Everything you need to know about AMR

Last week, Dame Sally Davies, our government’s Chief Medical Advisor (at least until the end of September) released a statement that a third of antibiotics on the NHS are prescribed without being properly accounted for by the doctors that prescribe them.

I read this in a lengthy article that talked about Dame Sally Davies, ‘AMR’, ‘The 2016 O’Neil Report’, and a few other buzzwords that sparked memories of what it was like to start a new subject in school with a the teacher using words I’d never heard before.

The antimicrobial resistance story in the news has become a bit like that soap opera where if you try and explain the plot it to somebody, you get a blank stare and are eventually interrupted with ‘wait, who’s Dirty Den?’ so you have to start over.

This blog aims to deliver the basic plot and the important characters. What is AMR? Why does it matter? What can we do? Who’s Dame Sally Davies? What’s the O’Neill Report?

Jargon Buster

There are a whole lot of terms that all have pretty much the same meaning. Here’s a few you might have spotted:

• Antibiotic resistance
• Antimicrobial resistance
• AMR
• Bacterial resistance
• Drug Resistance

The above terms (with a couple of really niche differences which scientists LOVE to ruminate over) all mean pretty much the same thing. They basically talk about the case where an antibiotic (also called an antimicrobial) stops working.

What is Antimicrobial Resistance?

A lot of people aren’t really sure of the particulars of how antibiotics work, and why they stop working. So, here’s the important bits:

• Illnesses that you can catch are caused by bacteria or viruses (when people talk about germs or bugs, they’re usually talking about these)
• Antibiotics kill bacteria, but don’t do anything to viruses
• If you are given antibiotics and don’t finish taking them, sometimes the bacteria evolve so that they resist the effects of the antibiotic
• Sometimes people take antibiotics when they don’t need to, and the same thing happens
• It’s the bacteria that become resistant, not the person who takes the drug. So when someone gets a resistant infection, they can spread that resistance to other people
• When antibiotics stop working, we have to find a different type of antibiotic to use. Eventually, we’re going to run out of antibiotics that work!

How do I know if I need antibiotics?

It’s all well and good saying antibiotics work with some diseases and not others, but how do you know? Here’s a great cheat sheet for you to use – remember, antibiotics work on bacteria, but not viruses:

Caused by bacteria:

• Strep throat
• Pneumonia
• Most Ear infections
• Some of the more nasty skin infections
• Chlamydia and Gonorrhoea (AKA ‘The Clap’)

Caused by Viruses

• Cold and Flu
• Chicken Pox
• Measles
• Cold Sores
• Norovirus
• Warts
• HIV

You might notice something about the second list – a lot of the most common illnesses are caused by viruses. If you don’t know what you have, always talk with your doctor before taking antibiotics.

How has this happened?

We know what diseases need to be treated with antibiotics, and we know what causes antibiotic resistance, so why are we in such a crisis?

You might have heard the story about penicillin: the first antibiotic to be discovered. In 1928, Alexander Fleming discovered that he could kill bacteria with an extract made from fungus.

This was eventually purified, mass produced, and marketed as the first antibiotic. Unfortunately, at the time they had no idea about antibiotic resistance, and antibiotics were used for everything. And I mean everything. They were seen as a miracle drug. They were used everywhere, from the medical clinic to the farmyard – just in case.

A lot of people hold on to this idea of antibiotics as a cure-all. So even when they don’t need antibiotics, they either have a stock leftover in the cupboard or they go in to the doctor and pressure them in to prescribing antibiotics. This means antibiotic resistance spreads needlessly.

The second reason is a more recent problem that really shone a light on the issue. There are lots of different types of antibiotics, discovered by many scientists since Alexander Fleming discovered penicillin. The issue is that over the past decade or so antibiotic resistance has spread faster than these scientists can discover new antibiotics.

Here is where the real problems begin: if bacteria become resistant to all our antibiotics, then we get thrown back to what medicine looked like in the first world war: infections suddenly become a deadly problem that can’t be solved.

AMR has been happening under our noses, and we didn’t realise until it got out of hand. Like many things in life, people didn’t really accept it was such a problem until it was quantified. Who did that? Well…

Power people

Lord Jim O’Neill is a British economist who has had a very successful career in both the private sector and working for the government. In 2014, David Cameron (then prime minister) tasked Lord O’Neill with creating an independent report on the state of antimicrobial resistance and to recommend actions the UK could take to stop it.

Two years later, the final report came out, and was basically the closest thing to ‘the full story’ that had ever been written. The report talks about what AMR is, how it threatens the world, and practical solutions the UK can use to curb the problem globally.

It’s basically the bible of antibiotic resistance and what we can do to solve the problem, which means it’s pretty much impossible to talk about AMR without mentioning Lord Jim O’Neill.

Dame Sally Davies is the UK’s Chief Medical Advisor to the UK government, and has been since 2011. Additionally, she has been on the World Health Organisation’s executive board and has been leading forums for them since 2004.

In both of these roles, Dame Sally Davies has been a powerful advocate for taking measures against antibiotic resistance globally. Her position in government and her many years of medical experience mean that Dame Davies is often turned to on matters of AMR, and her voice is a key one in raising awareness and taking measures against AMR.

What Can I Do?

One of the biggest ways that we as the general public can combat AMR is education. Congratulations: you’ve read this blog and that’s the first step! When a third of antibiotics being used are unnecessary, the biggest thing you can do is make sure you aren’t in that number. Make sure your family and friends aren’t in that number, and make sure that antibiotics are only being used when they need to be used – not just anytime you’re feeling ill.

Robert Millar

ECS Committee