Articles |
An overview of the Specialist Advisory Committee on Antimicrobial Resistance (SACAR)
Expert Advisory Support Group, Health Protection Agency, Colindale Avenue, London NW9 5EQ, UK
* E-mail: r.wise{at}bham.ac.uk
 |
Abstract |
|---|
 Top Abstract BackgroundThe work of SACARWhat of the future?Transparency declarationsReferences |
|---|
In 1969, the Swann Committee reported that there was a significant problem with regard to antimicrobial (mis)use in both human and veterinary practice and recommended that the UK Government establish a committee that should have overall responsibility for the whole field of antimicrobial use. This view was reiterated in 1997–8 by the House of Lords Science and Technology Committee, under the Chairmanship of Lord Soulsby of Swaffham Prior. In 2001 such a group, the Specialist Advisory Committee on Antimicrobial Resistance (SACAR), was finally launched. SACAR encompassed representatives from human and veterinary medicine and involved many branches of public health, pharmacy, nursing, bacteriology and virology. It met three times a year and has advised ministers and the Chief Medical Officer on current and emerging problems by providing expert advice to inform local and national policy on antimicrobial resistance. This Supplement provides an overview of the work of SACAR and its Subgroups.
Keywords: UK , government advisory committee , health policy
|
Background |
|---|
|
TopAbstractBackgroundThe work of SACARWhat of the future?Transparency declarationsReferences |
|---|
Antimicrobials were introduced into animal and human healthcare in the 1940s and 1950s and immediately enjoyed heavy usage. By 1947, L. P. Garrod, in an interview with the New York Times expressed concern that these lifesaving agents might well ‘breed resistance’. In the late 1940s, Thomas H. Jukes of the University of California, Berkeley, USA, discovered what he described at the time as, ‘A unique phenomena (sic)—perhaps without precedent in the history of medicine.’ Jukes found that when young poultry were fed a fermented ration containing the microorganism Streptomyces aureofaciens (used to produce chlortetracycline), they showed a dramatic increase in weight gain.1 This, combined with breeding and other changes helped halve the lifespan of the broiler chickens to just 6 or 7 weeks before slaughter—a major economic advance. By 1969, 168 tonnes of antibiotics were being fed or injected into animals in the UK as compared with 240 tonnes used in humans.2
In 1969, the UK Government asked the Swann Committee to report on antimicrobial use in both human and veterinary practice.3 The Committee concluded that there was a significant problem and made several recommendations. For example, animal feed antibiotics should not be those used in human medicine as this could compromise efficacy in man. Swann also recommended that the UK Government establish a committee that should have overall responsibility for the whole field of antibiotic use ‘...whether in man, animals, food preservation or for other purposes’. The following decades proved that the problems of resistance multiplied but antimicrobial control fell upon the professionals rather than central Government.
In 1997–8 the House of Lords' Science and Technology Committee, under the Chairmanship of Lord Soulsby of Swaffham Prior, reminded Government that an advisory committee was long overdue. Its opening remarks were clear, stating that ‘...resistance to antibiotics constitutes a major threat to public health’.4 In 2001 such a group was finally launched known as the Specialist Advisory Committee on Antimicrobial Resistance (SACAR) with representatives from human and veterinary medicine and involving many branches of public health, pharmacy, nursing, bacteriology and virology (Appendix 1).
|
The work of SACAR |
|---|
|
TopAbstractBackgroundThe work of SACARWhat of the future?Transparency declarationsReferences |
|---|
SACAR has met three times a year and has advised ministers and the Chief Medical Officer on current and emerging problems by providing expert advice to inform local and national policy on antimicrobial resistance. It is sobering to realize that over the past 5 years what were in some instances nascent issues (for example, extended-spectrum ß-lactamases) have emerged, and established problems [such as methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile infections] have grown. In addition, glycopeptide-resistant enterococci, multi-resistant Acinetobacter spp., vancomycin-resistant S. aureus, Panton-Valentine leucocidin-related and community-associated MRSA continue to be a concern and the Department of Health (DH) in England and the bodies in the devolved administrations of Scotland, Wales and Northern Ireland have all been responding to these problems. One example is the Scottish Executive's initiative on antibiotic management in hospitals which has been incorporated into the new DH Code of Practice. SACAR has enjoyed good relationships with all these partners and we have all learnt from each other. Horizon scanning is undertaken at all our meetings to assess emerging issues. This is a continuing role of SACAR so that recommendations can be made in order to direct surveillance to new areas of concern in a timely fashion. Time is indeed of the essence, as I would characterize the current problem as one of both ‘accumulation’ and ‘acceleration’, in other words, problems, once established, rarely or slowly diminish and the pace of change is increasing.
Some highlights of the past 5–6 years include the funding for research, the establishment of antimicrobial pharmacists in most district general hospitals and the spur to cross-professional guidelines on MRSA. The Andybiotic, ‘Ask about Antibiotics’ and school educational campaigns (promoting basic principles of effective infection control such as hand washing and appropriate prescribing of antibiotics) are most welcome and must continue. We have started to build good relationships with the Medicines and Healthcare products Regulatory Agency and advise them regularly upon the need for prudent prescribing. Although I, personally, have some sympathy with the current policy of extending the prescribing base to include other healthcare professionals, I cannot help but believe that the more people who can prescribe antimicrobials, the more will be prescribed. It is necessary for those overseeing such a policy to realize that antibiotics are indeed different to other classes of therapeutics—overuse them at society's peril. It is interesting to note that in much of Europe, the trend is in the opposite direction, namely, to reduce the availability of antimicrobials.
Central to many activities is surveillance to underpin advice. We are moving towards the ‘Holy Grail’ of robust linking of the knowledge of resistance rates, prescribing patterns and clinical outcomes, but there is still work to be done. Gratifyingly, we now have information from the Paediatric Subgroup on the extent of childhood prescribing (which was unknown before) as well as now having published data on the risks of reducing antibiotic prescribing in children, which refutes earlier alarmist reports. Four years ago, we had little idea how antibiotics were used in our hospitals (in fact, we knew more on how they were employed in General Practice), now thanks to an alliance with the Healthcare Commission we have a far clearer picture and decisions need to be made as to how to put these valuable data to best use.
SACAR has been involved in a number of publications. Arguably, first amongst these must be the proceedings of an intergovernmental meeting held in December 2005 during the UK presidency of the EU.5 The subject was the promotion of new technologies. It addressed the increasing problems presented by the lack of new therapeutic agents and the slow progress in developing new diagnostics. The problems underpinning these issues (such as high costs and perceived poor returns on investment) demand to be addressed, lest the vicious circle be given yet another twist. Time is not on our side.
SACAR has run annual conferences, primarily to act as a forum for pharmacists, but gratifyingly, these have been well attended by others. In recent years, SACAR has collaborated with the British Society for Antimicrobial Chemotherapy (BSAC) and other societies in the delivery of regional educational workshops across the UK and Ireland, which have been very well received. The importance of such professional education activities cannot be over emphasized.
As indicated, we have enjoyed extremely welcome relationships with others. The devolved administrations have already been mentioned. The BSAC has been unstinting in its assistance. The Hospital Infection Society, Infection Control Nurses Association, Royal Pharmaceutical Society and the Health Protection Agency (HPA) all deserve our sincere thanks.
It goes without saying that any group such as SACAR is totally dependent upon the enthusiasm of its members (Appendix 1). The Chairs of the Subgroups have worked ceaselessly and have gained my admiration. A considerable debt of gratitude is deserved by them and their members. The DH has been extremely supportive, often in difficult times (after all, who is not always asking for more resources?). Finally, the HPA who supply SACAR with secretariat support (and more recently a pharmacist lead) are heartily thanked.
|
What of the future? |
|---|
|
TopAbstractBackgroundThe work of SACARWhat of the future?Transparency declarationsReferences |
|---|
I would highlight a number of urgent concerns. Firstly, I do believe that we should undertake our surveillance on a more meaningful and immediate basis: we need to track new problems as they arise and, as mentioned above, the link between prescribing, resistance, and clinical outcomes needs to be addressed in both hospitals and communities. Secondly, we must not let the hard lessons that have been learnt by our (mis)use of antibacterials be repeated as more antiviral agents become available: we are already encountering resistance to antiretrovirals and neuraminidase inhibitors. Thirdly, the knowledge base of professionals and the public must be enhanced. Medical education has altered considerably over the past decade and there has been a loss of training in the use of anti-infectives. Similarly, the public needs to enter a partnership with the professionals to ensure that antimicrobial agents are only requested when necessary. Fourthly, it must be realized by those making policy, that antimicrobials are a limited resource, to be conserved by all possible means. A recent survey in the British Medical Journal6 ranked the introduction of antibiotics as second only to sanitation as the most important medical milestone; there is a real danger of losing them. Finally, as Swann highlighted, the intimate relationship between animal and human use must never be forgotten.
SACAR is now standing down and a new body (to be known as the Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infections) advising on both resistance issues and healthcare-associated infections is being formed. There is good sense in such a linkage as the two problems are so closely intertwined and we all wish Professor Roger Finch, the Chair of this new committee, every success. The new committee will have a major task ahead. The past shows that new problems can sweep upon us. The problems that the Swann committee highlighted almost four decades ago have multiplied and few if any have diminished.
|
Transparency declarations |
|---|
|
TopAbstractBackgroundThe work of SACARWhat of the future?Transparency declarationsReferences |
|---|
R. W. holds consultancy agreements and has received honoraria from a number of pharmaceutical companies. The contents of this article do not contain any references to the products or research activities of these companies. This statement is provided solely in the interests of transparency.
|
References |
|---|
|
TopAbstractBackgroundThe work of SACARWhat of the future?Transparency declarationsReferences |
|---|
1 Schell O. Antibiotics in Your Meat. http://www.aliciapatterson.org/APF0306/Schell/Schell.html://www.aliciapatterson.org/APF0306/Schell/Schell.html (1 February 2007, date last accessed).
2 Meikle J, Brown P. Alarms rang 50 years ago. http://www.guardian.co.uk/antibiotics/Story/0,202004,00.html (5 December 2006, date last accessed).
3 Swann MM, et al. Report of the Joint Committee on the Use of Antibiotics in Animal Husbandry and Veterinary Medicine (1969) London: Her Majesty's Stationery Office.
4 House of Lords Select Committee on Science and Technology. Report. Resistance to antibiotics and other antimicrobial agents (1998) London: The Stationery Office.
5 Finch R, Hunter PA. Antibiotic resistance—action to promote new technologies. In: J Antimicrob Chemother (2006) 58. report of an EU Intergovernmental Conference held in Birmingham, 12–13 December 2005: UK. (Suppl. S1).
6
Ferriman A. BMJ readers choose the "sanitation revolution" as greatest medical advance since 1840. BMJ (2007) 334:111.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  Lord Soulsby of Swaffham Prior The 2008 Garrod Lecture: Antimicrobial resistance--animals and the environment J. Antimicrob. Chemother., August 1, 2008; 62(2): 229 - 233. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||