Women’s health and antibiotics - The drugs don’t work

With antimicrobial resistance (AMR) and superbugs on the rise, policy makers around the world are looking for solutions to this serious threat to public health. Antimicrobial resistance is considered a worldwide public health threat due to lack of new antibiotics to combat resistant bacteria as current drugs become less effective.  Furthermore, there is the high potential for the transfer of resistant genes in our environment, potentially impacting our gut microbiome, consisting of hundreds of trillions of bacteria that may play a role in maintaining our health. The hunt for new antibiotics is on, but we are perhaps paying less attention than we should to the role of infection prevention, stewardship and diagnostics. Let’s focus on Urinary Tract Infections (UTIs), the second most common form of infection in the UK.  

Half of all women experience a UTI at some point in their life , but healthy behaviours that help to maintain a healthy urinary tract can reduce the need for antibiotics and the chance of resistant infections.  Various initiatives are underway to improve antibiotic stewardship and ensure appropriate prescribing, but resistant infections are on the rise.  So what more can we do to tackle the growing public health problem of AMR?  There are 225,000 hospital admissions a year involving UTIs, so the potential health economic benefits of keeping patients out of hospital are significant.  

This was the subject of a recent roundtable debate I chaired in Parliament, supported by leading UTI charity the Bladder and Bowel Foundation, and Ocean Spray Cranberries, a cooperative of 700 cranberry growers.  The discussion brought together leading public health experts, parliamentarians and healthcare professionals, to forge recommendations for policy makers and the NHS.  

The experts agreed that we need to improve public awareness of how to prevent UTIs, for instance through better hydration and diet.  Diet – including hydration, avoiding constipation and a daily intake of a cranberry product – can help maintain a healthy urinary tract.  However, the NHS is not currently making sufficient use of dieticians who can advise and support patients.

We agreed on the need to improve the accuracy and speed of diagnostics, to enable smarter prescribing on the basis of microbiological results. We also need more isolation facilities in hospitals for patients with resistant organisms, and more infection control nurses in the community.

Perhaps the greatest challenge of all is achieving behaviour change; so that as patients, we stop demanding antibiotics from our doctors in situations where they are of little help.  However, there is a corresponding responsibility on the NHS to improve diagnostics, so that medical professionals are supported to make more informed prescribing decisions.

With a major report commissioned by the Prime Minister on AMR due this summer, it’s all hands on deck in the fight against antimicrobial resistance. We should not forget that preventative strategies have an important role to play here alongside the discovery of new drugs.

Baroness Masham of Ilton is a Crossbench Peer