The First Annual European Antibiotic Awareness Day 

The Science Museum, London

Tuesday 18 November 2008



This was the first European Antibiotic Awareness Day, hosted in the United Kingdom, and was one of a series of events held across the European Community to bring to the attention of the public the importance of antibiotics in medicine.


Roger Finch, Chair, Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infections (ARHAI), chaired the event and explained that there had to be awareness amongst health professionals and the public on the importance of antibiotics in medicine, and the inappropriate use of these drugs posing a serious threat to the way we can deliver treatments in the future.


MRSA Action UK were pleased to have been invited to attend this conference because as an organisation that supports those who have been affected by healthcare infections we know only to well the devastation that these infections leave behind. We are aware however of the importance of information being given to the public about the proper and correct use of antibiotics to fight infections. MRSA Action UK believes that antibiotics were the single most important discovery in the history of medical science and no other discovery in this field has had the greatest positive impact. They were considered miracle drugs. Over the years they have saved millions of lives, not only by killing bacteria that cause some of the worst infectious diseases in man and animals, but by opening up new types of treatments that would be impossible without them.


We are reminded that the advisory Committee on the Microbiological Safety on Food (ACMSF) advised the UK government in 1999 that much of our modern medicine depends heavily upon the control of infection with antibiotics, and if this were to become largely ineffective it would have calamitous consequences for medical science.


The Health Minister Ann Keen MP was the first speaker and gave support to the conference's aims and objectives in raising awareness. The Minister spoke about the importance of Alexander Fleming's discovery and how it had opened up new types of treatments that not that long ago were only dreamed about. The Minister was conscious that the key to better understanding was information and awareness of the importance of this valuable resource to medicine. The Minister spoke about the need for people and groups to work together as a team and that in Brussels they were having a Television awareness campaign to raise the public's awareness. This is something we as a Charity have been campaigning for some time and would like to see this adopted in this country.


The Minister also thought that to raise the awareness of the importance of antibiotics, we have to include children. Again our Charity has said that we have to preserve our current supply of antibiotics for future generations, because they are the ones who will pay the heaviest price for inaction on this subject. There has been a poster campaign in relation to raising the awareness of antibiotics within our schools and the Minister was there also to make an award to the best poster.


There were many presentations given during the day on the importance of the use of antibiotics, and the real theme of the day was called "Myth busting". This was aimed at really getting to the point of what is true and what is false in relation to antibiotics.


The first presenter Alan Johnson from the Health Protection Agency spoke about antibiotic resistance and that this was nothing new. In fact resistance to antibiotics has been around for some 60 years. It is difficult to conceive that in 1952 virtually all infections caused by staphylococcus could be cured by penicillin. But by 1982 a worrying 90% of patients infected with the staphylococcus bug needed treatment with other antibiotics. Penicillin - the best known, cheapest and most widely available antibiotic in the world - no longer worked against staphylococcus. Doctors didn't worry about this because they had other antibiotics to prescribe; the medical profession assumed that it could always stay one step ahead of the bugs in developing new and better antibiotics but that Pharmaceutical companies have not been developing newer antibiotics as quickly. The medical profession had seemed to have lost the concept of "Darwin's Theory" that is "survival of the fittest". The speaker agreed that there had to be a major drive to educate the public and the medical profession to prescribe antibiotics prudently and that we had to use this finite resource correctly and avoid unnecessary use of antibiotics.


Professor Andrew Pearson from the Health Protection Agency spoke about the comparisons of surveillance around the world.  The Professor explained that 10% of patients admitted to hospital catch an infection. The American approach is the drive to save 5 million lives and we should look at this in a proper perspective in that "Someone is not a number - Soon is not a time".  What drew the attention to all of this with regard to healthcare infections were mortality rates, and that our mandatory reporting of MRSA bactereamias has driven down the numbers contracting bloodstream infections.


In the USA they are to fine hospitals who fail to control infections in their establishments and this has started to happen, with some effect.  One of the questions raised was why does the surveillance show that men are more susceptible to MRSA than women. One of the reasons that this could be happening is that men are catheterised more than woman in hospital.


The Professor said that C-diff is more complicated to tackle with a 50/50 breakdown of infections. There are now problems with C-diff within the community that we must now look to taking action on. There was good evidence from the USA about data monitoring with regard to antibiotics and that real-time data is the key. Only three hospitals in the UK strictly monitor antibiotic usage, while in the USA the number is 400.


David Livermore from the Health Protection Agency spoke, dispelling the myth that we are running out of antibiotics.  He showed that the greatest development of antibiotics was in the 1950's 60's and 1970's and we are still developing newer and better antibiotics all the time.  However the rate of development had slowed down. He showed that there was very little on the market or in the pipeline in the development of antibiotics for "Gram Negative" bacteria. We needed to look at the new drugs on the market, and assess if do they have an advantage over the older antibiotics available. There was a rapid rise in resistance in respect to some of the more useful antibiotics and any delay in effective therapy not only raised mortality, but also resistance.


His compelling argument was that with the rise in resistance and the delay in therapy there was the perception that doctors were prescribing ever more powerful antibiotics in the fear of losing a patient. This meant that we were using up our reserves of antibiotics that were considered the drugs of last resort as a first line treatment. He also showed that the reason for the slowdown in developing newer treatment with antibiotics was cost. MRSA Action UK is aware that big Pharmaceutical companies are reluctant to fund the discovery of new antibiotics because drugs that cure in a few days are poor for profits. Realists say that scientists are running out of ways of targeting bacteria.


Martin Kiernan who is President of the Infection Prevention Society and a Member of ARHAI, gave a presentation "Prevention is better than the cure". Martin began by saying that medicine started out without the advantages of antibiotics and we were able to perform some operations.  He reiterated that of course in the days before antibiotics were available, the only defences against infections were cleanliness and aseptic techniques.  The discovery of antibiotics did however make many of the interventions in medical science we take for granted possible. They have though given us a false sense of security that we have conquered infections forever, which of course we haven't.


Although resistance is increasing, we must look he said at the overall picture.  If we look at MRSA and C-diff for example, the rates of infections are coming down.  He attributed this to the surveillance systems we have in place for these bacterium and that they have concentrated everyone's mind on them.  In fact Martin was able to show that although the infection rates for these two bacteria are still too high in this country, we should take some comfort that they are reducing faster in the UK than in any country in the world. This does not mean that we have beaten the bugs, just that we have shown that you can reduce these bacterium if you have the determination to do so.  These reductions, he said, have been achieved by better infection control using root cause analysis as a tool to determine what when wrong if a patient contracts an infection in hospital. Martin made the comment that "with infections, it is not the end, it is not even the end of the beginning, but it is the beginning of the end of high infection rates".


Martin finished his presentation saying that infections are not inevitable even in the old and vulnerable. We do need people in the community to continue the same standard of care taken in our hospitals. This has to be a joint fight against these bacteria, and that antibiotics are precious and should only be used if necessary. "Prevention is always better than the cure".


In the afternoon the first presentation related to the use of antibiotics in animals, primarily in animals reared for food. Susan Dawson - Veterinary Medicine & Member of ARHAI, said there has been increasing concern of late about the spread of resistant bacterium from animals to humans.  There rules and regulations concerning the use of antibiotics in animals, and their use as growth promoters in this country are banned. However with the methods employed with the rearing of animals in such an intensive manner, there are concerns that the over use of this precious resource could have an impact on human health.


There are given rules about the use of antibiotics in animals in this country which means that before an animal can go for slaughter, there has to be a set down period of time from the last ingestion of an antibiotic to the animal going into the food chain. All antibiotics given to animals are by prescription only by a vet, and vets must only prescribe antibiotic drugs that are solely for animal use.  MRSA Action UK is aware that vets can only prescribe antibiotics for animal use only, we do have serious concerns that those antibiotics used by the vets do come from the same family of antibiotics that are used in human medicine.  Avoparcin is an antibiotic that is used in the livestock industry and comes from the same group of antibiotics such as Tiecoplanin and Vancomycin of the Glycopeptide group.  Vancomycin is regarded as the antibiotic of last resort for the treatment of a MRSA infection and as such with the news that there have been some Vancomycin resistant strains of MRSA (VRSA) this gives us great cause for concern for the future of medicine.


Our Charity's concern is that originally it was thought that acquired resistance in a bacterium only occurred through mutation in existing genes, which would mean that the resistant trait would be confined to the mutant bacteria and spread of resistance confined to that particular bacteria (vertical transmission). In the 1960s it was shown that resistance, in addition to mutation, could also be developed through the uptake of existing genes. In this case, the resistant trait through mobile genetic elements can also spread to other bacterial clones, to other bacterial species and even to other genera (horizontal transmission) (Amabile-Cuevas and Chicurel, 1992).


Dr Chris Butler, General Practioner, demonstrated how the myth of antibiotic resistance began in hospitals.  He showed that over 80% of all prescriptions for the use of antibiotics were prescribed in the primary care setting.  There is enormous pressure on Doctors from their patients to prescribe antibiotics for conditions that do not necessarily need them.  There was also the misconception he said that dirty hospitals create antibiotic resistance when in fact they contribute to the spread of existing resistance. Antibiotic resistance is created by prescribing the wrong antibiotic for a condition, and by the improper use or failure to finish the course of antibiotics.  Evidence shows that antibiotic prescribing for one condition can influence resistance in another.  There needed to be more communication and information with patients in the GP surgeries on whether there needs to be a prescription given for a condition that could clear itself given the time.  Doctors needed to talk to their patients and inform them of the problem of resistance and that antibiotics must only be used as a last resort.  There needed to be a clear shared decision made between the patient and the doctor.


Professor Michael Lewis gave a presentation from a Dental perspective and the role they play in this profession. Professor Lewis showed the audience the effects of infections in the mouth and the damage and distress this can cause. He showed that far from the perception that tooth ache is not only painful; it can be life threatening if left unchecked. He explained that all too often a dentist would give a prescription for an infection when in fact purely draining the infected area of the puss would in many instances cure the problem. He explained that once the puss had been drained from the infected site the body's own immune system could clear up the infection itself.


Professor Lewis explained that unknown to many people there is on average one death per month from dental infection.  Dentistry accounts for 7% of all antibiotics prescribed in the UK and in 1989 5% of dental abscesses contained resistant strains to penicillin.  By 1995 this had risen to 55% showing that resistance was a growing problem within dentistry.


Jonathan Cooke presented on the role of the pharmacist in medicine. He began his presentation showing that there are 39,000 pharmacists in the UK in 12,500 premises, including hospitals, the veterinary profession, industry and others.  He explained that prescribing antibiotics was currently the most common medical intervention. The cost to the NHS for prescribing antibiotics is over 10 billion pounds with Primary Care Trusts accounting for 7.5 billion pounds, hospitals some 2.8 billion pounds and 800 million pounds for others.


The final presentations centered on information and communication for the public.  Roger Finch said that we live in a world of microbes which we carry on us all the time.  In fact we could not survive if we did not have the right balance of microbes in and on our bodies. They are essential for a healthy life; however we are constantly putting this fine balance to the test every time we take an antibiotic. There was a need to educate the public on the importance of antibiotics and we should not expect to be given them every time we demand them from the doctor.  He reiterated the fact hat we needed to dispel the myth surrounding some stories in the media who call bacteria such as MRSA and C-diff viruses.  They are not viruses but bacteria which antibiotics will fight.  The public's perception is that antibiotics will work on viruses, which they will not. He also said that the public must be educated in basic infection control and hygiene if we are to begin to roll back these bacteria.


Clionda McNullty, Microbiologist and Member of ARHAI, presented the findings of a study asking people in different age groups what they knew about antibiotics.  It showed quite clearly that people aged 16 to 24 knew far less than older age groups.  They were asked how important hand hygiene was in controlling infections, and this age group scored badly.  They concluded that there had to be an awareness program and it should be aimed at children to educate them on the importance of hand hygiene and basic infection control.


Clionda outlined the E-bug campaign which has been devised to educate children of the importance of vaccines, benefits of antibiotics and the over use of antibiotics.  The aims of e-bug were also to increase understanding and to improve personal hygiene.  E-bug is now in 18 countries world wide with IT links and is student friendly.  The website can be accessed at


The areas of hand and respiratory hygiene and spread of infections in the community is covered, demonstrating when and how to wash hands, so reducing spread of infections. Decreased spread of respiratory, gastrointestinal and skin infections will, in turn, contribute to the reduction in antibiotic use, and reduce the spread of antibiotic resistance.


In order to achieve the objectives, a series of pupil activities has been created for junior (for 9-11 year olds) and senior schools (for 12-15 year olds) linking in with each country's National Curriculum, in close collaboration with the Departments of Health in each country.  Each country may have their own specific cultural needs and problems associated with antibiotic overuse and hygiene. These are researched, assessed and incorporated into the activities.  Different countries will be able to use the activity worksheets that most suit their aims to encourage prudent antibiotic use, control antibiotic resistance and reduce the spread of infectious disease and antibiotic resistance.  The programme includes the development of a website hosted by the National electronic Library of Infection in the UK.  Downloadable resources will be available including interactive games, quizzes and links to other resources and web sites.


Key Stage 2 Learning Resources have been developed in collaboration with the Health Protection Agency in preparation for the roll out to schools as part of the national curriculum.



The BUG Investigators and Andybiotic is used in schools and has interactive games and resources and is proving successful and popular.


Members have told us that their children are now telling everyone to wash their hands from the learning at their schools, so the campaign is starting to have an impact.


The resources are available to view and download at:



Professor Brian Duerden CBE, Inspector of Microbiology, Department of Health, concluded the day by outlining what the Department of Health were doing to raise public awareness on the use of antibiotics. He showed the department's advertising campaign using "andybiotic" and the slogan "don't wear me out". This was aimed at the press, magazines, GP surgeries and GP non-prescription pads. The campaign has been run on several occasions in 1999, 2000, 2003 and 2006. An evaluation showed that on public awareness there was a small increase, but in respect to patients' expectations of receiving a prescription there was a small reduction.


The "bug investigator" has had more impact.  A new campaign in Spring 2008 ran for 4/6 weeks.  A survey showed that 32% of people had read about the campaign, 49% had seen the campaign in Doctors surgeries, 31% had seen the posters, and 54% had said they felt the materials in the campaign had made it clear to them that antibiotics can't treat colds or flu. Professor Duerden said that antibiotics were life-saving bullets and essential for modern medicine, without them many infections would be impossible to treat, major surgery would be impossible and cancer treatment and transplant operations would be impossible.


Professor Duerden finished his presentation with the comment that we needed to make a bigger impact to educate everyone on the importance of preserving the stock of antibiotics that we have.  MRSA Action UK agree with the comments of Professor Duerden, if we lose the effectiveness of antibiotics many of the medical advances made in the last 30 years will be consigned to the history books.  This year we celebrated the 80th anniversary of Alexander Fleming's gift to mankind, how much of that legacy will be left on the 100th anniversary?


Derek Butler
MRSA Action UK