Push for antimicrobial resistance public awareness

Patients have once again been publicly warned not to pressure GPs into prescribing antibiotics that are not clinically required.
 
Among those urging caution is Australia’s Chief Medical Officer Professor Tony Lawler, who released a statement for World Antimicrobial Awareness Week this week, saying people should not take antibiotics ‘just in case’, nor use antimicrobials prescribed for other people.
 
Professor Lawler said tackling this resistance requires partnerships across the human, animal and environmental health sectors, as ‘the health of one affects all’.
 
‘Don’t pressure your doctor or veterinarian for antimicrobials if they say you or your animals don’t need them,’ he wrote in a message released jointly with Chief Veterinary Officer Dr Beth Cookson and Chief Environmental Biosecurity Officer Dr Bertie Hennecke.
   
‘Instead ask about other ways to manage the signs and symptoms.’
 
The awareness week is designed to highlight the dangers of antimicrobial resistance (AMR), which is cited by the World Health Organization as one of the most significant threats facing health professionals.
 
In one study, AMR was linked to almost five million deaths in 2019, including 1.27 million directly attributable to a resistant bacterial infection. Research recently published in The Lancet suggested that number could rise to almost two million by 2050.
 
Sydney GP Dr Michael Tam, a member of the RACGP Expert Committee – Quality Care (REC–QC), told newsGP the right public health messaging can be useful but is not always effective.
 
‘It’s a very important issue, because we all will suffer if we lose access to effective antibiotics, especially effective antibiotics that can be used orally,’ he said.
 
‘Public health messaging is very helpful because it sets the framing.
 
‘At the same time at the practical pointy end, when someone is sick in front of you, they’re actually not very useful arguments.’
 
He said that where he practises in South Western Sydney, there are some of the highest rates of antibiotic use in Australia, and GPs face pressure when patients have a preconceived idea of what they need – especially for their child’s treatment.
 
Dr Tam said a local study suggested that even when people understand the concept of AMR, it does not always influence their behaviour.
 
‘It’s really about trying to understand what the individual thinks the antibiotic is going to do for them,’ he said.
 
‘For instance, if they think the antibiotic will help with the pain, if their concern is actually addressed, the person is often quite happy not to have the antibiotic.’
 
Strategies such as delayed prescribing also have an impact, according to Dr Tam, but he warned about expanded pharmacy prescribing.
 
‘With some of the pharmacy trials, there are concerns you have easier access to antimicrobials and there is the likelihood that more will be used,’ he said.
 
‘That’s not been very coherent if the overarching goal is to reduce the use of antimicrobials in settings where they’re not likely to be beneficial.’
 
Dr Tam said the threat of antimicrobial resistance could have a profound impact on health professionals.
 
‘Antibiotics completely revolutionised modern healthcare. In the pre-antibiotic era, if you got pneumonia, you had a good chance of dying,’ he said.
 
‘If we get to the point where most oral antibiotics are no longer effective for everyday type infections such as urinary tract infections, then what would now be simple-to-manage health conditions may require very invasive treatments, maybe hospital-based treatments.
 
‘Imagine in parts of the world where healthcare is much more limited: it may mean that having what we now consider to be a simple everyday infection could lead to death.’
 
According to the Australian Commission on Safety and Quality in Health Care, there has been a reduction in antimicrobial use in Australia under the PBS since 2015 – although it notes an ‘unknown quantity of antimicrobials dispensed privately and supplied over-the-counter’.
 
Last year, there were 22 million antimicrobial prescriptions in Australia, a slight increase on the previous year, but 17% lower than 2019 and 24% lower than 2015.
 
Professor Mark Morgan, Chair of the REC–QC , told newsGP earlier this year that antibiotic resistant ‘superbugs’ are already causing significant harm.
 
While he noted that community use of antibiotics has gradually declined in Australia, he believes they are still over-prescribed, especially for acute respiratory infections.
 
‘It is vital that antimicrobial stewardship is practised consistently across all sectors of healthcare,’ Professor Morgan said.
 
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