AMR 250

Resistance is not futile

Date: 25 March 2019

As humans, resistance to commonly prescribed antibiotics is one of the biggest global health threats we face.

Since the first use of penicillin, in 1945, millions of people have been successfully treated with antibiotics, but antimicrobial resistance (AMR) is on the rise.

Though hundreds of different types of antibiotic now exist, no new classes of antibiotic have been discovered since the 1980s and around the globe, AMR infections now cause a staggering 700,000 deaths each year.

Whilst most bacteria are killed when antibiotics are used, resistant germs can survive and even multiply. Overuse of antibiotics makes resistant bacteria more common and the more we use them, the more chance germs have of becoming resistant. AMR occurs when bacteria, viruses, fungi and parasites no longer respond to the drugs used to treat the infections they cause.

Repeated and inappropriate use of antibiotics is still increasing and without action, deaths from untreatable infections are predicted to rise to 10 million by 2050.

Confronting AMR is now an urgent priority for global health and the UK government has set goals to contain and control antimicrobial resistance by 2040. The way forward is dependent on clinical research and the NIHR is playing a crucial role.

The North Thames region is a highly active area for AMR research, with a variety of approaches to tackling AMR.  

One of the studies recently completed was commissioned to evaluate the implementation of the Department of Health and Social Care UK Five Year Antimicrobial Resistance Strategy. The Policy Innovation and Evaluation Research Unit (PIRU), based at the London School of Hygiene and Tropical Medicine, has evaluated the Strategy and Chief Investigator, Professor Nicholas Mays, confirmed that reports from the study are currently under peer review and due to be published on the PIRU website. He said:“...the study is broad in scope and designed to provide a cohesive account of Strategy implementation at local, national and international levels in both animal and human health”.

Two further AMR studies are running and recruiting participants around the region.

The CAP-IT study, currently open at Royal London Hospital, part of Barts Health NHS Trust, is focusing on the use of antibiotics in children. Parents of young children under six will be given the opportunity to participate in the study, which looks at the use of amoxicillin, a commonly used antibiotic, for treating pneumonia. Little is known about how best to use amoxicillin for pneumonia treatment in this age group. 

Meanwhile, the ARK study, open at the Royal Free Hospital in London, is also set to open at North Middlesex University Hospital NHS Trust in April. This broad and interesting study will help develop a useful set of strategies to help doctors, nurses, pharmacists and patients reduce their use of antibiotics, whilst assessing patients’ health outcomes.   

As part of their research, patients and their relatives will be asked what they think about the information given to patients when they are prescribed antibiotics. Their feedback will be used to understand how best to explain appropriate usage, with the hope prescribers can change old and damaging behaviors.

Fiona Burns, Associate Professor in Sexual Health & HIV Medicine at UCL and the Royal Free London NHS Foundation Trust, and also the Infection Specialty Lead for CRN North Thames, stressed the important need for further research into AMR. She said: "Antibiotics are vital for our health and well-being and the development of AMR is a major concern. Studies like these, and the other NIHR trials running across the UK, are key to the vital health research needed to overcome the challenges of AMR and bring us new ways to tackle the dangers of infection.

"Tackling AMR does not simply involve developing new, ever more potent antibiotics, but also importantly looking at how we currently use antibiotics and ensuring that correct dosing, duration and antibiotic strategies both optimise clinical outcomes and reduce the likelihood of AMR in the future."

  • Summary:
    Confronting antimicrobial resistance is now an urgent priority for global health and the way forward depends on quality clinical research.
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    North Thames
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    • Infectious Diseases and Microbiology
    • Children
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