Home' Australian Pharmacist : Australian Pharmacist October 2016 Contents COVER
What about solutions?
While the problems of AMR are well documented, the question
now is how governments and communities worldwide tackle it?
In first part of his report, Lord O'Neill outlined steps to reduce
demand for antimicrobials. These included a global public
awareness campaign, improved hygiene and reducing
unnecessary use of antimicrobials in agriculture.
He also recommended developing rapid diagnostic to cut
unnecessary use of antibiotics. He said it was unacceptable that
the technology used to inform the prescribing of medicines
such as antibiotics had not 'evolved substantially in more than
His recommendation was that by 2020 it should be mandatory
for a rapid diagnostic test be completed to prove whether the
infection is bacterial before antibiotics were prescribed.
Lord O'Neill also recommended the development and use of
vaccines and alternatives to prevent infections and reduce the
need for antimicrobials.
At the community level, one way is to promote better use
In Australia, NPS MedicineWise has been running campaigns
with doctors and consumers for years to get the message across
that antibiotics may not be the answer to the patient's problem.
In 2015 it ran consumer campaigns on bill boards promoting
good hygiene and the message that colds and flu can be
managed without antibiotics.
In 2015, PSA and the Royal Pharmaceutical Society (UK)
sponsored a proposal which was adopted by the International
Pharmaceutical Federation (FIP) to develop a briefing document
on the role of pharmacists in AMR, The document would aim to
prompt action on the issue of antibiotics and AMR, and serve
as a foundation for future work within FIP on AMR -- including a
revision of the FIP statement on AMR.
AMR and responsible use of antimicrobials was also discussed at
a stakeholder roundtable held before the FIP Congress in Buenos
Aires last month.
Responding to the AURA Report, PSA National President Joe
Demarte said pharmacists could play a fundamental role in
antimicrobial stewardship in Australia and the pharmacy
profession in partnership with the Federal Government,
other health practitioners and consumers, should make an
effective and sustained contribution to a national response to
He said advice about the use of antibiotics had to be given to
consumers, in addition to antibiotic awareness weeks and other
'Pharmacists can give the proper counselling for these health
problems, ensuring that patients have a good understanding of
their illness and realistic expectations of its progression.
Priming the pipeline
The second part of the O'Neill report highlighted the need to
increase the number of effective antimicrobial drugs to treat
infections that have become resistant to existing medicines.
However, he also pointed out that there was insufficient
private and public investment in research and development
focused on tackling AMR. To support early-stage research,
he proposed a Global Innovation Fund endowed with up to
two billion US dollars over five years.
The O'Neill report recognised that progress had already
happened during the lifetime of the Review, including the
UK and China's nascent Innovation Fund focused on AMR,
stepped up efforts in the US via the Biomedical Advanced
Research and Development Authority (BARDA), and in
Europe via the Innovative Medicines Initiative (IMI) and Joint
Programming Initiative for AMR (JPI-AMR) programs. Also, the
US National Action Plan on Combatting Antibiotic-Resistant
Bacteria was launched in August.
According to the PEW Charitable Trusts there are presently 37
antibiotics at various stages of clinical development.
In Australia quite a few academic groups are researching
potential new antibiotics.
One such group, at the University of Queensland (UQ)
Institute of Molecular Biology Community for Open
Antimicrobial Drug Discovery (CO-ADD) researchers has
devised a creative way to access compounds in an attempt to
develop a 'collaborative' pipeline of new antibiotic candidates.
The group is 'mining' the huge number of existing compounds
from around the world that have been created by researchers,
made for a variety of different reasons but never tested
for antimicrobial activity. With funding from the Wellcome
Trust and support from UQ, Co-ADD has set out to test these
forgotten compounds for potential antibiotic candidates.
CO-ADD Program Coordinator, Mark Blaskovich told Australian
Pharmacist that most of the new antibiotics in the pipeline
were refinements of existing antibiotics.
He said that of the approximately 40 new antibiotics in the
development pipeline only 10-15 were completely novel
Another emerging issue is that most of these new compounds
are for Gram positive (G+) bacteria with few candidates for
extremely drug resistant Gram negative (G-) bacteria.
Dr Blaskovich said that because of the attrition rate in clinical
developments it was quite likely a significant number of those
were going to fail during the clinical trial program.
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