Last updated:

Antimicrobial resistance

pharmacist holding prescription drugs

"Ask a group of GPs how many feel they ever prescribe unnecessarily and only the terminally self-deluding will fail to raise a hand."

Dr Andrew Green

Antimicrobial drugs are used to kill or inhibit the growth of microorganisms capable of causing infection in humans and animals.

Antimicrobial resistance occurs when these microorganisms develop the ability to resist the actions of these drugs.

This is a natural phenomenon, but is accelerated by the overuse and misuse of antimicrobials in medicine, as well as in veterinary practice and modern farming, and can be exacerbated by poor infection control practices.

 

  • What is the issue?

    Doctors have expressed significant concern about the threat of a ‘post-antimicrobial age’, where current antimicrobials will be ineffective due to increasing levels of resistance.

    This represents a major public health issue: Drug resistant infections are already responsible for an estimated 700,000 deaths globally, per year. Without action to stop the spread of resistance it has been estimated this figure could reach 10 million by 2050.

    Resistance also has the potential to severely limit the ability to carry out many routine and complex medical treatments, where antimicrobials are necessary to prevent infection, such as in surgery or chemotherapy.

    Antimicrobial resistance infographic

  • What is being done?

    In 2013 the UK Five Year Antimicrobial Resistance Strategy was published, which set out a range of recommendations for tackling the problem of antimicrobial resistance. It was developed in collaboration with all devolved administrations in the UK and a wide range of government departments and agencies.

    Doctors have highlighted the importance of maintaining a continued focus on tackling antimicrobial resistance, and have called for the publication of a renewed strategy after the current one expires in 2018.

    Addressing the threat of antimicrobial resistance

    • improved antimicrobial prescribing in clinical practice, with the aim of preserving antimicrobial sensitivity for as long as possible
    • the introduction of tighter regulation to significantly reduce the inappropriate use of antimicrobials in farming practices
    • International collaboration aimed to tackle the global threat of antimicrobial resistance
    • greater support for the development of new antimicrobials
  • How do we tackle the issue in clinical practice?

    Tackling the development of resistance as a result of the use of antimicrobials in clinical practice represents a key challenge for healthcare professionals.

    A number of factors may contribute to inappropriate prescribing practice, including:

    • concerns that not prescribing antimicrobial medications may result in an undetected infection going untreated and a worse outcome for the patient
    • lack of access to diagnostic testing and inadequate time to carry out diagnostic testing in primary care settings
    • pressure from patients to prescribe antibiotics for viral or self-limiting infections
    • workload pressures, including short consultation times in general practice
    • fear of complaint, litigation, or adverse publicity or feedback, including, for example, via the NHS friends and family test.

    We reported on the recent successful efforts to reduce antimicrobial prescribing in primary care. It is important that doctors continue to be supported in this area, to ensure antimicrobials are prescribed appropriately.

    This should include a focus on improving access to timely diagnostics, so that doctors could be sure whether to prescribe antibiotics or not, as well as efforts to improve education and awareness of antimicrobial resistance among patients. This must be underpinned by wider efforts to reduce the pressure on general practice, to allow adequate time with patients for conversations about antimicrobial prescribing to take place. See more about our continued work on lobbying for an Urgent prescription for general practice.

  • A 'one health' approach

    The inappropriate use of antimicrobials occurs in both human and veterinary medicine. Antimicrobial usage in human health only accounts for less than half of all antimicrobial usage worldwide, and doctors have expressed particular concern about the ways in which antimicrobials are used in animals, particularly in agriculture, and the contribution this has to the development and spread of antimicrobial resistance.

    There are specific concerns about the routine administration of antimicrobials to healthy animals, as well as concerns about the use, in agriculture, of those antimicrobials critically important for human medicine.

    Antimicrobial resistance infographic

    The BMA supports a ‘one health’ approach to tackling antimicrobial resistance, which recognises that action is required across human medicine, veterinary practice and agriculture to minimise unnecessary or inappropriate use of antimicrobials, to ensure they continue to be effective in treating infections.

  • A global approach

    Addressing the threat of microbial resistance is a fundamental global health priority, and the responsibility of all countries. While it may be seen as a threat facing the health sector, given the great human cost of inaction, the economic and global security cost are excessive and will continue to grow if resistance is not tackled.

    The UK is not alone in recognising the threat, and AMR has reached great prominence at the highest political levels including the Global Action Plan (GAP) announced by the World Health Organisation in 2015. At the UN, in September 2016, in only the fourth time the UN general assembly had addressed a health issue, all member states committed to act on antimicrobial resistance.

    It is crucial that we use our own knowledge and experience in this area to promote best practice and facilitate global surveillance of drug resistance and antimicrobial consumption in both humans and animals.

    To aid this we are calling for two key factors:

    • investment in the surveillance of drug resistant infections, and international cooperation for data-sharing procedures to improve global responses. We believe that the UK government should promote investment by the international community in building laboratory capacity and capability in low-middle-income countries that have been severely affected by microbial resistance to enable better diagnosis.
    • focus on tackling antimicrobial resistance in low-middle income countries. AMR has the potential to severely limit the effectiveness of many routine and complex medical treatments, and we must improve antimicrobial prescribing in medical practice in the UK and internationally, so to preserve antimicrobial sensitivity for as long as possible.
  • Supporting research

    Alongside better stewardship of existing antimicrobials, the development of new antimicrobials is required to ensure antimicrobial therapy continues to be effective in the long-term. A number of recent reviews have highlighted the lack of progress in this area – raising concerns that at the current rate of development, it will not be possible to discover and market enough new antimicrobials to keep up with the spread of resistance.

    A government-commissioned review into antimicrobial resistance, led by the economist Jim O’Neil, suggested a number of areas for action, for supporting antimicrobial research and development. This included calls to increase public funding to support antimicrobial discovery and development, and to establish rewards for market entry to incentivise the development of new drugs. The UK Five Year Antimicrobial Resistance Strategy 2013-18 also recognised the need to address issues of commercial viability and market failure to encourage investment in antimicrobials.

    It is clear that to ensure effective antimicrobial therapy in the long-term, a comprehensive research agenda should be a priority nationally and internationally.

    This should focus on:

    • incentivising innovation and engaging the private sector, public institutions and academia in a programme of research for the development of new antimicrobials
    • improving surveillance of antimicrobial resistance and prescribing, and developing novel diagnostics to support antimicrobial prescribing.
  • AMR symposium

    The Board of Science hosted a symposium in May 2018 with the following objectives:

    • To discuss the opportunities for the health and veterinary sectors to combat AMR, how barriers might be overcome and identify collaborative solutions that can be implemented after the symposium
    • To inform the current development of the UK’s next AMR Strategy

    Participants included representatives from across the health, medicines, veterinary and farming sectors. There were also representatives from a wide range of BMA branch of practice committees, specialty committees and council committees in the devolved nations.

    Read the key themes that emerged during the symposium

    Find out more

  • Further resources