There is a great deal of work being done in the UK around AMR and the correct use of antibiotics, said Dr Duerden. Dame Sally Davies, the Chief Medical Officer for England, has taken a national lead across the UK on this topic and it has become her priority to address the problem. In addition, Public Health England have done a considerable amount of work on the issue and there are also frequent articles in the press criticizing doctors for being too liberal with the use of antibiotics.
Dr Duerden cautioned that although there is a focus on addressing AMR in the UK, this is made difficult by the already high GP workload and the scarcity of available resources for general practice. This is further compounded not only by the potential of Brexit negatively affecting pharmacy supplies, but also by signs that the antibiotic development pipeline is not as robust as people think it might be.
In September, NICE published draft guidance on the use of antibiotics for acute cough. Fundamentally this guidance indicated that doctors should recommend, where possible, non-drug treatments to patients who present with a cough. This guidance included recommendations such as the use of honey, herbal remedies such as pelargonium and cough medicines containing the antitussive dextromethorphan.
NICE also published draft guidance on the use of antibiotics for sore throat. This guidance uses clinical assessment criteria to decide whether the patients are likely to benefit from antibiotics or not, based on the probability of them having Streptococcus. In addition, the guidance contains useful information on self-management and refers to evidence that medicated lozenges can help reduce pain.
Beyond the guideline update, there has been increased surveillance on the usage of antibiotics. Dr Duerden confessed that while previously sceptical, that there is increasing evidence of a change in clinical practice. Whether looking at the overall volume of prescribing or the prescription of items such co-amoxiclav, cephalosporins and quinolones in relation to other antibiotics, Dr Duerden concluded there is now data that strongly suggest a reduction in the overall usage of antibiotics in the UK.