Authors: Martha Powell, Future Science Group
As part of our focus around World Antibiotic Awareness Week (13–19 November) we spoke to Professor Jonathan Cooke, a pharmacologist and pharmacist based in the UK who holds a special interest in antimicrobial resistance. He shares his thoughts on this pressing issue below:
First, could you introduce yourself and tell us a bit about your career to date?
I am a pharmacologist and pharmacist and have worked in the UK National Health Service (NHS) for over 30 years where I was Director for Research and Development and Director of Medicines Management and Pharmacy. Currently, I hold Honorary positions at the University of Manchester and Imperial College London (both UK).
I have a specialist interest in antimicrobial resistance having obtained a PhD in antimicrobial utilization and am an advisor to the UK Department of Health in antimicrobial resistance and healthcare-associated infections. I was also a member of the Clostridium difficile working party, where my activities included obtaining state funding for antimicrobial pharmacists in hospitals in England and Chairing the working party that introduced the original guidance on antimicrobial use in hospitals ‘Start Smart then Focus’ (www.gov.uk/government/publications/antimicrobial-stewardship-start-smart-then-focus)
Finally, I am a Member of the All Party Parliamentary Group on Patient Safety and Trustee for the Fungal Infection Trust.
Could you give us an overview of your current research projects?
Following on from leading national antimicrobial stewardship programs, I led the production of a national checklist for antimicrobial stewardship in hospitals from Imperial College London. I have collaborated with several teams on the development and evaluation of a topical antimicrobial agent employing Reactive Oxygen (RO).
There are now over 20 publications showing the effectiveness of the antibacterial, antifungal and antiviral benefits of RO in several settings and against multi-drug resistant (MDR) organisms and biofilms. Moreover, no resistance to RO has been demonstrated and clinical effectiveness has been demonstrated in acute and chronic wounds and catheter line sites. Caesarean Section rates have been demonstrated to have been reduced by up to 60% with a significant reduction in antimicrobial usage.
Other work through the London Diagnostic Evidence Co-operative at Imperial College has demonstrated the value of C-reactive protein point-of-care testing (CRP POCT) by clinicians in primary care for patients presenting with symptoms of respiratory tract infection (RTI). For example, up to 42% reduction in index prescribing of antibacterials has been demonstrated using CRP POCT.
Why is antimicrobial resistance a public health issue pertinent to everyone?
Because it brings the potential of simple infections, e.g. RTI and urinary tract infections, becoming untreatable through the spread of MDR organisms. Furthermore, routine procedures like chemotherapy and surgical operations could become life-threatening with the advent of MDR infections.
With regards to antimicrobial resistance, what do you think are the major challenges hindering our progress in this field?
We need improved, accurate diagnosis of infections that are amenable to existing antimicrobials – this is required to enable negative prognostics to determine when not to use antimicrobials and positive prognostics to determine when and how they should be used.
Do you think drug discovery for antimicrobials is sustainable?
No. The economic model for the development and implementation of new antimicrobials is broken and unless something radical is done then we will see no new agents coming forward.
What is your assessment on research into alternatives to traditional drugs?
There are some exciting developments but the administrative burden of research and development constraints mitigate against evaluation of new molecules and alternatives.
Finally, looking ahead, what do you think is the most promising (or important) strategy for combating antimicrobial resistance?
- Global restriction of access for most antimicrobials to informed healthcare professionals.
- Implementation of diagnostics that are being constantly being updated.
- Education of public and professionals.
- Monitoring antimicrobial usage
Take a look at our other World Antibiotic Awareness Week content here.