This week marks World Antimicrobial Awareness Week (WAAW 2022) – a moment to highlight the need for better awareness and understanding around antimicrobial resistance, which as the past two years has shown, is a serious threat to global public health.
The healthcare sector must work together to tackle antimicrobial resistance
Antimicrobial resistance (AMR) occurs when germs such as fungi, viruses and bacteria evolve to protect themselves against drugs designed to defeat them. While it is natural for resistance to drugs to develop to some degree, the use and misuse of antimicrobials is increasing their capacity for self-defence.
“In 2019, 5m deaths worldwide were associated with AMR, with 1.27m deaths directly attributable to bacterial AMR,” explains Dr Bradley. “This is placing a heavy burden on already stretched healthcare systems – for example, it costs the EU roughly €1.5bn annually in expenditures and productivity losses.
“While “antimicrobial” incorporates antibiotic, antiprotozoal, antiviral and antifungal medicines – resistance to antibiotics is particularly concerning. Without effective treatment of bacterial infections, even routine operations and minor surgery such as caesarean sections or tonsillectomy may become high risk.”
With the potential to affect not only the healthcare industry but also veterinary and agriculture sectors, it is an issue which requires urgent attention and collaboration to improve global health security.
Actionable steps to preventing antimicrobial resistance
Dr Bradley believes that the international healthcare industry urgently needs to work together to tackle antimicrobial resistance, with efforts focused around two key areas.
Increasing awareness and education with digital healthcare
Outside of the healthcare sector, awareness of antimicrobial resistance is relatively low; more needs to be done to increase understanding amongst the general public and to promote the responsible use of antibiotics among healthcare professionals.
“Digital health tools and online resources have a key role to play in increasing patient education and promoting self-care for conditions that don’t require antibiotics,” explains Dr Bradley. “For example, one-third of the public believe antibiotics will treat coughs and colds. Using patient engagement and messaging tools like Mjog can help practices to communicate with their patients at scale and sign-post them to trusted online guidance at peak times, such as during the winter cold and flu season. Giving patients the knowledge and reassurance to self-manage symptoms or know when to seek medical attention helps to ease pressure on primary care practitioners, whilst also helping patients to avoid unnecessary consultations and misuse of antibiotics.”
Online resources can also support clinician education by increasing accessibility to dedicated antimicrobial resistance training sessions.
“Peer to peer networks are also readily accessible through digital health with professionals sharing learnings, resources and expertise, more efficiently and across wider networks. At Kry we regularly undertake an antibiotic prescribing audit to determine clinician adherence of antibiotic prescribing to NICE guidance. Findings are shared via our clinician e-newsletter and virtual clinical audit meetings reinforce best practice and communicate areas for improvement,” adds Dr Bradley.
Using healthcare data effectively
Access to population health data plays a crucial role in the surveillance of antibiotic resistance and consumption, particularly at a national level as it gives clinicians and commissioners a better understanding of prescription patterns and resistant pathogens.
“The WHO's Global Antimicrobial Resistance and Use Surveillance System (GLASS), which collates and shares AMR data from across the globe, found high levels of resistance to ciprofloxacin, a broad-spectrum antibiotic sometimes required to treat Urinary Tract Infections (UTIs). This finding is consistent with reports that the antibiotic is regularly being overused for UTI treatment. Informed by this data, healthcare providers are able to implement more appropriate strategies and guidelines for responsible antibiotic usage.
“During the past decade, health bodies across the globe have increased collaboration and efforts to prevent antimicrobial resistance with many strategies and targets being implemented. In order to avert a global health emergency, we need to educate healthcare professionals and patients on the responsible use of antibiotics, particularly for conditions where antibiotics are inappropriate, for example viral illness. As well as prescribing at scale and leveraging data to improve best practices in antibiotics prescription – leading to better overall health outcomes,” says Dr Bradley.
Some studies have highlighted that antibiotic prescribing rates are higher in remote consultations than during in-person. Further studies highlight the need for antibiotic prescribing improvement within out-of-hours (OOH) primary care, where GPs are mostly confronted by patients with infections.
“Interestingly, our data at Kry shows we prescribe less broad-spectrum antibiotics than the national average,” explains Dr Bradley. “At Kry, we are very cognisant of the reputation of online providers overprescribing antibiotics, so we run regular audits of our antibiotic prescribing, in particular focussing on the appropriate treatment of UTIs and tonsillitis, both conditions with traditionally high levels of incorrect prescribing. We have clear treatment guidelines that we audit against and the continuous improvement cycle has enabled us to significantly reduce the number of inappropriate broad spectrum prescriptions issues. Education, prescribing at scale and utilising data more effectively can help to promote best practices in AMR.”
But to achieve this, the healthcare sector needs better collaboration across the health ecosystem to ensure that patients get access to the right treatment, as well as enable effective planning of resources and enhance policies to improve health security against the so-called ‘superbugs’.
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