International commitment to tackle antimicrobial resistance

The World Health Organization’s (WHO) supreme decision-making body urged members to adopt multi-sectoral National Action Plans that strengthen infection prevention and control measures, including water sanitation and hygiene; enhance participation in the Global Antimicrobial Surveillance System; ensure prudent use of quality-assured antimicrobials; and support the multi-sectoral annual self-assessment survey.
 
Associate Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care (REC–QC), told newsGP he believes antimicrobial resistance is the ‘global warming’ of healthcare that requires a ‘multipronged’ approach.
 
‘[It needs] high quality research, identification and understanding of positive variance, by which I mean the good news stories where improvements have been made and a concerted effort by all sectors of health, agriculture and vet practice,’ he said.
 
‘There are questions that I think still need to be answered by research. For example – if you introduce multiple measures to reduce antibiotic use – how will resistance patterns improve and how will the spread of super bugs be reduced? How long do resistant microbes survive once the selection pressure from antimicrobial treatments has been removed?
 
‘There needs to be monitoring of the impact of antimicrobial stewardship. Examples include, surveillance by swab and test methods, counts of the impact of resistant infections. We should also look at the unintended consequences of reduced antibiotic prescribing by monitoring potentially preventable hospital admissions due to infections.’
 
Dr Evan Ackermann, co-author of the RACGP’s Response to antimicrobial resistance in primary care, told newsGP the World Health Assembly’s (WHA) resolution is a ‘positive step’, but added that Australia is still ‘very much at the beginning’ of developing a national strategy.
 
‘It is … a timely reminder that antimicrobial stewardship is a critical issue facing health worldwide,’ he said.
 
‘For Australia and in particular for general practice, I think priority should be focused on what success looks like for primary care; consistency in semantics, eg antimicrobial versus antibiotic, systemic versus topical; what we are to measure and how we measure it; and what interventions are planned.
 
‘The Antimicrobial use and resistance in Australia 2019 (AURA 2019) report [also] paints some very positive findings for general practice – in general, antibiotic use is decreasing.’
 
The WHA resolution also requests that WHO Director-General Dr Tedros Adhanom Ghebreyesus significantly enhances support to help countries implement National Action Plans and mobilise funds, in collaboration with other UN agencies and partners.
 
Finally, it calls on Dr Adhanom Ghebreyesu to maintain the WHO list of Critically Important Antimicrobials for human medicine and keep member states informed of WHO’s work with the other members of the Tripartite (the Food and Agriculture Organisation and the World Organisation for Animal Health) and UN agencies.
 
Associate Professor Morgan added that shared decision making – often using decision aids – is another powerful technique that can help fight antimicrobial resistance, as they demonstrate the rather small impact antibiotics have on illness duration, especially compared with the risk of side effects.
 
‘If we added the impact on individual biomes I think that starts to build a partnership with patients in which people will happily choose not to take antibiotics for potentially self-limiting conditions,’ he said.
 
‘I am really pleased the AURA 2019 report describes that antibiotic use in primary care is reducing.’
 
However, while general practice is making ‘good progress’ reducing inappropriate antibiotic use, Associate Professor Morgan is worried about moves that potentially dilute GPs’ abilities to act as antimicrobial stewards.
 
‘I live and work in Queensland. The state government here has made the strange decision to allow pharmacy prescribing antibiotics for UTIs [urinary tract infections]. Given the significant increase in chloramphenicol use when this treatment was down-scheduled and many other international examples of increased antibiotic use when pharmacies supply without a doctor’s review, I think this is a backwards step,’ he said.
 
‘Queensland should ideally reverse the decision, and if not, the use of antibiotics should be carefully monitored. Going back to my global warming analogy – the Queensland Government decision to allow pharmacy prescribing of antibiotics is akin to opening up a new thermal coal mine.’
 
Aside from vowing to combat antimicrobial resistance, WHA delegates passed a resolution pushing members to implement the Declaration of Astana, as part of efforts to achieve universal healthcare coverage.
 
The declaration, adopted at the 2018 Global Conference on Primary Health Care, recognises the key role strong primary healthcare plays in ensuring countries can provide the full range of health services a person needs throughout their life.
 
In addition, the resolution also requires the WHO to finalise its Primary Health Care Operational Framework ahead of next year’s WHA.

antimicrobial resistance Declaration of Astana World Health Assembly World Health Organization