We need antibiotics that work

In the first of a series of blogs to mark World Antibiotic Awareness Week, the Deputy Chief Pharmaceutical Officer and NHS England’s Healthcare Acquired Infection and Antimicrobial Resistance Lead outline the changes they are making:

Dr Bruce Warner: Antibiotics have become a fundamental tool in a pharmacist’s armoury for treating disease, but one that we have started to take for granted.

Pharmacists are often the final point of contact a patient has with the health service before they take their medicines and, as such, they have a professional and ethical responsibility to ensure that patients get the very best possible outcomes from their medicines. And that includes preserving their effectiveness for the future.

The threat of antimicrobial resistance has made the importance of the interaction that pharmacy staff have with their patients all the more poignant. Patients need reassurance, advice, empathy and understanding if they are to feel confident to use antibiotics appropriately and in the best possible way to both get the outcomes they are looking for and preserve the effectiveness of antibiotics for future generations.

I see that as a fundamental role of pharmacy staff and will be working to ensure that pharmacists and pharmacy staff have the knowledge, skills and confidence to have those conversations with patients and prescribers.

By working with educators and practitioners to promote the principles of medicines optimisation and ensure that those conversations become part of routine practice, we will put pharmacists at the centre of the fight against antimicrobial resistance.

Elizabeth Beech: As healthcare professionals we are now well aware that antimicrobial resistance is a real and serious national and global problem.

We know better stewardship of our antimicrobials is required, and changing our behaviours associated with the use of antibiotics is essential.

Around 80% of antibiotic consumption is prescribed in primary care, and at least half of this is for respiratory infections, many of which are self-limiting. But patients who are feeling ill want to get better fast, and think antibiotics will help this happen. So how do healthcare professionals balance these demands?

A recent report from the Wellcome Trust has led me to reflect on my practice, and has changed the way I communicate messages about antimicrobial resistance. This report suggests:

  • ‘antimicrobial resistance’ means nothing to patients and the public;
  • the concept is very hard to grasp, and
  • nearly everyone assumes it’s the person, not the bacteria, becoming resistant.

It also suggests people do not understand, or care about, the big, global implications – but they do care about themselves, their families, and the personal implications of using antibiotics. They also feel unwell, and see antibiotics as proof they are ill.

As a result, I have changed my communication behaviour to use different words and messages, such as:

  • ‘Antibiotic resistant infections are increasing, and may affect you when you need an operation or have a urinary infection’.
  • ‘Antibiotics can harm the good bacteria in your gut, so protect yourself and your good gut bacteria and do not use antibiotics unless your doctor or healthcare professional tells you they are really needed’.
  • ‘You can feel quite ill when you have an infection like a cough, but antibiotics often do not help you feel better any faster, do not work at all for viral infections, and may harm your gut bacteria’.

So while I have not changed the core messages, I have thought more carefully about how I communicate those messages.

You can find out more at:

Dr Bruce Warner

Dr Bruce Warner, Deputy Chief Pharmaceutical Officer for England, works closely with the Chief Pharmaceutical Officer on the strategic and operational development of medicines policy for NHS England.

Prior to this post, Bruce worked as Deputy Director of Patient Safety at the National Patient Safety Agency (NPSA) and in NHS England where he led on the strategy for patient safety improvement and headed up the patient safety advice and guidance function.

Bruce has worked in most sectors of pharmacy including community, hospital, academia and at a PCG/T. He is also a visiting Professor of Pharmacy Practice at the University of Huddersfield.

Elizabeth Beech

Elizabeth Beech is a National Project Lead for Healthcare Acquired Infections and Antimicrobial Resistance at NHS England, and also works as a pharmacist for NHS Bath and North East Somerset Clinical Commissioning Group, where she has been based since 2007.

She qualified from Aston University and trained as a junior pharmacist at St Mary’s Hospital Paddington before continuing to work in a variety of roles within the NHS. She has worked as a Regional Clinical Pharmacist with the North Thames Regional Health Authority, as an academic teacher/practitioner and health services researcher at London University, and established an academic research and development support unit in Swindon on behalf of the South West Strategic Health Authority.