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#WHFEvents: AMR

On the 24th January 2023, during a debate hosted by the Westminster Health Forum and chaired by Fleur Anderson MP (above) a number of uncomfortable issues were brought to light by the panel of experts. Dental Review explores some of them.

Globally, it is estimated that 1 in 5 healthcare facilities has no running water and 1 in 10 has no proper sanitation. As a result, pathogenic infections are rife and have to be treated with antibiotics, which in turn drives the development of antimicrobial resistant (AMR) diseases. In 2016 a report predicted that, as a result, by 2050 global AMR infections will overtake cancer as the cause of death, estimating over 10 million deaths per annum.

Currently the UK and Western Europe joins Canada and the USA at the lower end of such infections. The map (top) created by the University of Oxford showed where the 1.2 million people killed by AMRs during 2019 are most densely concentrated. The darker the colour the greater the concentration. But we can’t afford to be complacent. There is a growing global trend and we are part of it.

COVID demonstrated just how quickly and easily a local problem can become a worldwide pandemic. But COVID itself is a virus which can’t be treated with antibiotics, a fact of which a surprising number of people in the western world aren’t aware. On 17th November 2022, the eve of European Antibiotics Awareness Day (EAAD), a pan-European survey on antimicrobial resistance shows that half of Europeans still incorrectly believe that antibiotics kill viruses (1)

A spokesperson said: “At the same time, 23 % of respondents have taken antibiotics over the past year, the lowest figure since 2009 and clearly showing that the work of Member States and the Commission to help raise awareness among citizens on the risks of excessive use of antibiotics is paying off. Much more however needs to be done.

“Antimicrobial resistance is posing one of the greatest risks to human health and is one of the top three health threats identified by the Commission’s Health Emergency Preparedness and Response Authority (HERA) that require coordination measures at EU level.

“New data published in the 17th November report by the European Centre for Disease Prevention and Control (ECDC) estimates that, throughout the European Union, Iceland, and Norway, more than 35,000 people die each year due to antibiotic-resistant infections. Such infections cause an additional €1.5 billion in healthcare costs and productivity losses in the EU.”

The new Global Research on Antimicrobial Resistance (Gram) report estimated deaths linked to 23 pathogens and 88 pathogen-drug combinations across 204 countries and territories in 2019.

In a report published by The Lancet and quoted in The Guardian in January 2022, it was estimated: “In high-income countries, AMR led directly to 13 deaths per 100,000 and was associated with 56 deaths per 100,000. In the western Europe region, which includes the UK, more than 51,000 people died as a direct result of AMR.” More than are dying from HIV/AIDS.

Currently the only way to combat this trend is through effective stewardship and the judicious use of antibiotics (latest estimates show that dentists are responsible for 4% of antibiotic prescriptions in the UK). Prevention is better than cure and it is advised that we can reduce the incidence of infection through effective hygiene and sanitation.

That might prove difficult when there is no running water or toilet facilities.

UK One health has a five-year plan (2019 to 2024) to reduce the incidence of drug resistant pathogens by 10%. Late last year to help aid this initiative the UKHSA Target AMR Toolkit (2) was established online to help healthcare professionals better advise patients, manage their expectations, and continue as they always have in the best interests of the population’s health.

However, it was thought that the problem has causes beyond primary care. The leverage points across the system included economics, culture (including diet), businesses, media influencers, consumers, pollutants, and policy makers. Water companies discharging raw sewage into the UK waterways could have become a factor.

In November 2022 it was estimated that water companies in the UK had discharged sewage more than 9,200 times during the previous 12 months, and were also accused of discharging sewage when there had been no rain more than 160 times – something they are not legally allowed to do.

It was explained that primary healthcare could help alleviate the AMR problem by helping the population make the best use of NHS resources. For example, the panel believed that the widely reported Strep-A infection in children could have been handled much better.

It was thought that a universal code for infections – clearly highlighting those that need antibiotics and those that don’t – would help busy GPs and junior doctors – who usually prescribe in hospitals – make more informed decisions.

There is another problem. Currently in the UK we lack qualified microbial consultants. Some 20% of the consultant posts in the UK remain unfilled. If we take into account the predicted rise in demand there remains an obvious need to expand the employment base of qualified specialists and use results of microbiological investigations to drive treatments and review medications.

Bacteriology still depends on 19th Century technology, which means growing bacteria cultures on nutritious agar jelly in order to identify the infection. It was asked why such an important health issue does not yet have access to the kinds of AI diagnosis tools available to dentists for orthodontics and radiographic analysis? How can we bring micro-bacteriology into the 21st Century when it has yet to reach the 20th?

It was concluded that microbiology laboratories are data rich but information and knowledge poor. There is an urgent need for modern machine learning including convolutional deep neural networks to examine mutations relevant to antimicrobial resistance, plus a need to show healthcare professionals the impact of their antibiotic prescription activities – without which it was said – there can be no learning.


1) Eurobarometer survey: only 1 in 2 respondents know that antibiotics are not effective against viruses: link https://ec.europa.eu/commission/presscorner/detail/%20en/ip_22_6951 (accessed 27.01.2022)

2) https://elearning.rcgp.org.uk/course/view.php?id=553 (accessed 27-01-2023)

See the original article here: Dental Industry Review