Select Committee on Science and Technology Seventh Report


A major threat

  12.1     This enquiry has been an alarming experience, which leaves us convinced that resistance to antibiotics and other anti-infective agents constitutes a major threat to public health, and ought to be recognised as such more widely than it is at present (see above, paragraph 11.1).

Prudent use in human medicine

  12.2     With a view to encouraging more prudent use of antimicrobials, health authorities should step up continuing professional development of doctors in the area of prescribing, especially by prescribing audit and feedback; by educational outreach; and, for GPs, by education in communication skills and other ways to avoid prescribing on demand (paragraphs 11.7 and 11.12).

  12.3     The Government and the health authorities must do more to educate the public about the proper use of antimicrobials. In particular, we recommend a campaign targeted at mothers of young children. Nothing must be done to deter people from visiting their GP promptly, or from taking their medicine when necessary; but the evidence that unnecessary antibiotics not only have public health consequences, but also increase the risk to the individual patient that any subsequent infection will involve a more resistant strain, should be presented to the public (paragraphs 11.13-14).

  12.4     We also recommend that—

      (i)  The Education Committee of the General Medical Council and the medical Royal Colleges should review the evidence that undergraduate curricula give insufficient emphasis to infectious diseases and antimicrobial therapy, and the Royal Colleges should increase the attention paid to antimicrobial therapy in their programmes of postgraduate education and vocational training (paragraph 11.6);

      (ii)  Industry and the grant-giving bodies should give priority to work on rapid affordable systems for diagnosis and susceptibility testing; where promising developments emerge, they should be quick to move them towards the market (paragraph 11.8);

      (iii)  The Medicines Control Agency should consider whether the drug licensing system could be used more effectively to encourage prudent use in the interest of public health (paragraph 11.9);

      (iv)  The Government and the ABPI must maintain their firm stand against over-the-counter antibiotics. The Government should engage in active diplomacy to ensure that, should the issue be raised in the EU Council of Ministers, their position is understood and their allies are in place; and, in the long term, to induce those Member States which are currently more relaxed about over-the-counter antibiotics to introduce more controls (paragraph 11.11);

      (v)  The NHS should work with the relevant professional bodies to see that courses of antibiotics are defined according to the best available current information (paragraph 11.15);

      (vi)  While the new guidelines from the Department of Health, recommending more rapid diagnostic tests and more stringent infection control in cases of suspected MDR-TB, are welcome, the Department must find the necessary resources (paragraph 11.16);

      (vii)  Those responsible for the NHS Information Technology Strategy should consider the contrast between the excellent data on GP prescribing, captured by both the Prescription Pricing Authorities and GPs themselves, and the lack of data on antimicrobial use in hospitals. All hospitals should install computer systems for patient-specific prescribing information at ward level (paragraph 11.17);

and we commend the work of the WHO, through its Division of Emerging and other Communicable Diseases Surveillance and Control, to equip professionals and regulators in the developing world to respond appropriately to pharmaceutical promotions (paragraph 11.10).

Prudent use in animals

  12.5     There is a continuing threat to human health from imprudent use of antibiotics in animals (paragraph 11.18).

  12.6     Antibiotic growth promoters such as virginiamycin, which belong to classes of antimicrobial agent used (or proposed to be used) in man and are therefore most likely to contribute to resistance in human medicine, should be phased out, preferably by voluntary agreement between the professions and industries concerned, but by legislation if necessary (paragraph 11.20).

  12.7     The veterinary profession must address the problem of over-use of fluoroquinolones and other potent agents of importance to human medicine by introducing rapidly a Code of Practice on when and how such compounds should be prescribed (paragraph 11.21).

  12.8     We also recommend that—

      (i)  MAFF and the new Food Standards Agency should consider the need to improve surveillance of resistance patterns in animals (paragraph 11.22);

      (ii)  Departmental and Agency boundaries must not be allowed to prevent the Government from getting a grip on the whole of the issue of resistance, in the interests of public health. A single multi-disciplinary Government committee to oversee all aspects of antibiotic use, as recommended by the Swann report, should now be established (paragraph 11.23);

      (iii)  MAFF should consider the evidence of Dr Coles which suggests that resistance in worms and scab pose a threat to the British sheep farming industry (paragraph 11.24).

Infection control

  12.9     Purchasers and commissioning agencies for hospital services should put infection control and basic hygiene where they belong, at the heart of good hospital management and practice, and should redirect resources accordingly; such a policy will pay for itself quite quickly. The NHS Executive should assure themselves that every NHS hospital is covered by a properly trained infection control team, as recommended in the Cooke Report (paragraph 11.26).

  12.10     The NHS should set itself targets for controlling MRSA in hospitals, and publish its achievements (paragraph 11.27).

  12.11     The NHS should draw up national standards and guidelines for community infection control management, along the lines of the Cooke Report for hospitals. These should include a requirement that every district health authority should have at least one community infection control nurse (paragraph 11.28).

  12.12     Those responsible for the review of the Public Health (Control of Disease) Act 1984 should consider Dr Mayon-White's evidence as to shortcomings of the provisions for compulsory medical examination and detention in hospital, and the case for a more humane regime, and for extending the legislation to provide also for supervised treatment at home (paragraph 11.29).


  12.13     The Government should engage constructively with the efforts of the BSAC and the PHLS to put resistance surveillance on a more strategic and comprehensive footing, and should find additional resources. NHS Trusts and universities should examine their priorities in the resourcing of their microbiological laboratories (paragraph 11.37).

  12.14     The Department of Health must reconsider the cuts in the Departmental subvention for the PHLS (paragraph 11.32).

  12.15     We also recommend that—

      (i)  The NHS R&D Directorate should support microbiological surveillance among the population at large, with a view to improving denominator information, as a legitimate call on the NHS R&D Budget. The MRC and the medical charities should also be prepared to support such work (paragraph 11.31);

      (ii)  Those responsible for the review of the notification provisions of the 1984 Act should consider the proposals of our witnesses for reporting of diseases by causative organism, and for mandatory reporting of certain resistances. The NHS must face the resource implications of any increase in the burden of reporting placed on hospital laboratories; and the level of feedback from the PHLS must be correspondingly improved (paragraph 11.33);

      (iii)  Health Ministers should set a deadline for full compatibility of definitions and data-collection between the PHLS and its analogues in Scotland and Northern Ireland (paragraph 11.34);

      (iv)  Those responsible for the NHS Information Technology Strategy should consider the scope for IT to facilitate surveillance (paragraph 11.35);

      (v)  The NHS should examine the ICARE Project run by the US Centers for Communicable Disease Control and Prevention (CDC), and consider the possibility of setting up something similar, possibly in partnership with CDC (paragraph 11.36);

      (vi)  The failure of clinical academic microbiology to attract recruits and fill senior posts must be addressed by the NHS, the HEFCs and the heads of medical schools. This seems to be a special case of a more general problem concerning the pressures placed on clinical academic medicine by the conflicting demands of the Research Assessment Exercise and the ever-growing burdens of teaching, service provision and administration; we have expressed concern about this before, and we do so again (paragraph 11.38).

New drug development

  12.16     The Government should respond positively to the EU proposal for an "orphan drug" regime, and should seek to ensure that the scheme gives the pharmaceutical industry a real incentive to work on novel treatments for problem diseases, particularly diseases of the world's poor such as malaria (paragraph 11.40).


  12.17     We commend the establishment of the Edward Jenner Institute. The numerous agencies committed to research into effective vaccines must keep up the good work (paragraph 11.41).

Antiviral drugs

  12.18     As new antivirals reach the market, the NHS must ensure that they are used prudently from the start, and that changes in susceptibility are monitored (paragraph 11.42). The PHLS reference laboratory for antiviral resistance must be adequately resourced (paragraph 11.43).


  12.19     The Government's exemplary support for the WHO Division of Emerging Diseases should be maintained, and the United Kingdom Government's example should encourage other nations and agencies to contribute to this vital work. We endorse the resolution on this subject which is to be considered by the World Health Assembly in May; we hope that the Assembly will pass it. The United Kingdom's good record of support for malaria research, and for the efforts of the WHO to help poor countries to combat this disease, must be maintained by the Government and the grant-awarding bodies (paragraphs 11.45-46).

Resources for research and data-collection

  12.20     Grant-awarding bodies and the NHS Executive should reconsider the important public health issues surrounding antimicrobial research and give such research an enhanced priority. This is a particularly suitable area of activity for the NHS R&D Strategy. We challenge the research community to come forward with proposals for antimicrobial research which will fully justify support from the grant-awarding bodies (paragraphs 11.48-49).

Information technology

  12.21     The NHS Executive must work towards the goal of compatible and interconnected IT for every GP, every hospital ward and infection control team, and every clinical microbiology laboratory. They must accept the considerable cost involved; and they must give a strong lead from the centre to ensure compatibility (paragraph 11.51).

A national strategy

  12.22     The Government should develop a strategy to safeguard the effectiveness of antimicrobials along the lines recommended in this report; they should back it with resources; and they should set themselves and the Health Services challenging targets for real improvement (paragraph 11.54).

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