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Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead pharmacist, Health and Wellbeing Directorate, Public Health England
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antibiotic pills1May 23 2016

Patients with coughs and colds should have a simple finger-prick test at community pharmacies to see if the infection is viral or needs an antibiotic. The proposal has been made by the Royal Pharmaceutical Society, following on from Lord O’Neill’s Review of Antimicrobial Resistance (AMR), published last week.

Lord O’Neill has been leading the review since 2014, and has now published the Review’s final report and recommendations, which call for:

  • having a massive global awareness campaign about antimicrobial resistance;
  • improved surveillance of antibiotic resistance both in humans and animals;
  • better incentives to promote investment for new drugs and improving existing ones;
  • the development and use of vaccines and alternatives;
  • the development and use of new, rapid diagnostics to cut the unnecessary use of antibiotics.

The report says that “diagnostics could transform the way we use antimicrobials in humans and animals: reducing unnecessary use, slowing AMR and so making existing drugs last longer.” In addition, it calls on wealthier nations to “make it mandatory that by 2020 the prescription of antibiotics will need to be informed by data and testing technology wherever available and effective in informing the doctor’s judgement to prescribe.”

Responding to the report, Professor Jayne Lawrence, Chief Scientist at the RPS, said that the generality of symptoms of some illnesses such as coughs and colds makes it very difficult for prescribers to determine the difference between viral and bacterial infections. This can lead to ineffective prescribing as often a broad spectrum antibiotic is the first type of treatment offered if the illness is thought to be caused by bacteria.

“This is in effect a scattergun approach which sometimes works, but which results in an increased resistance of bacteria to antibiotics,” she said. “What’s needed is a simple test, such as a finger-prick blood test which identifies the type of bacteria present so that they can be targeted with the right antibiotics, which is more likely to be successful.

“I’d like to see patients dropping in to their local pharmacist for advice and a test, so the right antibiotic could then be supplied. If the test reveals the patient has a viral infection, they could receive advice on how to treat their symptoms and how long to expect them to last. It’s often a lack of awareness of how long symptoms can persist that drives unnecessary visits to GP surgeries and requests for antibiotics.”

The Patients Association has also called on the Government to “encourage the use of new technologies, such as rapid point-of-care testing. More support needs to be provided to the areas that are not sufficiently implementing the key antimicrobial stewardship recommendations.”

Last week, the Association published its own report looking at how clinical commissioning groups are implementing the necessary guidance to address the inappropriate prescription of antibiotics. “There have been a number of recently introduced policy measures and financial incentives that encourage the delivery of improved antimicrobial stewardship at a CCG level, and this is something that should be welcomed,” said Katherine Murphy, Chief Executive of the Patients Association.

“However, failing to provide this focus and support for improving the uptake of key guidance already in existence will severely undermine the aspirations for this country to be a global leader in the battle against antimicrobial resistance, and will jeopardise the safety of patients in this crucial area.”

Links:

Review on Antimicrobial Resistance

AMR final report and recommendations

RPS comment

Patients Association comment

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