Antimicrobial Resistance

Presentation by Professor Monica M Lahra

Monica gave a fascinating and thorough summary of global concerns relating to anti microbial resistance [AMR]. Resistance is predicted to be a big problem by 2050, and is considered to threaten health and health care provision.

AMR is essentially a problem of overuse. Bacteria which come into contact with antibiotics, but are not killed have various means of developing resistance. Resistant organisms are now global and endemic in some countries. Some organisms have become resistant to last line antibiotics. AMR presents a threat to medical procedures and treatment, including chemotherapy, complex surgery and transplants.

Factors leading to resistance include:

• Mass food production. Antibiotics are needed to control disease, particularly where large numbers of stock are raised in minimal space as happens with large scale fish and pig farming. This is considered a major contributing factor.
• Large scale antibiotic dumping by manufacturers.
• Inappropriate prescription /overuse where antibiotics are not necessary /availability of non prescription antibiotics. The latter uncontrolled use is estimated to be even greater than current studies indicate as many countries do not collect data on non-prescribed supply.
• Travel. Global travellers are colonised with resistant bacteria which they bring home with them. (here Monica threw in a comment that we should avoid eating pastry or ice cream when travelling ).
• Lack of data. Inadequate surveillance has led to an inadequate understanding and response to the problem.

Peak global health organisations see AMR as a real threat as evidenced by a 2016 UN high level meeting on the subject and subsequent global planning to stem resistance. WHO have released a list of priority organisms and these have been categorised according to their threat level as urgent, serious, or concerning.

Responses required for tackling the problem include:

• Improved knowledge and awareness of the issue at all levels. This should include building awareness amongst industries such as food production.
• A solid global and national policy response, including workable frameworks and accountability.
• Optimisation of antibiotic use through stewardship, and reduction of antibiotic use through lowering infection rates.
• Investment in research and development.

Monica argued that now was not a time for complacency. We need to be careful about how we use this precious commodity. We need a workable road map of what to do, and commitment from business, which is likely to require strong governmental policy. 

At a clinic level, it raised questions for me about the wisdom of contact treatment where risk is low, and the contact indicates their willingness and ability to abstain from sex until results are received. We currently advise contact treatment, so is it too controversial to wait?

It also raises questions about any rollout of antibiotic prophylaxis for high risk groups

The presentation was a confident and engaging call to action.

On the throw away line regarding the risks of global dining, a friend who I informed about the presentation commented “deliciously infected by an Italian Gelato”.