Reflecting on four decades of antimicrobial stewardship in Australian healthcare settings
This week, as part of World Antibiotic Awareness Week, healthcare practitioners celebrated 40 years of therapeutic guidelines for antibiotics use in Australia.
Australia’s Antibiotic Guidelines were first published in 1978 after microbiologist Robin Pavillard reported in April 1977 that 25% of Staphylococcus aureus infections at The Royal Melbourne Hospital were resistant to many antibiotics.
This led to a meeting with representatives from major hospitals in Melbourne, including The Alfred Hospital, Austin Hospital, Box Hill and District Hospital, Preston and Northcote Community Hospital, Prince Henry’s Hospital, The Royal Children’s Hospital, The Royal Women’s Hospital, St Vincent’s Hospital, The Queen Victoria Memorial Hospital, The Royal Melbourne Hospital and Western General Hospital.
A small working party was formed to consider in detail the draft of the guidelines, according to Therapeutic Guidelines, with a first edition quickly finalised at another meeting on 8 December 1977.
The first edition of Antibiotic Guidelines was published in March 1978. The Hospitals and Charities Commission (Health Commission of Victoria from 1978) allocated $2248 to print 6000 copies of a small booklet able to be conveniently carried in a coat pocket for ready reference.
“Since antibiotic-resistant micro-organisms reflect antibiotic prescribing habits, we became interested in whether our clinical colleagues were prescribing antibiotics appropriately,” explains Dr Ken Harvey, who was one of the microbiologists that worked on the guidelines in the late ‘70s.
“This needed an evidence-based booklet, written by a range of experts from many teaching hospitals, that could be used to audit antibiotics prescribed for common conditions. The result was the 1st edition of Antibiotic Guidelines.
“Because drugs change, germs change, and knowledge change it was important to update this booklet at regular intervals,” says Dr Harvey, who is now an Associate Professor at the School of Public Health and Preventive Medicine at Monash University.
“We found that simply distributing Antibiotic Guidelines did not make a lot of difference to prescribing habits. The ‘Guidelines’ recommended older, more-cost-effective, narrow-spectrum drugs. Our colleagues would prescribe newer, expensive, broad-spectrum drugs. Where was this message coming from? It came from our friendly pharmaceutical industry. Their message to clinicians about antibiotic resistance was, ‘You can’t afford to be wrong; use blundermycin’!”
Dr Harvey says this led his group of experts to adopt the same methods of the pharmaceutical industry.
“We called it educational antibiotic advertising and academic detailing,” he says. “We were able to show that educational campaigns targeting the discrepancies between what is recommended and what is practised improved antibiotic prescribing.”
Fast forward 40 years: We now have the 15th edition of Antibiotic Guidelines produced by the independent Therapeutic Guidelines Limited.
“Audits, educational campaigns and surveillance are now run under the auspices of the NPS Medicinewise and the Australian Commission on Safety and Quality in Health Care,” says Dr Harvey.
Antibiotic use has improved but there is still room for improvement, especially in general practice, he says.
The Antibiotic Guidelines have become the “must have” resource for hospitals and health professionals.
“Their longevity and acceptance over 40 years is a tribute to the vision and dedication of the numerous people involved over the years.”
The World Health Organization has warned that antibiotic resistance is one of the greatest threats to human health today. There are few new antibiotics in the pipeline and resistance has emerged to virtually all the antibiotics now available.
Australians take too many antibiotics unnecessarily. In 2015, community use in Australia (defined daily dose per 1000 population per day) was 2.5 times that of Netherlands, adds Dr Harvey.
“The more antibiotics are used – and the more they are misused – the greater the problem of antibiotic resistance.
“It’s not all bad news. Awareness programs are making a difference and GPs have significantly reduced their rate of antibiotic over prescription in recent years. But we can and must do better.”
PSA president Dr Shane Jackson attended the 40-year anniversary celebration held by Therapeutic Guidelines, thanking those who prompted the work on behalf of pharmacists and healthcare practitioners across Australia.
Pleased to be at the celebration of 40 years of the #antibiotic @TGLGuidelines in #AntibioticAwarenessWeek – thank you to those leading clinicians back in the late 70s who prompted this work pic.twitter.com/e6ckiP8DyS
— Shane Jackson (@ShaneJacks) November 13, 2018
See more about the history of the Antibiotic Guidelines on the Therapeutic Guidelines history timeline website.