 2050, but also now sets out a workable blueprint for bold, global action to tackle this challenge.

"The actions that I'm setting out today are ambitious in their scope - but this is a problem which it is well within our grasp to solve if we take action now."

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