UK review of antibiotics use ‘will take too long’

UK Prime Minister David Cameron’s review on antibiotic use is welcome, but does not go far enough to tackle the massive healthcare issue posed by resistance to life-saving antimicrobials.

That is the conclusion of a parliamentary report which says there should be an immediate clampdown on inappropriate prescribing of antibiotics, along with measures to encourage the development of new drugs.

“Antimicrobial resistance has the potential to send medicine back to the early 20th century, severely limiting the use of what are now considered basic and routine surgical procedures,” says the Science and Technology Committee (STC) in its report.

Last week, Cameron launched an independent review to explore the economic issues surrounding antimicrobial resistance (AMR), responding to calls from the UK’s Chief Medical Officer Sally Davies for greater financial incentives for investment in antibiotics R&D at a time when most companies have abandoned the field.

While welcomed, the review is expected to take months to complete and the MPs – along with organisations representing the medical profession and pharmaceutical industry – maintain that something needs to be done right away.

Louise Leong, director of R&D policy at the Association of the British Pharmaceutical Industry (ABPI), said that while the review was welcome, it could take as long as two years before its recommendations are published.

“We agree with the Committee that this must not delay urgent work on a new economic model which could be agreed with the pharmaceutical industry sooner,” she said in a statement.

Specifically, the ABPI would like the UK to pilot alternative reimbursement models for antibiotics to encourage effective antibiotic stewardship and help drive R&D.

These could include upfront purchasing of novel antibiotics by the government, an insurance premium to help cover costs or nationally-agreed license fees that could remove local budget pressures and ensure prescribing is always based on clinical, not cost grounds.

That position is in alignment with the STC, which says in its report: “We hope that the review … will not delay work on any pricing alternatives that could be agreed with the pharmaceutical industry over a shorter timescale.”

Meanwhile, a joint statement on AMR from various Royal Colleges as well as the UK Faculty of Public Health calls for grassroots action from healthcare professionals to “take personal responsibility for enabling changes in culture around antibiotics prescribing,” as well as the incorporation of antibiotic prescribing data into national outcome measures.

Some companies are still plugging away at antibiotics R&D, but aside from some exceptions such as GlaxoSmithKline, AstraZeneca and Merck, big pharma companies are notable for their absence. A recent report from the Pew Charitable Trusts found that, of the 30 or so companies developing antibiotics today, only four are in the top 50 pharma companies by sales.

Pew paints a fairly bleak picture of the current status of antibiotic R&D, noting that there were 45 new antibiotics in development as of February 2014, including nine in Phase III testing and three at the pre-registration stage.

“Given the inevitability that some in development will fail and not be approved, it is clear that there are too few drugs in development to meet current and anticipated patient needs,” it said.

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