Taking steps to fight antimicrobial resistance in general practice

Paul Hayes

24/11/2017 11:41:32 AM

The RACGP has proposed a number of activities designed to respond to the growing issue of antimicrobial resistance.

The RACGP is seeking support from the Federal Government to reduce antimicrobial resistance in general practice.
The RACGP is seeking support from the Federal Government to reduce antimicrobial resistance in general practice.

‘The RACGP recognises that antimicrobial resistance is a major problem and community-wide action is essential,’ Dr Evan Ackermann, a GP and member of the RACGP’s Therapeutic subcommittee,’ told newsGP.
The RACGP today released its ‘Antimicrobial stewardship position statement’ and ‘Response to antimicrobial resistance in primary care’ with a view to supporting a collaborative approach to appropriate antimicrobial use.
‘Support from the Federal Government is needed to implement community education, clinical governance, education for GPs, infection control, outcomes measurements, and research for [antimicrobial resistance] in primary care,’ RACGP president Dr Bastian Seidel said.
‘Antimicrobial stewardship programs are currently underdeveloped in general practice and require a more targeted approach away from the hospital-based method. Providing evidence-based interventions to support GPs in their prescribing decisions is the first step to employing an effective antimicrobial stewardship program.’
The RACGP has outlined a number of its key activities in ‘Response to antimicrobial resistance in primary care’, organised within six specific areas:
Community education

  • Publish a public position statement on antimicrobial stewardship
  • Work with other organisations (such as NPS MedicineWise) to develop and promote awareness of, and educational resources for, the need to reduce antibiotic use
Clinical governance
  • Advocate for the utilisation of Medicare funding as a resource to improve antimicrobial resistance strategies in general practice
  • Advocate for regulatory support to reduce unnecessary antibiotic use in the community:
    • Remove the over-the-counter pharmaceutical listing of topical antibiotics (eg chloramphenicol)
    • Encourage clinical information system software vendors to remove automatic prescription repeats for antibiotics
    • Date limits to prevent patients from taking an unnecessary second course and/or attempting to treat other unrelated ailments with a course of antibiotics not intended for the original purpose
    • Authority prescriptions for some antibiotics for which there is a national imperative to reduce use
GP education
  • Provide educational resources for GPs on effective methods for the safe reduction of antibiotic prescribing in an online toolkit
  • Collaborate with the National Prescribing Service to deliver effective health messages for GPs and their patients
  • Support the implementation of clinical guidelines on antibiotic prescribing by:
  • Address the topic of antibiotic prescribing/antimicrobial resistance in residential aged care facilities (RACFs) in the forthcoming edition of the RACGP’s Medical care of older persons in residential aged care facilities (the Silver Book)
Infection control Outcome monitoring
  • Develop appropriate antibiotic usage indicators for use within general practice
  • Work with government bodies to monitor national, state and Primary Health Network levels of:
    • antibiotic prescribing activity in primary care by health professional groups
    • rates of community antibiotic microbiome (commensals) resistance in Australia
    • hospital admission (including emergency departments) presentation rates for serious infections that might have been mitigated by antibiotic use in the community (eg community-acquired pneumonia, quinsy, otitis media, mastoiditis)
  • Research questions:
    • Strategies for safely reducing antibiotic use in general practice
    • The benefits of antibiotic treatment for common skin and soft tissue infections (such as wound infections, cellulitis, or infections following minor skin surgery) in primary care
    • Drivers of antibiotic prescribing in RACFs in order to determine how to support GPs to safely reduce antibiotic use

antibiotic-prescribing antibiotic-resistance antimicrobial-resistance antimicrobial-stewardship

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Sue Chambers   1/12/2017 8:06:04 AM

You are probably aware of "Script switch" which was put on our practice computers by the Primary Care Trust in UK,when you entered for instance a cephalosporin it would flash up a message about it's cost-effectiveness indications and warning of potential for C Difficile...would this be suitable here? As a GP from UK I can certainly see much higher use of Augmentin and Keflex here than UK, where generic Amoxycillin or Flucloxacillin are first line

Evan Ackermann   1/12/2017 11:18:26 AM

Hi Sue - was not aware of this intervention. Did you think it worked - or was it a source of annoyance? Do you think the spectrum of microbial resistance is different here compared to the UK?