http://bmj.com/cgi/content/full/323/7311/472
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News
Leading the resistance
In 1969 a working party chaired by Lord Swann examined the safe and
effective use of antibiotics in animals and humans. It recommended
that the government recruit an expert advisory group. In July this
year, such a group had its first meeting.
A recent report from the House of Lords Select Committee on Science and
Technology
at
whose commendably nagging insistence the new advisory group has
finally been createdsaluted
its advent. The committee further declared itself "appalled
that [it] has taken so long." As if to emphasise the point, the
report prints the comment in bold type.
"It's been 31 years," says microbiologist Professor Richard
Wise, the chairman of the new group. His unprompted use of the precise
number bears witness to a weary familiarity with it. But why now?
"It's a question of political agendas. The House of Lords set
up their select committee at just the right time. People were starting
to get more and more concerned about things like MRSA [methicillin
resistant Staphylococcus aureus], for example."
Wise trained in Manchester but has spent the past 25 years working in
Birmingham, the last five years occupying a personal chair in
clinical microbiology. As a scientific adviser to the Lords
committee, he is no stranger to microbial resistance. Indeed, it has
been a concern of his for some time.
The Specialist Advisory Committee on Antimicrobial Resistance will have an
overarching role in the medical, veterinary, and agricultural use of
antibiotics. It will advise the government on strategies in
research, training, and public education; scan the horizon for new
threats and opportunities; and offer more specific advice as required.
"We need better systems of surveillance," says Wise. "At the
moment we use very crude measures of resistancenamely,
what's reported by laboratories. But we don't have any real
denominator data. We don't know the rate of, say, pneumococcal
resistance to penicillin in children. Surveillance needs to be
beefed up a lot.
"We must also find out more about attitudes to antibiotic resistance.
Do people know what it means, and why we've got it? A lot of the
public don't seem to realise that a finite resource is dwindling as
time goes by.
"And they don't always understand the nature of the problem. You hear
people say, `I've become resistant to antibiotics'. But it's the
bacteria that get the resistance." The media don't always help,
he adds. "I've heard BBC reporters making this mistake."
Professional education too is needed. "Sixty six per cent of
antibiotics are given for upper respiratory tract infectionsof
which probably over 90% are viral." Practitioners must know these
facts; but maybe it's less a question of knowing than of feeling. Maybe
antibiotic prescribing is medicine's equivalent of smoking: hard to
give up because the rewards are both slow to materialise and
difficult to link to the action taken.
It's not as if the reality of microbial resistance has only recently dawned;
Alexander Fleming can be heard talking about it in a BBC recording
made in the 1940s. So can Richard Wise explain why we have been so
negligent for so long? "Between the '40s and the '70s," he
says, "there was a plethora of new agents, so resistance problems
were seemingly being contained." He laughs. "And there was
that famous remark by a US surgeon general that the time had come to
close the book on infectious diseases."
During the '70s and '80s resistance went on increasing, but no new drugs
came along. "There's only been one completely new drug during
the whole of my professional career."
What does Wise say to those who argue that insights into bacterial genomes
are bound to offer us a stack of new targets and so a range of new
drugs? "I say... maybe. I think there's going to be a gap, a
dearth of compounds for at least 10 years."
While acting as adviser to the Lords, Wise travelled to find out how other
countries were coping. "It's obvious that the issue is moving
up the agenda all over the world," he says. And anyone who
thinks things are bad in the United Kingdom should find out what
it's like in the developing world.
"I went with the World Health Organisation to Sri Lanka. There they
have no control on antibiotic use. You can go to your village healer
and you're given an antibiotic out of a jar of coloured pills. You
come back tomorrow for another, and so on until you can't afford any
more. The WHO put together an initiative on microbial resistance
last year. But they've got a heck of a job."
Antibiotic misuse has what Wise calls a "societal impact." By that
he means that someone's careless use of antibiotics today is putting
others at risk tomorrow. But at least there's no malice intendedwhich
is more than can be said about another of his interests: pathogenic
microbes and bioterrorism. As a civilian consultant to the army, he
takes the threat seriously. "They're the sort of weapons that
someone with a BSc (failed) could make by Monday." If anything,
he's surprised that so far we've had so little bioterrorism, even in
the form of hoaxes. It's one horror we don't have to cope withyet.
Right now, each of the 20 or so members of the Specialist Advisory
Committee on Antimicrobial Resistance is thinking about what the
group's priorities should be. When they next meet they will put
together a work plan. If Richard Wise then has a little less time to
spend on the reading, gardening, and white burgundy he enjoys, the
rest of us will know that someone who takes microbial resistance
seriously has the ear of government. A listening ear, we must hope.
Geoff Watts presents the Radio 4 science programme Leading Edge.
Sixty six per cent of antibiotics are given for upper
respiratory tract infectionsof
which probably over 90% are viral
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