Table 3

Responses to open-ended questions on antimicrobial resistance (AMR)

QuestionResponses
Nightmare scenario
  • Global spread and dominance of totally antimicrobial resistant pathogens—returning to the preantibiotic era

Priorities for future research/policy
  • Environmental impact of antimicrobial use in humans, animals and crops

  • Emerging bacterial resistance to biocides and disinfectants.

  • AMR transmission from and to companion animals.

  • Balancing food production capacity with AMR concerns.

  • Need for comprehensive AMR surveillance; understanding the selection, expansion and spread of multidrug-resistant mobile genetic elements (mapping the mobile gene pool).

  • Antibiotic stewardship—understanding why doctors prescribe and patients demand, antimicrobials inappropriately.

  • Better infection control within health and aged care facilities.

  • Point-of-care diagnostics (including rapid species identification and drug susceptibility testing).

  • Use of highly selective bacteriophage therapy.

  • Adaptive clinical trial designs for rapid assessment of multidrug regimens

  • Alternative drug development funding models that considers the public good.

  • Non-antimicrobial approaches to controlling infections.

Most important research question
  • Are there effective treatment strategies that will reduce selective pressure and on-going evolutionary ‘escape’, such as increasing bacterial susceptibility to immune attack or reducing the risk/impact of invasive bacterial infection only?

  • What are the key characteristics of a healthy microbiome and the short and long term impacts of antimicrobial induced changes?

Issues that require public consultation
  • Restricting antimicrobial access to reduce inappropriate use, for example stronger regulation or increases in price

  • How best to educate the general public and prescribers about the dangers (personal and environmental) of inappropriate antimicrobial use.

  • Balancing animal and human welfare considerations.

  • Balancing distributive justice and community versus individual cost–benefit.

  • AMR, antimicrobial resistance.