O’Neill final report on AMR has specific recommendations about antifungal resistance

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Lord Jim O’Neill’s global Review on AMR has set out its final recommendations, providing a comprehensive action plan for the world to prevent drug-resistant infections and defeat the rising threat of superbugs – something that could kill 10 million people a year by 2050, the equivalent of 1 person every 3 seconds, and more than cancer kills today. Building on eight interim papers, this is the final report from Lord O’Neill’s Review, established by the UK Prime Minister David Cameron in 2014 to avoid the world being “cast back into the dark ages of medicine”.

There are 4 general recommendations and 5 ideas about how to pay for it:

1. A global public awareness campaign to educate all of us about the problem of drug resistance.

2. The supply of new antibiotics needs to be improved so they can replace existing ones as they become ineffective.

3. We need to use antibiotics more selectively through the use of rapid diagnostics, to reduce unnecessary use, which speeds the incidence and spread of drug resistance.

4. We must reduce the global unnecessary use of antibiotics in agriculture.

With respect to fungal diseases and antifungals, similar priority areas were identified by O’Neill (Report p64)

“• Agriculture: Most crops are treated with fungicides, many with triazoles, which are similar to human triazole antifungals. We do not believe you can take away these products en masse, without endangering global food security. However some of the areas where these products are used most extensively are in the production of luxury items such as flowers and wine, which are not critical to food security. In these products, limits or bans might make sense, though there could be economic repercussions. There needs to be greater research into where triazole antifungals are overused, how this use can be minimised and whether their use is really necessary in particular areas. Further to this, we think that new classes of antimicrobials should not be used in farming, unless essential to particular major crops.

“• Environment: Like antibiotics there is a problem with factories dumping active pharmaceutical ingredients or antifungals into the environment, and like antibiotics this needs to stop. Similar regulations should therefore be considered for antifungals as we have discussed for antibiotics.

“• Diagnostics: Often fungal infections are mis-diagnosed as TB or other illnesses, meaning that necessary antifungal treatment is not given and unnecessary antibiotic therapy is given. Greater use of rapid diagnostics would play a major role in reducing inappropriate antibiotic and ensuring appropriate antifungal use. Surveillance of resistance also needs to be expanded both geographically and across populations. Furthermore, diagnostic reference capability needs to be enhanced and subsidised where appropriate in this area.

“• New drugs: The early clinical development pipeline has grown substantially in the last three years with eight compounds in early clinical development. If this healthier pipeline fails to translate into more new drugs, then governments should look at market entry rewards and early-stage funding for research.”

Professor David Denning of the University of Manchester and President of the Global Action Fund for Fungal Diseases, welcomed the report and commented: “Imprecise diagnosis of infection leading to ‘blind’ therapy could be minimized with addition of rapid fungal disease diagnostics to every hospital’s normal test portfolio. Excess use of fungicides for crops and dumping of active pharmaceutical ingredients with antifungal activity in the environment needs to abolished. The call for enhanced ‘diagnostic reference capability’ chimes with GAFFI’s call for an expert in fungal disease and reference laboratories in every country in its 10 year Roadmap ’95-95 by 2025’.

Report ; Press notice