Mary Henry (Independent)

They are a great success, managing to change their little jackets overnight so that whatever affected them yesterday has no effect on them today. New antibiotics are being introduced only to be defeated within a few days. We have not put enough emphasis on the role of the laboratory, which can be the key to diagnosis and surveillance in acute hospitals in particular. We must know what the mechanisms are in these changing bacteria so that we might have some idea of the best way to make progress. Only in the laboratory will we manage to find out anything about suitable prescribing, in the hospital and outside.

I very much regret that 100% of our cervical smear tests now go to Dallas in the United States, since it has a terrible effect on morale in Irish laboratories conducting such screening. What will happen to the training of medical scientists if we outsource all our specimens? The international privatisation of specimens from hospitals would be a terrible mistake and I hope that the Minister can rectify that problem as soon as possible.

The resistance of many bacteria is probably under-diagnosed owing to insufficient surveillance in hospitals, never mind what is happening in the community where we frequently have very little idea what is occurring. There have been cases where we do not know what mechanism caused the bacteria to change and we must know that because genes coded for resistance emerge in one strain only to be transferred to others. That DNA change means that various mechanisms can be used by the bacteria to defeat an antibiotic.

That can make a difference to how one directs one's next line of treatment. For example, if the enzyme b-lactase is produced, it breaks down the b-lactam ring in penicillin, and that is the anti-bacterial part. If one knows that the bacterium is using that mechanism, one will not try a cephalosporin since the same thing will happen, moving on instead to a different type of antibiotic such as a tetracycline.

This can also happen with gram-negative bacteria, including e.coli, and there are other methods that the bacteria can use, such as altering the penicillin's binding proteins so that it cannot work. One needs to know exactly what they are doing, and our laboratories are not receiving sufficient investment in the area. It must be done countrywide and not just in research laboratories. It is terribly important that we get at it as quickly as possible if the problem of multiple drug resistance is not to worsen further.

It is only if we take such steps that microbiologists will be able to advise surgeons, physicians and junior hospital doctors of the next best antibiotic rather than allowing the scattergun approach seen in far too many hospitals. Part of our problem is that medical scientists are not being encouraged enough or given enough finance to investigate the area.

Senator Glynn noted that I raise this constantly, and I heard the Minister speak on it on the radio, namely, the education of the public into desiring antibiotics where they are not strictly necessary. I see from the text of the amendment that the Government parties acknowledge the upcoming television and radio campaigns to increase awareness of the importance of hand hygiene among hospital staff, visitors and patients. What about a campaign on expectation and the feeling that if one visits a general practitioner and does not come away with a prescription for an antibiotic, the consultation has been a failure? Most upper respiratory tract infections are viral and many of the pneumococci are resistant to antibiotics, yet 40% of antibiotic prescriptions are for upper respiratory tract infections.

The Government must invest in educating not only the public but GPs and hospital doctors. Pharmaceutical companies are now relied on to hold medical seminars and so forth, but they will hardly suggest that people cut down their use of antibiotics. The Government will have to get involved and carry out trials of different treatments. One would be as well to put one's head over a bowl of friar's balsam and inhaling. The Government must get involved in such trials because no one else will be able to do so. Antibacterial wipes, which are advertised on television, are lethal and should not be allowed at all.

I must refer to the abuse of antibiotics in the food chain, particularly among poultry and pigs who are brought up in factory farms. Although these are called growth enhancers in their food, they are antibiotics. They may not be used by humans, but they are encouraging resistance among animals and poultry. There is far too casual an attitude about this and it should be discouraged.

This is a matter of surveillance and investment in our laboratories, and education of patients and doctors as to the appropriate use of antibiotics.