Taking steps to fight 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

• 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

• 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:
  • integrating them into general practice clinical information system software
  • supporting GPs to access existing clinical guidelines on antibiotic prescribing (such as Therapeutic Guidelines: Antibiotic and Therapeutic Guidelines: Respiratory)
• 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)

• Develop a module for the RACGP’s Standards for general practices (5th edition) to outline practice-based infection control policy
• Continue dissemination of the RACGP resource Infection prevention and control standards for general practices and other office-based and community-based practices (5th edition)

• 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

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