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Editorials

Action on antimicrobial resistance

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7161.764 (Published 19 September 1998) Cite this as: BMJ 1998;317:764

Not easy, but Europe can do it

  1. Richard Smith, Editor
  1. BMJ

    “We screwed up, and we ought to say so and apologise. Doctors were handed the wonderful gift of antibiotics but are destroying them through indiscriminate use. We don't need another committee. We know what to do: we should just use them less.” So spoke Norman Simmons, emeritus consultant microbiologist from Guy's Hospital, London, to a tremendous round of applause at last week's panEuropean meeting in Copenhagen on antimicrobial resistance.

    Increasing resistance to antimicrobial agents is health care's version of global warming. The serious problems are global and lie in the future. Evidence is uncertain. There is no technical fix. An adequate response depends on ordinary doctors and patients changing their everyday practices. We may have to give up our antibiotics for minor infections just as we may have to give up our cars for unimportant journeys. Multiple parties, including many vested interests, are involved, and there is a tendency to fall back to blaming each other. There are few votes in tackling antimicrobial resistance seriously, yet the problem can never be ameliorated without a political lead. And, crucially, no country can solve the problem alone. A multinational, preferably global, response is essential. Micro-organisms know no national boundaries.

    Microbiologists have been discussing antimicrobial resistance for over 20 years, but the subject is now beginning to be taken seriously by many broader organisations. Last week's “Copenhagen recommendations” (available in full at http://www.microbial.threat.dk/) join proposals from the World Health Organisation, the European Union, and, in Britain, the House of Lords Select Committee on Science and Technology and the Standing Medical Advisory Committee. The beauty of the Copenhagen meeting was that it brought all parties together: politicians from health and agriculture, academics, doctors, other clinicians, vets, farmers, representatives of the pharmaceutical industry, and bureaucrats. “We are all sinners here,” said Einar Krag, Denmark's chief medical officer and the guiding force behind the meeting. The universal admission of sin meant that we could all hope for redemption. The result was a remarkable degree of consensus.

    The only issue that deeply divided the conference was banning antimicrobial agents as growth promoters in animals. Most of those at the meeting favoured a ban, but others wanted a full risk assessment before any decision was made. Others pointed out that the European Union already has the laws it needs to solve the problem: it simply needs to enforce them.

    The Copenhagen recommendations have four main parts. Firstly, the European Union and the member states must recognise the seriousness of the problem of antimicrobial resistance. At present some countries do but others don't. Secondly, high quality data must be collected across Europe on the extent and effects of resistant micro-organisms and on the supply and consumption of antimicrobial agents. Thirdly, and this is perhaps the hardest part, Europe needs a wide range of measures to encourage the prudent use of antimicrobial agents: these include education of professionals and the public; widespread introduction of guidelines in human and animal medicine; the introduction of antimicrobial teams to cover hospitals and communities; and wider availability of diagnostic tests for infected patients. Fourthly, Europe needs a coordinated research programme with an emphasis on evaluating interventions to reduce the harm caused by antimicrobial resistance.

    All of this is a challenge to Europe. It will be easy to keep talking while the problem worsens. Effective action will not only ameliorate a major problem but will also demonstrate that different groups within Europe can work together on difficult issues. Unusually, I'm optimistic.

    Acknowledgments

    RS acted as rapporteur for the conference and had his expenses paid by the Danish Government.

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