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Antimicrobial resistance:A growing threat to public health, warn pharmacists

By Irish Pharmacist - 02nd Dec 2023

From left: Researchers Dr Rob Elmes and Luke Brennan. Image: Maynooth University

The overuse and misuse of antibiotics is a continuing concern; meanwhile researchers at
Maynooth University have created a new molecule to kill bacteria that have developed resistance

The continued overuse and misuse of antibiotics in Ireland, and globally, is a continuing concern to health, Irish pharmacists have warned. According to the Irish Pharmacy Union (IPU) the risks of antimicrobial resistance are significant and, while awareness of the issue is growing, more needs to be done to support more prudent use of antibiotics.

Dr Susan O’Dwyer, Head of Professional Services at the IPU, said: “Antibiotics remain among the most important medicines in modern healthcare and have saved countless lives. However, we must recognise that their ability to do so in the future will be diminished if misuse and overuse is not addressed.

“The dangers of antimicrobial resistance are now well established and in Ireland growing numbers of bacteria are becoming more resistant to antimicrobials. It is incumbent upon everyone, both healthcare providers and patients, to play their part in reducing the impacts of resistance. The warning is very real and failure to act poses a real threat to public health.”

Highlighting a common misconception, Dr O’Dwyer cautioned against self-prescribing, or reusing leftover antibiotics from previous illnesses. “In our pharmacies we will sometimes hear patients referring to having some antibiotics from a previous infection that they can take. This is never a good idea. You should only take medications prescribed for you for a particular ailment. Follow the instructions exactly, and complete the course of your medication as directed.”

Dr O’Dwyer concluded by reminding patients that antibiotics have no impact on many common winter bugs. “As we enter the winter coughs and colds season it is important to remember that antibiotics will not provide any benefit to sufferers of Covid-19, flu, or the common cold.”

Key advice

In the community, many infections can be prevented through hand hygiene, vaccination, and other measures such as respiratory etiquette and physical distancing, potentially resulting in a decreased need for antibiotics;

Antibiotics are not effective against infections caused by viruses such as Covid-19, common colds, or influenza. They should only be used to treat bacterial infections;

Antibiotics do not work like painkillers, and cannot relieve headaches, aches, pains or fevers. Taking antibiotics for the wrong reasons will not aid recovery, and may even cause side-effects such as diarrhoea, nausea, or skin rashes;

If a healthcare professional confirms that antibiotics are necessary, take them exactly as prescribed (at the correct dose and intervals), and finish the full course even if you are feeling better;

Do not save antibiotics for later use or share them with others;

Avail of vaccines for conditions such as flu, Covid-19, and pneumococcal disease at your local pharmacy.

Meanwhile, a study which was published in the journal Chem recently, has demonstrated, for the first time, the use of table salt to cause cell death in bacteria. Researchers at Maynooth University were part of an international study that created a new molecule to kill bacteria that have developed AMR.

“We are discovering new molecules and looking at how they bind to anions, which are negatively charged chemicals that are extremely important in the context of the biochemistry of life,” explained lead researcher Luke Brennan of Maynooth University. “We are laying the fundamental foundations that could prove useful in combatting various diseases from cancer to cystic fibrosis.

“This work shows how using our approach, a sort of ‘Trojan horse’ that causes an influx of salt into cells, we can effectively kill resistant bacteria in a way that counteracts known methods of bacterial resistance,” added co-author Dr Rob Elmes of Maynooth University.

“These synthetic molecules bind to chloride ions and wrap it up in a ‘fatty blanket’ that allows it to easily dissolve in the bacteria’s membranes, bringing the ions along for the ride and disrupting the normal ionic balance. The work is a great example of foundation knowledge in chemistry fundamentals impacting on unmet needs in human health research.”

Earlier this year, a researcher Dr Stephen Cochrane of Queen’s University Belfast bagged €1.5million in funding for a project that aims to discover and develop new antibiotics that can kill drug-resistant ‘superbugs’. Months later, a global team of scientists led by Prof Martin Caffrey of Trinity College Dublin created a molecular blueprint of a key enzyme found in bacteria that may help chemists create new drugs that can suppress disease-causing bacteria.

Separately, the European Federation of Pharmaceutical Industries and Associations (EFPIA) has emphasised the severe threat posed by antimicrobial resistance to EU and global public health. Confronting this complex challenge requires a comprehensive approach, encompassing enhanced surveillance, prudent use, preventive measures, and the development of essential antimicrobials crucial for combating antibiotic-resistant infections.

New antimicrobials

Among the array of measures, new antimicrobials are expected to deliver substantial benefits to European patients, healthcare systems and society as a whole, as well as cost savings for member states. While the development of novel antimicrobials remains central to our battle against AMR, the World Health Organisation acknowledges that “the clinical pipeline and the recently approved antibacterial agents are insufficient to tackle the challenge of increasing emergence and spread of antimicrobial resistance”.

The ongoing revision of the EU general pharmaceutical legislation underscores the significance of this issue, and we are encouraged by the constructive debates within the European Parliament on the most effective means to incentivise the research and development of novel antimicrobials. Recent analysis by the Centre for Global Development found that the new EU antimicrobial incentive program would save 20,000 lives and deliver $15.5billion in total benefits, with a return on investment of 4:1 over the next 10 years.

In light of various proposed solutions, we emphasise the importance of implementing an incentive model that entails a sufficiently large incentive promoting sustainable innovation, aligned with the EU’s contribution or fair share of the necessary global incentive, delinked from revenue, and aligned with stewardship. It is crucial that any proposed model is both feasible and implementable within the EU legal framework, avoiding further delays in action. In this regard, the introduction of transferable exclusivity vouchers (TEV) would play a crucial role in reducing the burden and cost of AMR through the development of new antimicrobials. The pharmaceutical legislation holds the potential to shape the future of EU actions against AMR, and EFPIA stands ready to contribute to this effort. Together, we can effectively address the looming threat of AMR and safeguard the health of current and future generations.

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