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The World Health Organization (WHO) has declared that Antimicrobial Resistance (AMR) is one of the top 10 global public health threats. The work of Professor Michael Sharland and his research group at St George’s has had a major national and global impact on antibiotic prescribing.

The inappropriate and overuse use of antibiotics, particularly those with a broad spectrum (targeting multiple types of bacteria), is the single most important driver of AMR. It is estimated that antimicrobial-resistant infections played a role in almost 5 million deaths in 2019, with more needed to be done to prevent resistance taking hold.

Researchers in the Centre for Neonatal and Paediatric Infection at St George’s, led by Professor Sharland, have undertaken a body of work to optimise antibiotic use in children. A clinical trial, spearheaded by the St George’s team assessed antibiotic dosing for children and found that three days of antibiotics is as effective as seven days for children attending hospital with pneumonia

Following the group’s renowned research into optimising antibiotic prescribing in children, the team helped the WHO Essential Medicines List Committee develop a new classification system of narrow, broad-spectrum and last resort antibiotics.

The new Access, Watch and Reserve categories were then combined into the WHO AWaRe index. In 2019, this AWaRe metric became a vital component of WHO efforts to combat AMR, when the Director General announced the first global target to reduce inappropriate broad-spectrum antibiotic use. This target challenges individual countries to meet 60% of their total antibiotic prescribing using narrow-spectrum Access group antibiotics by 2023, based in part on St George’s work.

“If we can encourage healthcare providers to use narrow-spectrum Access antibiotics as opposed to broad-spectrum drugs, then we can help prevent the rise of resistant infections,” explains Professor Sharland.

“Our research aims to highlight the inappropriate use of broad spectrum antibiotics, so that strategies can be taken to optimise the dosing and medicines used.”

The group’s efforts have already led to improvements in prescriptions in the UK. Since 2014, approximately nine million more children are now being given appropriate doses of the antibiotic amoxicillin for community infections in the country. The results of the CAP-IT trial, will also allow for 100,000 children between 2021 and 2026 to receive shorter durations of antibiotics.

“We’re delighted to have been able to see real change based on our research,” says Professor Sharland.

“Shorter, appropriate durations of antibiotic use will not only reduce the burden on families giving medicines to young children, but will also help to curtail antibiotic resistant infections in future,” he adds.

Find out more about the history of the team’s work.

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