"The drugs don't work" - 10 years on

"The drugs don't work" - 10 years on

Reading: "The drugs don't work" - 10 years on 3 minutes

In March 2013, the first in-depth report from the Dame Sally Davies, CMO, was published with the title “The Drugs don’t work”.

The report provided stark reading, with data charting increased resistance of bacteria to antibiotics (termed antimicrobial resistance; AMR) and concluded with several priority actions.

But the details in the report were not new. The first ‘UK AMR Strategy’ (2000) was developed in response to the recommendations contained in the Standing Medical Advisory Committee report ‘Path of Least Resistance’ (1998). This strategy did lead to significant changes including improvements in antibiotic use, increased funding for the development of new drugs as well as additional support for AMR related research in the UK. In parallel to this, new vaccine programmes as alternative approaches to infection management were being implemented.

The 2013 report created further impetus in this field and in September 2013, the ‘UK Five Year Antimicrobial Resistance Strategy 2013 to 2018’ was published, setting out actions to address the key challenges to AMR.
The following recommendations were included in the 2013-2018 plan:

  • preserve the effectiveness of our existing antimicrobial agents
  • tackle poor domestic prescribing (which is fuelling resistance)
  • encourage the development of new agents in the future
  • address the import of resistant bacteria from infections or colonisations acquired overseas which pose an increased risk for security and resilience

It recognised that the threat of AMR cannot be eradicated, but that it can be managed to minimise the impact for human and animal health. In the 5 years of the plan, significant progress was made in reducing antibiotic use, supporting the plan’s first 2 targets. Plans and targets have continued since 2018, with ongoing monitoring and reporting.

Overall, antibiotic use fell by 15.1% between 2017 to 2021, exceeding the target. However, there was a rise in estimated number of severe antibiotic resistant infections in 2021 compared to 2020 (equivalent to 148 cases a day in 2021). This rise is consistent with those seen in previous years, albeit at a slower rate during the Covid pandemic, where factors such as reduced social mixing played a part.

Given this dynamic picture there is a continuing need to support responsible antimicrobial use across all sectors to minimise antibiotic use and reduce the evolutionary pressures that encourage resistance.

An antibiotic resistance awareness week is held in November each year in the UK and Europe to continue to raise and spread awareness amongst health professionals and the public. Ideas and resources to support the week are made available via the UK Health Security Agency.

Whilst it is recognised that AMR cannot be eradicated, the aim is to manage it so that the threat to, and impact on, human and animal health is minimised.

For insight into the relationship between antibiotics and the gut microbiome, sign up to CPD with Dr K Barrett.

Davies, S. (2013). The Drugs Don't Work: A Global Threat. Penguin Books, UK.