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GPs must keep up the fight against antimicrobial resistance



professor colin garner crop

When it comes to antibiotics, GPs are seemingly being shot at from all sides.

While receiving abuse from patients deprived of their miracle medicine, you have had to live with the endless headline-bashing about needlessly prescribing antibiotics.

We know GP prescribers have been leading the way in reducing antibiotic use in recent years, and continued to disseminate fewer antibiotics since the turn of the calendar year despite the worst flu outbreak for a decade.

And yet as Pulse recently reported, antimicrobial resistance continues to rise, once beaten bacterial infections such as scarlet fever and TB are back and the dire apocalyptic warnings about a pre-medicine age where someone could die from something as simple as an infected scratch, continued to be issued.

The media have been highlighting an agricultural industry that has abused antibiotics

So when fingers were pointed at prescribers for causing the problem, they were wrong, right? Not quite. The overprescribing of antibiotics has and will continue to play a part in creating resistance.

But it is far from being the only contributor, and until we take a whole society approach to curbing the problem, 90 years after the discovery of penicillin, antibiotic resistance will live up to its billing as the most dangerous health problem facing humankind.

Along with turning the spotlight on medics, the media have been highlighting an agricultural industry that has abused antibiotics by using them not only to treat sick animals, but as a barrier against bacterial infection in intensive farming. Britain’s pork and poultry producers in particular have taken the lead in reducing the amount of antibiotics making it into the food chain, but that good practice still has some way to go to match Scandinavia, and world sanctions are going to have to be imposed to stop appalling husbandry in some countries – including, notably, some parts of the USA.

Press headlines are also humming with tales of antibiotics leaching into our environment. A report from China revealed that antibiotic residues were being found in some rivers and lakes in Sweden, while the University of Exeter highlighted increased antibiotic resistance in surfers arising from being exposed to resistant bacteria in sea water whilst surfing.

The pharmaceutical industry is only just waking up to its responsibilities to developing alternatives to the antibiotics they thought were not cost effective enough to produce. We recently warned it and the health charities, whose donors fund vital new treatments, that their new drugs to tackle cancer and so on will be useless if patients are contracting infections like MRSA.

And having made a promising start under former Prime Minister David Cameron, who at least gave a platform to the issue of antimicrobial resistance, government and politicians across the board have done little to incentivise research or advance the cause.

And then we come to the public, weaned on a belief that antibiotics can cure anything; and themselves under pressure to get better quicker and return to work faster. Last year’s ‘Keep Antibiotics Working’ campaign certainly raised awareness but within weeks of its first appearance on TV screens, GPs were feeding back that they were being threatened with being reported to the GMC or even facing physical abuse for not prescribing antibiotics.

Recent investigations by Pulse and in the Daily Mail also uncovered a suspicion we at Antibiotic Research UK have had for many years – namely, that the impatient patient has turned to the internet for antibiotics, with their availability likened to ‘ordering a pizza’.

Clearly there are much wider factors than GP prescribing when it comes to antimicrobial resistance.

That said, now more than ever, prescribers need to stay strong. And for all GPs, here is an opportunity to affect the health of this and future generations for the good.

Despite the negative headlines, the local GP surgery remains a pivotal place in our community, where fighting antimicrobial resistance should be practised and promoted. And though the rise of ‘Doctor Internet’ and the frustration around appointment times has so unfairly blighted the good name of the family doctor, you as GPs are still the most influential, respected and experienced dispensers of healthcare advice the public engage with.

So my message is: don’t duck it, even if you are not the silver bullet that will beat antibiotic resistance on its own.

Professor Colin Garner is the founder and chief executive of Antibiotic Research UK