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RCGP backs O’Neill’s call for investment in new antimicrobials

But GPs must also contribute to patients’ appropriate expectations about antibiotics

Louise Prime

Thursday, 14 May 2015

GP leaders strongly support the call for much greater investment in developing new classes of antibiotics, made by Jim O’Neill this morning in the third report from his Review on antimicrobial resistance. But they also welcome the review team’s examination of our ‘worrying reliance’ on antibiotics, and acknowledge that GPs have a part to play in managing patients’ expectations.

The Review estimates that possibly as little as US$16bn and no more than US$37bn over ten years “could achieve a substantially revitalised pipeline of four major new breakthrough antibiotics (and a number of important ‘follow-on’ products)”. The review team argued that, as a matter of urgency, pharmaceutical companies and governments across the globe need to collaborate on creating aligned incentives to encourage the development, manufacture and provision of new antibiotics.

But they pointed out that this is just a single part of the solution, and they called for changing behaviour around the use of existing medicines. They said: “Decisive action is also needed to change the way that antibiotics are used and misused in humans, animals and the wider environment.” Over the coming year they promised further papers looking at the critical issues – the use of antibiotics in agriculture, the potential for new diagnostic technologies to improve the way that doctors prescribe, and the scope for replacing some of our antibiotics usage with alternative ways to fight infections, such as vaccines or new therapeutic approaches.

Professor Maureen Baker, chair of the Royal College of GPs, said: “It is astonishing that a new class of antibiotic has not been produced in over 25 years – and we would strongly support more investment into research to develop new antibiotics to tackle emerging diseases, so that we can keep our patients safe now and in the future. But this isn’t going to happen overnight and in the meantime, it is important that we do whatever we can to help limit the growing, global resistance to antibiotics.

“Antibiotics are effective drugs when used appropriately and they can be used to treat a wide range of medical conditions. But we have developed a worrying reliance on them and GPs face enormous pressure to prescribe them, even for minor symptoms which will get better on their own or can be treated effectively with other forms of medication. We all have a responsibility to curb this trend, and we need to work with patients to make them realise that prescribing antibiotics is not always the answer to treating illness, so that we can all benefit when we really need them.

“The RCGP has highlighted the challenge that we face through resistance to antibiotics and we have developed the TARGET antibiotics toolkit, with Public Health England, to support GPs in the appropriate prescribing of antibiotics.”

The O’Neill team proposed three targeted interventions to overhaul the global antibiotics pipeline over the next ten years:

  • Commit lump-sum payments to successful drug developers to support a viable market for the highest priority antibiotics. A global body would make payments that incentivise the development of the most needed antibiotics to combat rising drug resistance. This approach ‘de-links’ the profitability of a drug from its volume of sales: it reduces the commercial imperative for a drug company to sell new antibiotics in large quantities, which can contribute to the development and spread of drug resistance.
  • Jump start a new innovation cycle in antibiotics by getting more money into early stage research. A global antimicrobial resistance (AMR) Innovation Fund of around US$2bn over five years would help boost funding for blue-sky research into drugs and diagnostics, and get more good ideas off the ground.
  • Catalyse discoveries into new drugs by supporting the antibiotics development process throughout the R&D pipeline. Innovative partnerships at early development stages between academia and industry, public bodies facilitating clinical trials, or lowering financial and regulatory barriers to successful drug development could all play a role to catalyse antibiotic discovery.

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