Day 2 :
Keynote Forum
Glenn S Tillotson
TranScrip Partners, USA
Keynote: Antibiotic resistance: The holistic viewpoint of outcomes and costs
Time : 10:00-10:30
Biography:
Glenn Tillotson has 30+ years pharmaceutical experience in early pre-clinical and clinical research, commercialization, medical affairs, scientific communications including publication planning strategic drug development, life cycle management and global launch programs. Dr Tillotson has been instrumental in the development and launch of ciprofloxacin, moxifloxacin, gemifloxacin and other antibacterials. Glenn has held several key committee positions at the American College of Chest Physicians, he is on the Scientific Steering Committee for the GTCBio. Annual Summit on Anti-infective Partnering. Currently Dr Tillotson has published >140 peer-reviewed manuscripts, presented >270 scientific posters and is on several journal Editorial Advisory Boards including the Lancet Infectious Disease, eBioMedicine and F1000
Abstract:
Antibiotic resistance is an increasing phenomenon in clinical practice with most common pathogens exhibiting one form of resistance or another. However it is the emergence of multi-drug resistant (MDR) pathogens that are grabbing the headlines. Moreover unlike cancer drugs antibiotics can save lives as has been demonstrted over the past 6 decades with pneumonia. This familiarity with antibiotics has led to a “generalization” of the class by the public. It is this conundrum which underpins the current paucity of new antibiotics being developed. The immediate clinical impact of these MDR infections is clear with the use of more drugs, longer hospital and intensive unit stays occurring widely. Moreover the financial impact of multi-drug resistant Gram negative infections has recently been analyzed. P aeruginosa was reported by Morales et al. that MDR PA infections cost 15,265 Euros compared with 4,933 for a susceptible strain of PA. This increase is particularly important when considering infections such as nosocomial pneumonia of which 30% are due to PA and of these >40% are MDR P. aeruginosa is the 3rd most common causative agent of nosocomial infections. These individualistic data should be part of the over-arching calculation for the value of new antibiotics, indeed a recent evaluation by ERG indicates the overall costs of certain infections indicate that a bigger financial and social impact is due to MDR pathogens. These data cover the totality of costs or holistic outcomes. Unfortunately these important data are not widely known nor appreciated by many stakeholders involved in drug formulation processes. As O’Neill et al. describe the critical need for new antibiotics but with the likely strict stewardship applied to new agents their use is likely to be highly controlled. This situation is a dis-incentive to pharmaceutical companies who are considering investing in this space. Although the overall numbers of MDR infections are relatively low their clinical and financial impact is escalating with costs growing beyond mere drug budgets. As we wait the O’Neil team’s recommendations being implemented it is imperative that the holistic impact of antibiotic resistance be assimilated and integrated into decision making. We need a realistic price to be assigned to new life-saving antibiotics so that essential resources will be invested
Keynote Forum
Martin Duerden
Bangor University, UK
Keynote: Antibiotic prescribing for respiratory tract infections in primary care
Time : 10:30-11:00
Biography:
Martin qualified in medicine from Newcastle University in 1982 and has worked as a GP since 1986. He obtained a Masters qualification in public health at Cambridge University in 1997. He has had a longstanding interest in applying evidence-based medicine to prescribing and therapeutics. He has previously worked for the National Prescribing Centre and the Department of Medicines Management at Keele University. From 1999 he has worked as a part-time GP in Conwy, North Wales, and initially worked as Medical Director for Conwy Local Health Board. Following the reorganisation of health services in Wales in 2009 he became Deputy then Acting Medical Director for the Health Board which manages all primary and secondary care NHS services in North Wales. He helped to organise and run the Diploma in Therapeutics at Cardiff University between 2005 and 2010. He chaired the New Medicines Group for Wales from inauguration in 2007 through to 2010. He is a Clinical Adviser on prescribing and evidence-based medicine for the Royal College of GPs, and is member of one of NICE's technology appraisal committees
Abstract:
In the UK 60% of all antibiotic prescriptions are for upper respiratory tract infections (URTIs), although for 60 - 90% of these an antibiotic will not provide resolution or symptom relief. Inappropriate prescribing contributes to antibiotic resistance (AMR), a WHO-recognised urgent issue threatening global health.We conducted an online multinational study of URTI patients in 33 countries (~500 in each). In the UK 68% of healthcare practitioner encounters for URTI in the last year were with a GP; of these 24% resulted in antibiotic prescription. Comparable rates of GP prescribing were seen in several other countries; e.g. USA (24%), Mexico (23%), and South Africa (26%), underscoring the global dimension of inappropriate prescribing. In the UK concerns around AMR have been raised by the Prime Minister and the Chief Medical Officer with forthcoming reports on antibiotic stewardship and risk-related behaviours from The National Institute for Health and Care Excellence (NICE). The Global Respiratory Infection Partnership (GRIP), a group of international experts, was established in 2011 to promote rational antibiotic use and stewardship for URTIs. Practical steps at national and local levels are urgently needed to bring about change, especially in behaviours. GRIP have created useful resources for multiple stakeholders to identify high risk patients and promote symptomatic relief for others.Despite considerable efforts, these UK data show continuing inappropriate antibiotic prescribing for URTIs, especially in primary care. Further education of GPs and patients is required. This is recognised as paramount and, based on its ‘5P’ framework, GRIP is committed to promoting non-antibiotic, symptomatic relief for self-limiting conditions.