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Doctors need dragging out of their comfort zone to avert the antimicrobial crisis, says lord

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6517 (Published 02 December 2016) Cite this as: BMJ 2016;355:i6517
  1. Joe Freer
  1. The BMJ

Doctors need “dragging out of their comfort zone” and should be using highly sensitive diagnostic tests rather than relying on an “educated guess” when prescribing antibiotics, Jim O’Neill, former commercial secretary to the Treasury, has said. The action is needed to avert the predicted 10 million annual deaths and $100 trillion (£80 trillion; €95 trillion) loss to global gross domestic product from antimicrobial resistance by 2050, he said.

O’Neill, who chaired a review on antimicrobial resistance earlier this year,1 was answering questions from MPs on the science and technology select committee on 30 November. He said that the government hadn’t responded to the “most aggressive” recommendations from his report and needed to do more to tackle antimicrobial resistance.

“The single most aggressive recommendation was that antibiotics should not be prescribed without state of the art diagnostic tests by 2020,” he told the committee. He questioned the view of Paul Cosford, medical director of Public Health England, that diagnostic tests should have only a secondary role.

Cosford, who was also being questioned, said that diagnostic tests “need to be used in the appropriate context and not take away from the professional judgment of a clinician.” He cited evidence from the IMPAC3T study,2 which showed that using the Royal College of General Practitioners’ antibiotic guidance toolkit reduced prescribing by significantly more than using a highly sensitive point-of-care test.

O’Neill said that he thought this was largely because the government had not given the affordable diagnostics market the “kick start” it needed, which meant that doctors were still relying on “a very educated guess.”

O’Neill went on to say that international cooperation was essential to reducing antimicrobial resistance, citing the United Nations General Assembly’s high level meeting on the matter earlier this year. “It is important to understand the nature of this problem: it doesn’t distinguish [international] borders,” he said.

Helen Shirley-Quirk, from the Department of Health, also giving evidence, agreed. She said, “A declaration has been called for mechanisms across UN agencies. Plans for that are in development, and they will play a critical role.”

However, O’Neill rejected the idea that international policy on antimicrobial resistance should have a structure modelled on the UN response to climate change. “These committees haven’t been that successful in the past,” he said. “As good as the UN agreement was, it’s only the end of the beginning.”

Although some progress has been made in reducing antimicrobial prescribing in the UK in the past year, Cosford claimed that there was still “huge variability.” He said, “We have seen reductions [in antimicrobial prescribing rate] in the hospital sector, but an increase in ‘antibiotics of last resort.’ There’s a huge amount still to do, and we need to keep a close eye on what we do.”

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