Researchers say Australia needs better monitoring to reduce antibiotic prescribing rates.

The authors of a review published in the Medical Journal of Australia say that about 1,600 people in Australia die as a direct result of antibiotic resistance each year.

“This will get steadily worse until, in 2050, deaths from currently treatable infections will overtake all cancer deaths,” the paper states.

The second consequence of the antibiotic resistance crisis is the risk that antibiotic resistance will pose to now routine high-technology medical care.

Without reliable antibiotic prophylaxis, procedures such as chemotherapy, bone marrow transplant, much major surgery (such as joint replacement) and invasive diagnostic procedures (like cardiac catheterisation) will become too dangerous to perform.

GPs contribute to most of the antibiotic tonnage consumed by humans in Australia, most often for acute respiratory infections (ARIs), say the authors.

They found a number of reasons why GPs prescribe so many antibiotics, including:

  • safety: it is difficult to separate apparently innocuous ARIs from the early stages of very serious infections
  • the doctor–patient relationship; GPs value this, and worry that not prescribing antibiotics threatens this relationship
  • time: GPs perceive that it is quicker to finish a consultation for ARI with an antibiotic prescription
  • misperceptions about effectiveness of antibiotics: GPs over-inflate the benefits of medical treatments generally

They suggest three key point for surveillance and potential targets:

  • the background level of antibiotic resistance in the community, using sentinel general practices to systematically sample infections or even uninfected attending patients
  • rates of total antibiotic prescribing by GPs
  • patient safety indicators, (serious infections admitted to hospital which might have been averted by earlier use of antibiotics)

The paper outlines are three approaches to help GPs reduce their antibiotic prescribing:

  • regulatory interventions, (such as having electronic health records default to “no repeats”
  • restricting access to several antibiotics earmarked for special conservation, via the Authority Prescribing System
  • the prescription of guideline-appropriate quantities, including externally administered interventions, activities that GPs can choose to implement themselves (including delayed prescribing, shared decision making, “nudge” techniques, voluntary audit and feedback, and highlighting non-antibiotic symptom treatment), and near-patient diagnostic testing to remove diagnostic uncertainty

“The Medical Research Future Fund has prioritised an initial $5.9 million to support antimicrobial resistance research, although what proportion of this fund will focus on reducing antibiotic use in the community remains to be seen. Strategies in Australia will require appropriate resources and implementation support for employing multiple modalities and a commitment for a sustained effort,” the authors concluded.