Greater transparency around antibiotic prescribing and infections is needed to tackle the global threat of antibiotic resistance, a panel of experts has said.
There are severe gaps in knowledge on the quantities of drugs given to animals and why, as well as poor recording of infections and deaths in humans, they claimed. The widespread overuse and misuse of antibiotics in human medicine and farming is a major driver of the global public health emergency, which already kills hundreds of thousands of people a year.
The experts were speaking at a roundtable event hosted by the Bureau, which has been reporting on the crisis since September 2016.
The panel included Ed Whiting of the Wellcome Trust, Dr Neil Wigglesworth of the Infection Prevention Society, Gwyn Jones of Responsible Use of Medicines in Agriculture, Coilin Nunan of the Alliance to Save Our Antibiotics and Daniel Berman of the Longitude Prize. Prominent academics, microbiologists and campaigners working in the field also took part.
There are very worrying gaps in the basic research around superbugs, said Dr Mark Holmes, a veterinary scientist at Cambridge University. For example, no one knows the true quantity of antibiotics being given to animals and what purposes they are being given for because it is not recorded in any consistent way.
“Even if you asked for one particular antibiotic going into a feedmill there is no record available in any feasible form,” he said. “In the NHS you have some control over that because it’s a monolithic organisation. In private enterprise - in veterinary practices - you’d have to get 500 people to sign up for a study for which there is absolutely no advantage for them.”
Having this basic information would stop academics having to make assumptions in a vacuum and allow them make informed decisions, he said.
Vets do record antibiotic prescribed to animals, and farmers increasingly write it down in their medicine books – but nobody bothers to collect this information, responded RUMA’s Jones. Vets, who are paid per prescription, stand to lose 20 to 30% of their income if antibiotic use on animals is restricted, he claimed.
Coilin Nunan, of the Alliance to Save Our Antibiotics, pointed out that while using antibiotics as growth-promoters in farming is banned, it is still legal to give them to animals when there is no disease diagnosed. Preventative antibiotics are routinely mass-administered in intensive farming to protect against disease in often overcrowded conditions.
Better data on antibiotic use on animals would help reduce inappropriate prescribing, it was agreed.
In human medicine, while data on prescriptions is available, not all hospitals have good records on how many people get superbugs and how many die.
Dr David Brown, of Antibiotic Research UK, said three members of his family contracted MRSA, including him. His father died of the superbug, he said, yet it was not recorded on his death certificate.
Experts explained one of the reasons for this is because it is extremely difficult to ascertain to what extent a drug-resistant infection has contributed to someone’s death. A patient with a superbug may die from it but their death may also have been caused by something else or be due to multiple factors.
Patients in hospital usually have a range of serious illnesses or medical conditions which lower their immunity and so doctors cannot with any certainty say how much of their death was caused by the infection.
Death certificates may be filled out by junior members of the team, at three o’clock in the morning when they are the only person around, said Dr Neil Wigglesworth of the Infection Prevention Society. “Death certificate data is poor. The only clear thing about death certificate data is that someone has died,” he said.
A GP who attended the event, Dr Oliver van Hecke from Oxford University’s Nuffield health centre, said death data was less relevant when it came to dealing with antibiotic resistance at the primary care level. He called for better recording of the effects of drug resistance other than superbugs; such as people being ill for longer, returning to their GP more often and having to be admitted to hospital.