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11 Jun 2019

Co-ordinated approach urgently required to slow progression of antibiotic resistance

Infectious disease experts from around Australia are calling for urgent action to address antibiotic resistance before it has a dangerous impact on remote Aboriginal communities.

Research has shown these remote towns have Australia’s highest rates of antibiotic resistance to bacteria like Staphylococcus aureus (golden staph) – around 50 per cent are resistant compared to 15 per cent elsewhere throughout the country – and according to an article published in the Medical Journal of Australia, it’s due to the heavy burden of infectious diseases combined with high rates of antibiotic use.

Associate Professor Asha Bowen, Head of Skin Health at the Wesfarmers Centre of Vaccines and Infectious Diseases based at the Telethon Kids Institute, led the first antimicrobial stewardship audits in the remote sector alongside partner organisations.

“Previous studies have shown that 50 per cent of Aboriginal children in remote communities have at least six antibiotic prescriptions by their first birthday, treating a range of conditions including respiratory tract infections, skin sores and ear infections,” said Associate Professor Bowen.

“We need updated, timely, high quality data about how antimicrobials are being used in the most remote parts of Australia to learn how big the problem really is – what we can see from current data mostly gained from hospitalised patients is only the tip of the iceberg.

“We already know that if we can’t slow the spread of antibiotic resistance to deadly pathogens in these remote communities, we will come to a point where there just aren’t any treatment options available to save the lives of people suffering life-threatening infections.

“The only way forward is a co-ordinated approach nation-wide, collating information to help us understand the true magnitude of the problem and prompting action to move skills and resources into the sectors that need it most. 

“This will ensure the necessary frameworks are developed and the knowledge is there to stay on top of the antibiotics being prescribed according to resistance problems in the area,” said Associate Professor Bowen.

Co-author Royal Melbourne Hospital Clinician Researcher Associate Professor Steven Tong from the Peter Doherty Institute for Infection and Immunity (Doherty Institute) and Menzies School of Health Research, says the hardest part is finding the right balance in this generation of antimicrobial resistance.

“We don’t want to discourage people from seeking treatment and taking antibiotics when they need them – we want to encourage healthcare providers to prescribe the right medications, to the right patients, for the right indication and for the correct duration of time,” said Associate Professor Tong.

“We also acknowledge antimicrobial resistance can’t be addressed in isolation - the drivers come down to the social determinants of health such as living conditions and access to clean water. The problem is all encompassing and we all need to work together to solve it.”

The research was carried out thanks to funding by the HOT NORTH Improving Health Outcomes in the Tropical North research program at Menzies School of Health Research.

“This is an important reminder of the disparities across Australia and the unique profile of infectious diseases in rural and remote settings. To support the provision of equitable health care to all Australians, we are leveraging off technology and establishing a cross-jurisdictional surveillance system that delivers timely and regionally–informed susceptibility data to key end-users,” said HOT NORTH Research Fellow, Dr Teresa Wozniak.

AURA 2019; the third Australian Report on Antimicrobial use and resistance in human health, is the Australian Commission on Safety and Quality in Health Care’s (ACSQHC) most recent report on analyses of data from the Antimicrobial Use and Resistance in Australia (AURA) Surveillance System and includes commentary on the higher and worsening rates of antimicrobial resistance in remote and very remote areas of Australia.

ACSQHC Chief Medical Officer, Dr Robert Herkes said the Commission supports the call to action to support antimicrobial stewardship and respond to antimicrobial resistance rates in rural and remote primary health care.

“The Commission’s recently released AURA 2019 Report includes data showing the higher and worsening rates of antimicrobial resistance in remote and very remote areas of Australia which supports the call for greater collaboration to specifically target action in this regard,” Dr Herkes said.

President of the Australasian Society for Infectious Diseases Professor Josh Davis said the MJA Perspective highlights a sometimes forgotten aspect of the complex issues around antimicrobial resistance in Australia.

“It adds weight to calls on the Australian government to establish a national co-ordinating centre on antimicrobial resistance, whose brief would include remote Indigenous communities as well as hospitals and urban primary care,” Professor Davis said.

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