Antibiotic resistance continues to rise

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"Antibiotic resistance continues to rise," BBC News reports as, despite warnings, the number of antibiotic prescriptions in the UK continues to soar, as do new cases of resistant bacteria.

Other news reports take different slants on the story, with The Daily Telegraph blaming the rise on hospitals and out of hours GPs.

The news follows the publication of a new report by Public Health England on the English surveillance programme for antimicrobial utilisation and resistance (ESPAUR), which reports the change in antibiotic prescribing and resistance over recent years.

The report highlights a number of key findings, including a year on year increase in antibiotic prescribing in England, with the majority of antibiotic prescribing taking place in general practice. There also seems to be variation across the UK, with areas with higher antibiotic prescribing also having higher rates of resistant infections.

Public Health England hopes this report will enable general practices and hospitals to compare their data with regional and national trends. They could then see if their rates are higher than other areas, and investigate why and if they can reduce these. This will also provide a baseline measure from which to track changes in both prescribing and resistance in England.

A world without effective antibiotics would not be a particularly pleasant one. Infections not currently regarded as serious, such as impetigo or cellulitis, could develop complications.

Also, medical procedures that we regard as routine, such as delivering a baby or removing the appendix, could carry a much higher risk if infection develops and there are no longer the antibiotics to cover it.

Some experts have warned that if not challenged now, the threat of antibiotic resistance could lead to an international medical crisis.

Antimicrobial resistance is a global health threat.

Antimicrobials are drugs used to treat an infectious organism, and include antibiotics (used to treat bacteria), antivirals (for viruses), antifungals (for fungal infections) and antiparasitics (for parasites).

When antimicrobials are no longer effective against infections they were previously effective against, this is called antimicrobial resistance. Regular exposure to antimicrobials prompts the bacteria or other organisms to change and adapt to be able to survive these drugs.

As the report says, the problem has been around for decades, but in the past it was seen as less of a problem as new antibiotics were regularly being developed. 

However, nowadays fewer new antibiotics are being developed, meaning we have fewer options and stronger and stronger drugs in our antibiotics armoury have to be used to treat common infections once they become resistant. This means we are now facing a possible future situation where we will be without effective antibiotics.

The report highlights the following:

The report highlights the following trends in antimicrobial prescribing:

As the report highlights, antibiotic prescribing and antibiotic resistance are inextricably linked, and overuse and incorrect use of antibiotics are major drivers of resistance.

The Chief Medical Officer for England highlighted the problem of antimicrobial resistance in the 2013 annual report, which led to the UK cross-government five-year (2013-18) antimicrobial resistance strategy.

This is the first report from the English surveillance programme for antimicrobial utilisation and resistance (ESPAUR). Their key aims are to develop surveillance systems to measure both antimicrobial prescribing and resistance, and to measure the impact of antimicrobial prescribing on antimicrobial resistance and patient and public safety.

The data in this report provides national and regional surveillance of antibiotic resistance and antibiotic use trends from 2010 to 2013. Public Health England cautions these are just single snapshots of data, so will require further investigation. They say further validation and exploration of the findings is needed.

The report highlighted that when comparing the maps of antibiotic prescribing and resistance across regions, areas with high prescribing in general have higher resistance levels. Primary and secondary care organisations are advised to audit their own prescription data to compare with regional and national trends.

Knowledge that their consumption is higher than national trends, and assessment of the reasons for this, should help them develop strategies to improve their prescribing as needed.

This information will provide a baseline measure from which to track changes in both prescribing and resistance in England.

People can help cut antibiotic (or wider antimicrobial) resistance by recognising that many common infections, such as coughs, colds and stomach upsets, are often viral infections that will go away after a short period without treatment ("self-limiting" infections). These infections do not need an antibiotic prescription as they will have no effect.

If you are prescribed an antibiotic (or other antimicrobial), it is also important to make sure you take the full course as prescribed, even if you feel better before you finish the course.

This will reduce the chances of the organisms being exposed to the drug but then surviving, allowing them to develop resistance if they encounter it again.

It will also increase the chances of you getting better, as by not taking a full course you may find the infection comes back and requires further antibiotic prescriptions, which further increases the chances of resistant organisms developing.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.