PM+: Pressing need for 'system change' in antibiotic use

Pharmacy 'stewardship' key to tackling antimicrobial resistance, argues EAHP's Roberto Frontini.

By Roberto Frontini

16 Jan 2015

In making a New Year appeal to the EU to redouble its efforts on antimicrobial resistance, I acknowledge the achievements already made in this area, including the innovative medicines initiative.

It is simply to state that, given the gravity of the health threat posed by antimicrobial resistance, there can be no room for complacency, and all avenues for improvement must be explored.

From the European association of hospital pharmacists' (EAHP) perspective this relates particularly to the better use of existing antibiotics.

"Given the gravity of the health threat posed by antimicrobial resistance, there can be no room for complacency, and all avenues for improvement must be explored"

Hospital pharmacy is a profession that prides itself on its expertise. When it comes to improving the use of antibiotics within hospitals we believe there is a pressing need for system change. Pharmacists should be brought to the fore in hospitals as front line fighters against antimicrobial resistance.

In very practical terms, every health system should ensure hospital pharmacists are involved in reviewing the duration of antibiotic treatment, preventing inappropriate antibiotic treatments, and educating other healthcare professionals on the restricted use of certain antibiotics.

This developing role for the pharmacy profession is known as 'antimicrobial stewardship' and could be helpfully endorsed at a European level to encourage more countries to engage in such health system change.

While we see excellent progress in some European countries, sadly, like much else in healthcare, when we look across Europe the picture appears all too patchy and uneven.

So where does the European Union fit within this? While the EU does not have direct legal competence as to how each member state runs its own healthcare system, it does have an established role in cross border health threats, promoting best practice and facilitating the exchange of professional expertise and experience.

With these roles in mind, we see a host of unrealised opportunities for the EU to help better calibrate Europe's response to antimicrobial resistance.

EU 'Joint action' programmes have been achieved in areas such as health workforce planning, health inequality and mental health. Is there not a strong case for such collaboration in the area of antimicrobial resistance?

This could include best practice sharing on establishing of antimicrobial stewardship programmes within hospitals, and leveraging information IT resources.

"Pharmacists should be brought to the fore in hospitals as front line fighters against antimicrobial resistance"

The EU's health programme has also invested heavily in projects to encourage pan-European collaboration in health promotion and health information. Should the health programme not increase the number of projects its supports to fight antimicrobial resistance?

Governments have collaborated to achieve council recommendations in areas such as patient safety, physical activity and rare diseases. Is there not also value in achieving consensus between countries on the actions required in every national system to improve antimicrobial stewardship?

Beyond the immediate priority of achieving further development of antimicrobial stewardship programmes, there is also the need to continually improve the research environment for new antibiotics, and tackle antibiotic misuse in other sectors.

The European commission's partnership with the pharmaceutical industry through innovative medicines initiative is potentially promising for the prospect of new antibiotics, but the tangible proof of this hope remains to be seen.

I consider that both the European medicines agency and European centre for disease prevention and control are responding well, with a sense of their responsibility and some helpful own initiatives.

However, there is always more to do, including improvements to clinical trials networks for antibiotic testing, and further adaptions of regulatory approval systems for new antibiotics.

Lastly, the misuse of antibiotics in other sectors such as agriculture, the veterinary sector and aquaculture has to be kept strongly in mind. Here the commission has a crucial role in breaking down silo policy thinking and ensuring all its directorate generals work closely to demonstrate a value-added EU response to the antimicrobial resistance challenge.

At the start of the new commission term, now is the time for its leaders and masters to ensure the European community's response to the antimicrobial resistance challenge is everything that it can be. Future generations are watching.