Community stewardship needed to strengthen defence against antibiotic resistance

The growing threat of antibiotic resistance and Australia's overuse of antibiotics means we need a more careful approach to antibiotic use in the community, according to Duncan McKenzie of the Royal Hobart Hospital, Matthew Rawlins of the Royal Perth Hospital, and Bond University's Professor Chris Del Mar.

Writing in the latest edition of Australian Prescriber, the authors say we need urgent action to preserve antibiotic effectiveness into the future as our use of existing antibiotics leads to more antibiotic-resistant bacteria and the pipeline of new antibiotics dries up.

"Community GPs prescribe the greatest proportion of antibiotics in Australia. Clearly, successful strategies to improve antibiotic use and reduce adverse events in hospitals need to be extended to the community where the antibiotic use is at its greatest," say the authors.

"In hospitals, strategies using 'antimicrobial stewardship' have reduced inappropriate antibiotic use by 22-36 percent. These strategies improve patient outcomes and reduce the adverse consequences of antibiotic use, including antibiotic resistance, side effects and unnecessary costs."

The authors write that strategies such as computer-based restriction of antibiotic prescriptions, regular ward rounds by infectious disease doctors, and feedback for prescribers have improved antibiotic use in hospitals.

"One example of success is the antibiotic stewardship program launched at the Royal Hobart Hospital in 2009. In its first year, the program reduced spending on antibiotics by 30 percent and saw a 20 percent reduction in prescribing of certain antibiotics."

According to the authors, Australia needs similar strategies to improve antibiotic use in the community where it is greatest.

"Three strategies have already been implemented in the community with some success. Antibiotic restriction, prescriber and patient education, and post-prescribing feedback measures contributed to a reduction in antibiotic prescribing for acute respiratory tract infections between 2000 and 2005. But since then, little has changed."

The authors say one solution could be to establish antimicrobial stewardship teams to provide ongoing education for prescribers and consumers, coordinate research, and collect data in the community.

"We've seen the success of initiatives that combine doctor, patient and public education in the NPS MedicineWise campaign to reduce inappropriate prescribing for acute respiratory tract infections.

"Working with health professionals to reduce inappropriate prescribing while also addressing consumers' misconceptions about antibiotics is one of the best ways to build a systematic defence against the growing threat of antibiotic resistance."

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