Experts get to grips with antibiotic resistance

lots of pills with an antibiotic capsule on top

Antibiotic resistance poses a major threat to global and Australian health, a group of leading experts in the area say.

At an industry briefing convened by Reckitt Benckiser, members of GRIP Australia—part of the Global Respiratory Infection Partnership, which involves leading primary care, hospital doctors, microbiologists, pharmacists and researchers—met to discuss raising awareness of antibiotic overuse for Upper Respiratory Tract Infections, including sore throats.

All participants said they wanted the public to understand that there were symptomatic alternatives, such as anti-inflammatory medications that would help alleviate URTIs, without the need for antibiotics.

The critical issue, the panel said at the briefing, is antibiotic resistance because GPs are dispensing them too often and consumers still feel they are the answer to colds and flu; antibiotics do not combat viral infections, however.

Despite ongoing campaigns by NPS MedicineWise and WHO about antibiotic overuse, Australia has one of the highest antibiotic prescribing rates in the world.

Consultant pharmacist Debbie Rigby says there is an urgent need to educate all groups, as overuse is leading to antibiotic resistance world-wide.

Chair of the Australian arm of the group, pharmacist John Bell, concedes that the issue is a double-edged sword, as some people genuinely need antibiotics.

However, there needs to be a conversation with customers and patients about how this is managed, which involves all healthcare professionals, he says.

Rigby agrees, but cautioned against a scare campaign. “[We] don’t want to scare people, but antibiotic resistance is the most critical thing that is affecting society.”

Dr Dominic Dwyer, infectious disease physician, from Westmead Hospital, Sydney, says convincing the public about the over-use of antibiotics, especially with the cold and flu season now upon us, is not easy.

“It’s a real struggle to explain it to the community.”

But he also agrees with Associate Professor John Gullotta, specialist and GP, Sydney Medical School, University of Sydney, that pharmacy and GPs have a major role in education.

A/Prof Gullotta says GPs, for a variety of reasons, are often under pressure to prescribe unnecessary antibiotics for URTIs, as patients ‘expect’ a script.

He stresses that people generally do not need antibiotics for viral UTIs; however certain groups, such as those patients with co-morbidities or immunosuppressed may need them.

“It is not a blunt ‘no’ to antibiotics,” he says. “In my practice I prescribe symptomatic OTCs on prescription paper to make a more formal recommendation.”

He adds that pharmacy staff should not just tell patients to go to their GP as it then makes it hard if the patient does not need an antibiotic.

Rather, pharmacy should recommend customers see their GP for an examination as they may need other treatments or medications—a subtle difference in the language used is important.

“The role of the pharmacist is in medication counselling and also advice on symptom control, and the recommendation of appropriate OTCs or S3s,” he says.

He says in the pharmacy setting making an accurate assessment about the need for antibiotics is “difficult”.

“The pharmacist does not have the full history and knowledge of the patient. This includes past medical history—and they cannot examine the patient or order tests.

“If the GP feels the patient needs an antibiotic then there should be no argument, and appropriate medication counselling should be provided by the pharmacist, including course duration and common side-effects.

Asked if he thought push to reduce the number of scripts written for antibiotics would lead to ‘doctor-shopping’, Gullotta thought not.

“I don’t believe it will lead to more doctor shopping if the advice given to patients is explained with care.

“I always tell patients that if they feel worse, or are not getting better to let me know so that they can be reviewed again, and of course, the need for antibiotics re-assessed if required,” he told the AJP.

“It is my practice to never make the patient feel inferior if they present for advice, or present for re-examination, especially in infants, children or the elderly whose condition may change quickly.”

It is always better to err on the side of caution when it comes to infection and health in general, he says.

“If a patient is bluntly turned away with no explanation and just a brazen ‘no’, then yes, it may lead to a breakdown in the GP-patient relationship, and the patient may seek another opinion from another GP.

“However, in my opinion this is rare if the option is given to return if the patient is worse.”

Dr Bell stresses that antibiotic misuse can only be effectively addressed by taking a more collaborative, approach to patient care, and guiding patients suffering from URTIs towards symptomatic relief and self-management strategies.

“We know antibiotics will not help relieve cold and flu symptoms nor speed up recovery, as the majority are caused by an inflammatory response to a viral infection.

“It’s crucial that as trusted healthcare professionals we are actively educating patients on the real source of their cold and flu symptoms and the effective anti-inflammatory and other symptomatic non-prescription treatments available. At the end of the day, patients simply want relief and to feel better from their symptoms.”

To support the GRIP initiative, free localised education materials will be available for download and guide patient counselling.

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