Call for changes to combat superbug threat


World Antibiotic Awareness Week 2020. Source: WHO

For World Antimicrobial Awareness Week, the PSA has urged pharmacists to discuss duration of antibiotics treatment with patients

The World Health Organization (WHO) has estimated 10 million people could die from antimicrobial resistant (AMR) infections globally by 2050 if no action is taken.

As part of World Antimicrobial Resistance Awareness Week (November 18-24), the PSA is urging pharmacists to work with patients to take antibiotics for the number of days advised by the prescriber.

To support pharmacists and patients, the cautionary advisory label (CAL D) for antibiotics has been revised and will be published in the next edition of the Australian Pharmaceutical Formulary (APF25) due for release January 2021.

PSA National President Associate Professor Chris Freeman said the revised label is a change to the previous recommendations and is the result of comprehensive stakeholder consultation.

“This is one of a multitude of actions to help combat bacterial resistance to antibiotics,” he said.

“Taking antibiotics for longer than necessary does not improve outcomes and increases the risk of acquiring resistant organisms.

“As the revised CAL D presents a change in behaviour for patients, pharmacists need to work with patients on the appropriate duration of treatment for antibiotics.

“Pharmacists should confirm that patients are aware of treatment duration and if a patient is not aware, or it is not specified on the prescription, the pharmacist should consult with the prescriber to confirm the intended duration.”

Under the new guidance, patients should stop taking the antibiotic when the prescribed duration of treatment is complete and any unused antibiotics should be returned to the pharmacy for disposal.

The PSA also reminded pharmacists to discuss with patients the importance of contacting the prescriber if their symptoms worsen or do not improve in the timeframe advised.

Meanwhile, also as part of World Antimicrobial Resistance Awareness Week, Monash infectious diseases experts have called for a register that systemically captures all patient-level data to spotlight the growing superbug emergency and put it firmly on the public health agenda.

Dr Nenad Macesic, from Monash’s Department of Infectious Diseases, Central Clinical School, argued that the superbug data currently recorded by the Antimicrobial Use and Resistance (AURA) surveillance system is too narrowly focused on pathogens and AMR in a laboratory setting.

A broader register, including clinical patient-level data, would help capture the true impact of AMR. Many superbug infections currently go unrecorded and the cause of death in some cases may be erroneously attributed to a co-existent condition, Dr Macesic said.

“The true death rate could be captured by ascertaining whether patients had an AMR infection at the time of death or shortly preceding it,” Dr Macesic said. “This would likely identify a greater number of patients where AMR infection may have contributed to their death, including in COVID-19 patients.

“A critically ill COVID-19 patient might develop an AMR infection in intensive care that is ultimately fatal, however their death may nevertheless be attributed to COVID-19.”

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