‘Last Resort’ Antibiotics Pose Growing Threat to Healthcare, Report Warns

Public Health England finds use of such drugs has risen since 2010 while antibiotic-resistant infections continue to increase

The use of antibiotics of last resort has risen significantly in England during the last five years as antibiotic-resistant infections continue to grow, posing a threat to healthcare.

A report from Public Health England (PHE) said usage of antibiotics when all other treatments have failed has risen since 2010, with the use of carbapenems and piperacillin/tazobactam increasing by 36 per cent and 55 per cent, respectively, from 2010 to 2014, although the rate of increase is slowing. Both are used in intensive care, transplant or cancer units against serious infections such as pneumonia and kidney infections.

“Their use, while very small, has increased in the last few years. It’s quite challenging,” said Dr. Susan Hopkins, the healthcare epidemiologist at PHE and the report’s lead author. “We want hospitals to move away from these last resort antibiotics after two or three days of treatment to use more targeted antibiotics. There is a lot of work taking place to tackle antibiotic resistance and reducing prescriptions of antibiotics is just one strand of that work.”

Last resort antibiotics, also known as broad spectrum drugs, are effective against a wide range of bacteria, but are more likely to drive antibiotic resistance. They are used when doctors do not know what type of infections they are dealing with.

The PHE report said that overall antibiotic resistant infections continue to rise. The rate of E. coli and Klebsiella pneumoniae bloodstream infections increased by 13.5 per cent and 17.2 per cent, respectively, from 2010 to 14. E. coli can cause severe stomach cramps, vomiting and diarrhoea that may be bloody, and in serious cases can lead to kidney failure and death. Klebsiella pneumoniae causes urinary tract infections and pneumonia but can also lead to blood poisoning.

The report showed there has been a rise in the overall consumption of antibiotics through GP surgeries, although the actual number of prescriptions is falling. Between 2011 and 2014, there was a 6.5 per cent rise in total antibiotic consumption (defined as doses of antibiotics per 1,000 people per day). “This suggests that longer courses and/or higher doses of antibiotics are being prescribed in general practice,” the study said.

But use of broad-spectrum antibiotics has fallen in GP surgeries to 8.5 per cent – the drop means English GPs are the lowest prescribers of some of these drugs in the EU. For some bacteria, there have also been good results in cutting infections. Streptococcus pneumoniae infections fell by 23 per cent between 2010 and 2014, which may be related to increased pneumococcal vaccination rates.

In 2014, most antibiotics in England were prescribed in general practice (74 per cent), followed by prescribing for hospital inpatients (11 per cent), hospital outpatients (7 per cent), patients seen in dental practices (5 per cent) and patients in other community settings (3 per cent). Antibiotic prescribing to hospital inpatients increased significantly by 11.7 per cent and to hospital outpatients by 8.5 per cent between 2011 and 2014. With the exception of general dental practice, antibiotic prescribing increased across the NHS in 2014.

Health experts have warned that rising resistance to antibiotics routinely used to prevent patients from getting infections during and after surgery is disastrous. It will mean increased risk for operations such as Caesareans, hip replacements and appendix removal, and also treatment for cancer patients, who are given antibiotics because chemotherapy drugs undermine their immune system, making them vulnerable to infections.

“Antimicrobial resistance is a major threat to the delivery of healthcare across the globe,” said Dr. Mike Durkin, NHS England’s director of patient safety. “As one of the largest healthcare providers in the world, it is vital the NHS is seen to lead that fight against the global problem of antimicrobial resistance so these immensely important medicines can be preserved for now and future generations.”

Release of the PHE’s second annual report on antimicrobial resistance coincided with a World Health Organisation survey, revealing widespread public misunderstanding about antibiotics. The survey found that 64 per cent of people mistakenly believe antibiotics can cure cold and flu, when in fact antibiotics have no impact on viruses.

Nearly one-third (32 per cent) believe they should stop taking antibiotics when they feel better, rather than completing the prescribed course, and over three-quarters (76 per cent) think antibiotic resistance happens when the body becomes resistant. In fact, it is bacteria, not humans or animals, that become resistant to antibiotics.

Antibiotics in blister packs. The report shows there has been an increase in overall consumption of antibiotics through GP surgeries. (Photo: Alamy)