Fighting the resistance
A recent article in the Medical Journal of Australia again reminds us of the growing threat of antibiotic resistant bacteria. Increasingly in Australia we are seeing antibiotic resistant infections occurring in the community and being acquired during international travel. This in turn serves as a reminder about responsible prescribing.
As GPs we are at the frontline of health care. We can and do play a significant role in preventing the occurrence and spread of antibiotic resistant organisms. But we must be vigilant. Bacteria are quick to adjust, spontaneously mutating or changing their genetic code to survive the antibiotic, and then sharing it with other bacteria.
Helping our patients understand the futility of antibiotic use for colds and viruses is a fundamental step we can take in protecting the potency and effectiveness of existing antibiotics. Helping them also to understand how to avoid common infections and the risks associated with overseas medical travel. Prudent use of antibiotics is another. This includes not using them when their benefit is minimal. Patients will of course need to understand that the symptoms they are experiencing is their own immune system working to resolve the infection. They also need to understand that using antibiotics in such cases may actually do more harm than good. Not only can it contribute to the development and transfer of resistant bacteria but patients risk possible side effects, such as upsetting the balance of gut bacteria and rashes.
Encouraging patients to vaccinate against preventable infections is another. Ensuring infants are immunised against Haemophilus influenzae type B, and at risk patients are vaccinated against influenza and Streptococcus pneumonia will help prevent illness and thus patient demand for antibiotic treatment.
When it is determined antibiotics are necessary narrow spectrum antibiotics, using optimal dosages and regimens, should be used. Patients should also understand the importance of taking the whole course as prescribed.
NPS Medicinewise, of which is the AMA is member, provides a range of material and resources to support GPs in the quality use of medicines. Regarding this issue the following may be helpful:
· practice points for prescribers and advice on assisting patients to adhere to therapy duration is available at: http://www.nps.org.au/publications/health-professional/nps-direct/2013/june-2013/duration-of-antibiotic-therapy
· a respiratory tract infections symptomatic management pad and patient counselling tool is available at: http://www.nps.org.au/health-professionals/resources-and-tools/decision-and-management-tools
The Therapeutic Guidelines also offers guidance on treatment protocols for a range of infections and antibiotic use across co-morbidities and high risk patients.
Concerns have been raised that globally the increase in antibiotic resistance has been driven, not only by unfettered use of antibiotics in human health, but also in agriculture and animal husbandry. In Australia, the Department of Agriculture, Forestry and Fisheries and the Australian Veterinary Association are fully involved in national strategies to limit antimicrobial resistance. The evidence is that the contribution of antibiotic resistance of antibiotic use in Australian animals is small, if any. This is due, no doubt, to Australia’s tight controls over the use of antibiotics in animals, which can only be prescribed by a veterinarian. Regulations require the antibiotics used for human health are different to those used in food animals, and different antibiotics are used for particular species and particular uses.
While a lot of ground breaking work is being done to combat the growing rise of antibiotic resistant bacteria prevention is the key. Preventing infections and preventing bacteria resistance getting a foot hold. This is part of the new strategy for fighting bacteria outlined by the Office of the Chief Scientist last year. The rule being to treat infection without driving resistance.
As GPs we have an important role to play in this frontline activity. Educating our patients about when it is appropriate to use antibiotics and when it is not, and of the importance of taking any course of antibiotics as prescribed. Responsibly prescribing and vaccinating against preventable infections. In doing so we help prevent infections and reduce antibiotic resistance. Reducing illness duration, hospitalisations, and the need for expensive therapies.