Memorandum by The Royal Pharmaceutical
Society of Great Britain
1. The Royal Pharmaceutical Society of Great
Britain is the professional and self-regulatory body for pharmacists
in Great Britain. The Society's functions include: maintaining
the register of pharmacists and of pharmacies; regular inspection
of pharmacies to monitor standards of practice and compliance
with legal and professional requirements; accrediting undergraduate
pharmacy degree courses; ensuring fitness to practice at the point
of registration; promoting continuing education; and producing
clinical audit tools for pharmacy practice, and tools to support
uni- and multi-professional clinical governance. The Society also
produces a Code of Ethics containing standards governing the conduct
and practice of pharmacists.
2. Amongst the objects of the Society are:
To advance chemistry and pharmacy.
To promote pharmaceutical education
and the application of pharmaceutical knowledge.
Thus, we have a major interest in fighting infection,
particularly in the development and best use of medicines to combat
3. Since the House of Lords Resistance
to Antibiotics report four years ago, there has been considerable
interest in antibiotic resistance. To take stock of the position
and look forward to what is needed in the future a meeting was
held at the Royal Pharmaceutical Society on "Anti-infectives:
the way forward" in the Summer of 2002. This was organised
principally by the Institute of Biology and the Royal Pharmaceutical
Society of Great Britain, but with assistance of a number of learned
societies within the Affiliated Societies together with the Department
of Health and Medical Research Council.
4. As a result of the meeting certain observations,
predictions for the future and suggested actions were developed.
These are given below and are offered in evidence to the Committee.
5. At the moment:
There are 5,000 deaths per annum
in the UK from infectious diseases contracted in hospitals.
There has been no completely new
class of antibacterials developed in the last 30 years.
Virtually all major pharmaceutical
antibiotic research has moved out of the UK.
New antibiotics take in excess of
12 years to bring to market at an approximate cost of £250
Any new antibiotics would be promoted
for use by companies seeking to recover development costs, which
is counter to the desire to limit their use to treat resistant
In many countries, antibiotic availability
and use is so indiscriminate that resistance is a serious burden
6. Importantly in 2002 we are aware of these
Parliamentarians understand how important
these issues are, and in 1998 the House of Lords published a report
on antibiotic resistance.
Antibiotic use as prophylactics in
agriculture is declining, with application as growth promoters
negligible in the UK.
We have the necessary scientific
and medical expertise to prevent the future scenario envisaged.
7. The bad news is that:
In 1969 the Swann Committee recommended
that Government address resistance, but the Expert Advisory Committee
on Antimicrobial Resistance recommended by Swann was only set
up in 2001.
Little progress has been made implementing
recommendations of the House of Lords Report issued in 1998.
Continuation of the national surveillance
system currently provided by the PHLS is in doubt.
8. If the situation remains unaltered, then
within the next couple of decades:
There will be more strains of bacteria
resistant to all antibiotics in our communities and within many
hospitals in the UK.
There will be strains of bacteria
resistant to some antibiotics in all hospitals in the UK.
Reliable surveillance data on the
various antibiotic-resistant strains of bacteria in either our
hospitals or local communities will not be available.
Numbers of intensive care patients
will rise (costing £1,000-£1,800 per patient per day),
resulting in a commensurate increase in NHS costs.
A marked increase in the number of
deaths per annum from infectious diseases will occur in the UK.
It is unlikely that effective new
antibiotics will be available to tackle the problem.
There will be few medical microbiology
specialists being trained at degree level, and new doctors will
have only a rudimentary grasp of infectious disease.
The UK will have returned to the
pre-antibiotic era and average life span will significantly decrease.
9. To prevent this future scenario, decisive
action is urgently required.
The UK must:
Ensure that the recently published
UK Antimicrobial Resistance Strategy and Action Plan is actively
adopted by all stakeholder departments and agencies. The Interdepartmental
Steering Group, and the recently established Expert Advisory Committee
on Antimicrobial Resistance, must continue to press for widespread
acceptance of the strategy.
Develop a cross-departmental co-ordinated
funding programme, involving charities and industry as appropriate,
to stimulate efforts in antibiotic research, to facilitate effective
long-term surveillance of antibiotic resistance, and to tackle
the growth of hospital-acquired infections.
Increase funding for academic research
focussed on development of new therapeutics.
Provide a more favourable climate
for pharmaceutical companies to develop new antibiotics by extending
market exclusivity for these beyond the current 20 years from
patent registration, through changes to patent legislation, to
provide patent rights running 20 years from marketing.
Ensure that foreign policy champions
best practice for antibiotic use overseas, particularly in Europe,
with new products being given EU-wide licences.
Require literature and advice at
school level to encourage pupils to pursue careers in pharmaceutical
science and medical microbiology and related professions. Government
Departments should liaise with learned societies to this end.
Revise medical and veterinary curricula
to reflect the significance of infectious disease and the appropriate
use of antibiotics.
10. The science behind the above evidence
was presented at the meeting and is contained in the enclosed
book of Abstracts of the presentations which also gives key, relevant
references from the scientific literature in support of the evidence