Antibiotic resistance

In 2003, the UK Department of Health's announcement of a £12 million funding package for the Hospital Pharmacy Initiative marked a major step in the development of antimicrobial stewardship (AMS), resulting in updated local antimicrobial guidelines, improved relationships between microbiology/infectious diseases and pharmacy, and greater education and training for healthcare professionals in prudent antimicrobial use (Gilchrist et al, 2015).

Vergnano et al (2020) recently described the characteristics of paediatric AMS programmes in 17 UK regional children's hospitals with paediatric intensive care and paediatric infectious diseases (PID) departments. They found that microbiology/pharmacy-led services were more likely than PID-led services – 75% vs 33% – to implement antimicrobial restriction, to focus on broad spectrum antibiotics and to review patients with positiveblood cultures.

The apparent reluctance to address the challenges of antimicrobial resistance (AMR) and AMS can hardly be attributed to lack of advance warning. For example, as Lobanovska and Pilla (2017) note, in 1940, it was shown that an E. coli strain could inactivate penicillin by producing penicillinase, by 1942, penicillin resistance was documented in four S. aureus strains recovered from hospitalised patients and by the late 1960s, more than 80% of community- and hospital-acquired strains of S. aureus were penicillin-resistant. Further, by December 2014, the O'Neill Review on Antimicrobial Resistance (2014) was predicting a global death toll of 10 million people by 2050, making AMR the biggest cause of death above cancer.