Background
Antimicrobial resistance ("AMR") is a global public health concern and the Government, in recognition of the major threat posed by AMR, set up the High Level Steering Committee on Antimicrobial Resistance ("HLSC") in 2016 to formulate strategies in collaboration with the relevant sectors to tackle the threat.
In 2017, the HLSC formulated the Hong Kong Strategy and Action Plan on Antimicrobial Resistance (2017-2022) ("Action Plan"), which proposed recommendations in six key areas as follows:
- Strengthen knowledge through surveillance and research;
- Optimise use of antimicrobials in humans and animals;
- Reduce incidence of infection through effective sanitation, hygiene and preventive measures;
- Improve awareness and understanding of AMR through effective communication, education and training;
- Promote research on AMR; and
- Strengthen partnerships and foster engagement of relevant stakeholders.
For details of the Action Plan, please refer to https://www.chp.gov.hk/en/static/49301.html.
Actions Taken by the Pharmacy and Poisons Board ("the Board") in Combating AMR
One of the objectives in the Action Plan is to strengthen regulation on over-the-counter purchase of prescription-only antimicrobials. As the statutory authority to regulate pharmaceutical products and traders under the Pharmacy and Poisons Ordinance, the Board together with the Drug Office of the Department of Health have taken actions in relation to the five strategic interventions proposed under the objective as set out below in the past few years:
- To enhance inspection against Authorized Seller of Poisons ("ASPs"), including the identification of ASPs that purchased large volumes of antibacterials, and conducting special unannounced inspections against these ASPs –
- Conducted special unannounced inspections against certain authorized sellers of poisons (“ASPs”), especially those purchased large amount of antimicrobials from wholesalers and manufacturers. From 2017 to 2019, a total of four successful prosecutions involving antibiotics were resulted;
- Assisted the Antimicrobial Resistance Division of the Centre for Health Protection (“CHP”) to collect data on the supply of antimicrobials from licensed pharmaceutical wholesale dealers and manufacturers as part of the surveillance measures to estimate the consumption of antimicrobials in various sectors (e.g. hospitals, private doctors, community pharmacies, etc);
- To enhance Test Purchases (“TPs”) of antibiotics against ASPs –
- Conducted more TPs of antimicrobials against retailers;
- To review disciplinary actions against offences related to antimicrobials –
- Reviewed and revised the criteria to increase the deterrent effect against the illegal sale of antimicrobials by licensed pharmaceutical traders;
- To solicit support from licensed drug retailers in strengthening the provision of relevant health information –
- Held meetings with licensed pharmaceutical traders, trade associations and pharmacist associations to emphasize the importance of AMR and to solicit their assistance in displaying posters on proper use of antibiotics; and
- To keep in view the necessity to amend the relevant ordinances –
- Strengthened the sale control of six antimicrobial substances Including Nifuratel, Nifuroxazide, Nitrofural, Nitrofurantoin and Nitroxoline which would be regulated as prescription drugs with effect from 18 October 2020 while Metronidazole would be regulated as prescription drug with effect from 14 February 2021.
With the above interventions and support of the ASPs and pharmacists, the overall proportion of antimicrobials supplied to community pharmacies decreased from 18.4% in 2016 to 12.7% in 2017 and 8.0% in 2018.
For more information about AMR, please visit the dedicated website of CHP at
https://www.chp.gov.hk/en/features/47850.html#10001.
For more information about the supply of antimicrobials in Hong Kong, please visit:
https://www.chp.gov.hk/en/static/101901.html.