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Antibiotic resistance: a health hazard for rural and remote communities

The World Health Organization is today (5 May) mounting a global campaign to tackle antibiotic resistance through wider uptake of handwashing.

Croakey readers can follow the campaign via #handhygiene and #antibioticresistance.

In Australia, concerted efforts are needed to tackle antibiotic resistance in rural and remote communities, the recent National Rural Health Conference was told, as Melissa Sweet reports below for the Croakey Conference News Service.


Melissa Sweet writes:

The global scourge of antibiotic resistance – which a recent British report estimated may cause 10 million deaths annually by 2050 if not addressed effectively – is of particular concern for rural, remote and regional communities in Australia.

Speaking at the recent National Rural Health Conference in Cairns, infectious diseases physician Dr Krispin Hajkowicz said non-metropolitan communities faced a triple whammy.

They were often at increased risk of infections, as well as being at increased risk of developing antibiotic resistance due to the high level of antibiotic usage in many rural areas.

Exacerbating these concerns was the lack of a specialist medical and pharmacist workforce to tackle antibiotic resistance in rural and remote areas, he said.

In Queensland, there were no infectious diseases physicians outside of Brisbane, Rockhampton, Mackay, Townsville and Cairns, said Hajkowicz, who is director of the Queensland Statewide Antimicrobial Stewardship Program and a senior staff specialist in infectious diseases at Royal Brisbane and Women’s Hospital, as well as a senior lecturer in the School of Medicine at the University of Queensland.

“The whole concept of antimicrobial stewardship has become central to controlling the threat of resistance in Australia,” he said.

“Mandatory anti-stewardship programs have been implemented in Australia since 2014 but it’s very important to have specialist knowledge from infectious diseases physicians and from pharmacists to run these programs and achieve really good results.

“Where programs have been rolled out in Australia, there have been substantial reduction in the usage of antibiotics… but it takes expertise and knowledge that isn’t currently available in rural and remote Australia.”

In parts of Queensland, 50 per cent of Staphylococcus aureus infections were now resistant to treatment with methicillin, he said, meaning that frontline antibiotics would not work for many patients.

Instead, alternative antibiotics had to be used, which were potentially less effective and more toxic, adding to the complexity and burden of treatment, he said.

Numerous reports have shown that Australia’s use of antibiotics in human health is relatively high, being well above the OECD average.

A national survey cited in Australia’s First National Antimicrobial Resistance Strategy 2015–2019 found that, overall, 30 per cent of antibiotic prescriptions were deemed to be inappropriate, and this was mainly related to unnecessary use of broad spectrum antimicrobials and incorrect duration of treatment.

As well as contributing to increasing antimicrobial resistance, unnecessary and inappropriate use is also causing harm to individual patients, Dr Hajkowicz said.

“There is individual patient harm every time a patient receives an inappropriate antibiotic,” he said.

“Every time you take an antibiotic … the bacteria in your gut are also affected and over time you will personally develop antibiotic resistant bacteria in your gut.

“If you then become really, really unwell with severe infection, pneumonia or a blood stream infection and need an antibiotic, it may not work at the critical moment in your life … and it may lead to a really poor outcome.”

Standards needed for community based care

The National Safety and Quality Health Service Standards have driven improvements in antimicrobial stewardship in hospitals and acute care settings, but Dr Hajkowicz said similar standards were also needed for community-based healthcare.

He said:

There are no overarching community healthcare standards for antimicrobial use at the moment: that is something we would like to see progress down the track.

I think GPs and primary care clinics are doing their absolute best under the circumstances but with all the competing needs they have, there is a potential gap there, and programmatic support, auditing and surveillance are going to help primary health care practitioners achieve better antibiotic use without a large investment in time.

We would like to see hospitals, community primary care, and public health networks all aligned and working together on this problem with a clearly defined research agenda with excellent education, and a program of restriction, audit and surveillance of antibiotic use throughout the country.”

Dr Hajkowicz said a big focus on consumer engagement and public education was also needed.

“At the end of the day, consumers drive health care and we know they definitely drive requests for antibiotic scripts,” he said.

“For them, understanding the risks associated with taking antibiotics for viral infections would be key.”

In five years time, he’d like to see patients arriving at GP clinics without an expectation of getting an antibiotic.

Instead, they would come with the idea of being reviewed to make sure they are not critically unwell, understand how long they need to take off school or work, and have a discussion about treatment but without expectation this would lead to a script.

Further reading:

http://www.health.gov.au/internet/main/publishing.nsf/content/1803C433C71415CACA257C8400121B1F/$File/amr-strategy-2015-2019.pdf

https://amr-review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf


Watch this Croakey interview with Dr Krispin Hajkowicz


More on the Queensland Statewide Antimicrobial Stewardship Program

Hajkowicz and his colleague Dr Minyon Avent, an Antimicrobial Stewardship pharmacist, promoted the Queensland Statewide Antimicrobial Stewardship Program at the conference: see these tweets below and also the program website.

antibiotics launchantibiotics launch1


10 recommendations from the 2016 UK Review on antimicrobial resistance:

  1. Undertake a global public awareness campaign
  2. Improve sanitation and prevent the spread of infection
  3. Reduce unnecessary use of antimicrobials in agriculture and their dissemination into the environment
  4. Improve global surveillance of drug resistance and antimicrobial consumption in humans and animals
  5. Promote new, rapid diagnostics to reduce unnecessary use of antimicrobials
  6. Promote development and use of vaccines and alternatives
  7. Improve the number, pay and recognition of people working in infectious disease
  8. Establish a global innovation fund for early stage and non-commercial R&D
  9. Introduce better incentives to promote investment for new drugs and improving existing ones
  10. Build a global coalition for real action – via the G20and the UN.

 


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