Below are extracts fro a WHO news release. Full text here:

27 February 2017 – WHO’s list of antibiotic-resistant “priority pathogens” include bacteria that pose the greatest threat to human health. The list is intended to guide and promote research and development of new antibiotics in an effort to address growing global resistance to antimicrobial medicines.

‘Dr Marie-Paule Kieny, WHO’s Assistant Director-General for Health Systems and Innovation. “Antibiotic resistance is growing, and we are fast running out of treatment options. If we leave it to market forces alone, the new antibiotics we most urgently need are not going to be developed in time.”…

‘The most critical group of all includes multidrug resistant bacteria that pose a particular threat in hospitals, nursing homes, and among patients whose care requires devices such as ventilators and blood catheters. They include Acinetobacter, Pseudomonas and various Enterobacteriaceae (including Klebsiella, E. coli, Serratia, and Proteus). They can cause severe and often deadly infections such as bloodstream infections and pneumonia.

‘These bacteria have become resistant to a large number of antibiotics, including carbapenems and third generation cephalosporins – the best available antibiotics for treating multi-drug resistant bacteria.

‘While more R&D is vital, alone, it cannot solve the problem. To address resistance, there must also be better prevention of infections and appropriate use of existing antibiotics in humans and animals, as well as rational use of any new antibiotics that are developed in future.’

Cochrane review: Support for health professionals reduces unnecessary use of antibiotics in hospitals

‘An updated Cochrane Review published 9 February has identified effective and safe ways to reduce unnecessary use of antibiotics in hospitals. Guidelines and policies that promote better targeting of antibiotics in patients who need them have the greatest impact when they are supported by the most effective ways to change doctors’ behaviour…

‘The researchers found 221 studies from the US, Europe, Asia, South America, and Australia. The interventions were aimed at healthcare professionals who prescribe antibiotics to hospital in-patients receiving acute care, and those undergoing planned surgery. The interventions broadly fell into two categories. ‘Restrictive’ techniques applied rules to make physicians prescribe properly, whilst ‘enabling’ techniques provide advice or feedback to help physicians make more informed prescribing decisions…

‘Interventions that included enabling or restrictive techniques were consistently more effective than interventions that relied on simple education alone (e.g. meetings or distribution of guidelines)…’

Comment (Neil PW): This is a useful review but it appears the vast majority of the 221 studies were conducted in high-income countries where prescribers have good access to reliable information on medicines. Globally, and especially in low and middle income countries, we know that ‘most prescribers receive most of their prescribing information from the pharmaceutical industry and in many countries this is the only information they receive.’ World Medicines Report, WHO, 2011. Also, the review looks at hospital prescribing, where access to reliable, update information is generally better than in primary health care.

It is common sense that access to reliable and approapriate information on medicines is a sine qua non for rational prescribing. Yes, there are many porescribers who have aberrant prescribing habits despite good access to information, and this is what this systematic review seems to be largely about (not the majority of prescribers, particularly in primary care in LMICs, who practise with inadequate access to information).

As other HIFA members have said frequently, ‘Context is everything’.

Best wishes, Neil

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