Prescribing improving, but antimicrobial resistance persists


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NPS MedicineWise is highlighting issues of antimicrobial resistance this week

Today begins the 2016 global Antibiotic Awareness Week (14-20 November 2016), and Australians are being urged to understand that antibiotic resistance is happening here and now, with increased rates of resistance being reported to many commonly-used antibiotics.

A new article from NPS MedicineWise describes how penicillins continue to be the most commonly-prescribed group of antibiotics in Australia, however, recent Australian data has suggested their ability to work against certain bacteria may be at risk.

NPS MedicineWise medical adviser Dr Andrew Boyden says that antibiotic resistance happens when bacteria change to protect themselves from an antibiotic. When this happens, antibiotics that previously would have killed the bacteria, or stopped them from multiplying, no longer work.

 

Antibiotics still prolific in Australia

Australia has high antibiotic prescribing rates, with more than 30 million prescriptions for antibiotics provided to Australians in 2014. Nearly half of the Australian population were prescribed at least one course of antibiotics.

“The more antibiotics are used, the more chances bacteria have to become resistant to them,” says Dr Boyden.

“Antibiotic-resistant bacteria can develop after antibiotic use. People can pass resistant bacteria on to others in a number of ways including through coughing or contact with contaminated hands, which is why hand hygiene is so important.”

Evidence suggests that inappropriate antibiotic prescribing by health professionals may be decreasing. For example, according to BEACH data, systemic antibiotics prescribed for acute upper respiratory tract infections have dropped from 32.8% of presentations in 2011-2012 to 29.0% in 2013-2014.

However, prescribing data indicate that antibiotics are still being frequently prescribed in situations that are not consistent with evidence-based guidelines, and that antibiotic type is sometimes not optimal.

 

Infections increasingly harder to treat

Spokesperson for the Australasian Society for Infectious Diseases, Associate Professor Katie Flanagan says that she and her colleagues are seeing an alarming increase in antibiotic resistant organisms in our hospitals, even among patients that have never been admitted to hospital previously.

“Many patients carrying these organisms have to be managed in individual rooms with private bathrooms, and the medical staff have to wear gloves and gowns for each patient encounter,” she says.

“In some cases the patients are simply colonised but not unwell with the organism (e.g. carrying the organisms on their skin or mucosal surfaces), but if they develop an invasive infection they can be difficult to treat because they don’t respond to first line antibiotic therapy.

“More worryingly, we are now starting to see cases of resistance to our last resort antibiotics such as meropenem, and are therefore facing a future where some infections may be impossible to treat.”

 

Pledge to handle antibiotics with care

Dr Boyden says the reality is that antibiotics are losing their power, but this Antibiotic Awareness Week—which has the theme ‘handle with care’—everyone can be part of the solution with their everyday behaviour.

“You can make antibiotic resistance worse if you use antibiotics when you don’t need them, use old packs of antibiotics for a new infection, share antibiotics among friends or family, or fail to take antibiotics as your doctor prescribes, including the right amount and at the right time,” he says.

This Antibiotic Awareness Week, individuals can pledge to do five things to reduce antibiotic resistance:

  • I will not ask for antibiotics for colds and the flu as they have no effect on viruses
  • I understand that antibiotics will not help me recover faster from a viral infection
  • I will only take antibiotics in the way they have been prescribed
  • I understand that it is possible to pass on antibiotic resistant bacteria to others
  • I will make a greater effort to prevent the spread of germs by practising good hygiene

 

NPS MedicineWise has an ongoing campaign to raise awareness about the serious public health issue of antibiotic resistance, and create behaviour changes that drive down inappropriate prescribing in Australia by health professionals and the misuse of antibiotics by consumers.

For Antibiotic Awareness Week 2016, NPS MedicineWise is again working with key national and international organisations in response to the growing problem of antibiotic resistance.

To find out more, and to get involved in this year’s global Antibiotic Awareness Week, go to nps.org.au/aaw2016

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3 Comments

  1. tom boyd
    14/11/2016

    Most antiboitics (approximately 80% in Australia, see statistics on kgs of antibiotics used by importation license application, a surgogate for who is using them) are used in subclinical dosages (not to eliminate bacteria, just to kill some and leave the more resistant ones to proliferate) used for animal growth enhancement in animal feed, agricultural use on crops to increase yields, fish farms feed to increase yields with the 20% remaining for human use. Monitoring resistant bacteria in humans is a blinded view of why resistant bacteria are rapidly rising. Most, if not all, resistant bacteria origins that have been traced ( see JETACAR report in AU and CDC report in US), come from animal origins (non-human). In surveys of resistant bacteria in animal environments, levels are alarming, they range from 25% to 87% of samples testing positive for resistance to some antibiotics. This is easily correlated with the use in these environments. With billions of bacteria exposed to subclinical doses of antimicrobials (name used for antibiotics) with the consequence that the more resistent ones survive, it is easy to understand how these then are tranferred from there to the animals and when handled or sold as food to the rest of the human race. To emphasize the overuse in humans, to the detriment of underusing, causing death and suffering, is a disservice and ingenuous given the elephant in the room. Do a service to humanity and share this information. It may not be friendly to the hand that feeds you, but morally required to have any semblance of the true picture.

    • Ronky
      23/11/2016

      You appear to be misapplying statistics from the USA to Australia where the situation is very different. Australia has a much more restrictive regime on the use of antibiotics in the agvet industry, and this has been tightened even further following the JETACAR report. Few antibiotics are allowed to be used in animals and in a very limited range of situations, especially in food-producing species, and they do not include any antibiotics which are of the same class as any of those used in man. They are not used at all on plant crops. Australia has far less need of antibiotics in agvet as many of the animal and plant diseases which are endemic in the rest of the world are absent here; and also because most of our livestock are raised on broadacre pastures rather than intensive farming where diseases easily spread. Australia has an enviable worldwide reputation for our clean, green, drug-free and disease-free livestock and food. Our rivals for export markets not infrequently start rumours to the contrary to try to steal our export customers.

      Also, bacterial resistance to antibiotics has been continuously present since billions of years before man existed, and resistant bacteria arise and spread no matter how responsibly man uses antibiotics. See e.g. http://www.medscape.com/viewarticle/870145?src=WNL_infoc_161122_MSCPEDIT_TEMP2&uac=92342BV&impID=1237518&faf=1

      • tom boyd
        26/11/2016

        I am quoting from scientifically reviewed articles on Australian use of anitbiotics. I am not sure what you base your opinion of ‘clean, green, drug free and disease free’. The most recent statistics available which I found in Australian Pesticides and Veterinary Medicines Authority 2014. Quantity of antimicrobial
        products sold for veterinary use in Australia: July 2005 to June 2010. ACT, Australia:
        Australian Pesticides and Veterinary Medicines Authority (2009-10, ten years after the JETACAR recommendations were published) report that at least 2/3 of antibiotics are used for 2 specific uses in agriculture, stock growth enhancement (more than half of all antibiotics used in Australia) and ‘therapeutic’ uses in stock animals. These do not count the uses in fowl, fish, and horticulture (such as almonds, apricots and peaches). I am curious as to your background and employment (hopefully not wasting time on a non-believer of the scientific method, a fanatic who works for/beholden to the pharmaceutical industry.. I am an Australian university trained health professional with some typing/spelling challenges). The rate at which resistent bacteria are found in samples of water, soil and feed range from 25% to greater the 50% in cases investigation origins/reserviors of bacteria resistent to some classes of antimicrobials. Also, most antibiotics use in agriculture, if not all, come from the classes used for human use (i.e. have the same mechanism of slowing bacterial growth). See the table in the AURA 2016 report on amtibiotic use by class and purpose, showing the the broad overlap.
        For many of the reasons above, the Australian College of Physicians recommends the cessation of use of anti-microbials in agriculture except in single animal use (i.e. not broad application to the environment).
        I fear for the addition death and suffereing of vulnerable individuals who are not given antibiotics because of hysteria about possible resistent bacteria developing, when all evidence found to date point to the development of theses in

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