'Nature’s fighting back': Antibiotic resistance scares, frustrates Australian doctors

File photo. Source: AAP

The rise of antibiotic resistance in Australia is frustrating and even scary, doctors say, with patients already presenting with infections that cannot be treated.

Australia’s increasing antibiotic resistance, caused by overuse of the drugs, is frustrating and scaring doctors.

Royal Melbourne Hospital infectious diseases physician, Kirsty Buising, told SBS News not enough was being done to halt the overuse of antibiotics, particularly in the community.

“Antibiotic use is climbing rapidly worldwide and Australia is arguably one of the highest users,” she said.

“We’re seeing the increase in resistance causing real clinical practical problems for us.

“I treat patients for whom I can’t find drugs that work.”

She said it would likely take several years for her and her research team to gather all the information they needed to establish the true extent of the antibiotic problem in Australia.

Figures from the Pharmaceutical Benefits Scheme (PBS) and the Repatriation Pharmaceutical Benefits Scheme (RPBS) show there were more than 29 million antibiotic prescription issued to 10 million unique patients, 45 per cent of the Australian population, in 2013.

However, the true rate is likely to be even higher as the figure of 29 million prescriptions does not take into account hospital antibiotic use or private prescriptions.

Professor John Turnidge, the senior medical adviser at the Australian Commission on Safety and Quality in Health Care, said Australia’s rate of antibiotic prescription by general practitioners was more than double that of the Netherlands and significantly higher than that of Sweden, but was similar to the UK on a per capita basis.

He said the use of the drugs in hospitals was probably similar quite similar to other countries, but there were no exact figures.

The rate of antibiotic use had been steadily increasing in Australia for the past 25 years, Professor Turnidge said.

“I treat patients for whom I can’t find drugs that work.”

“One of the most sinister things about antibiotic resistance is many bugs are able to stack [resistance to different drugs] up so you end up with multi-drug resistant bugs,” he told SBS News.

Associate Professor Buising said audit campaigns, which formed part of her research into antibiotic overuse and resistance, had lowered use in hospitals and residential aged care homes.

But these audits were much more difficult to implement in relation to GPs, because they were not controlled by a central body like hospital staff were.

Speaking at an Antibiotic Awareness Week briefing in 2015, infectious disease physician and microbiologist Professor Peter Collignon said Australia’s antibiotic resistance was relatively low.

“In Australia I think we’re very lucky,” he said.

“We have low levels of resistance despite having high levels of antibiotic usage in people. And what are the reasons for that? I think Pharmaceuticals Benefits and government regulations have a bit of it, because we don’t use as much of some of the worst types of antibiotics as some other places do.

“The fact that we don’t import fresh meats, the fact we have effectively banned some antibiotics like fluoroquinolones.”

Only 60 per cent of prescriptions compliant with guidelines

Professor Turnidge said there were two factors that contributed to antibiotic over use – the expectations of patients that they will be given them and over-prescription in the community.

A report from the Commission’s Antimicrobial Use and Resistance in Australia (AURA) project, found only 60 per cent of prescriptions “were compliant with national prescribing guidelines”.

In surgical situations, where antibiotics are used as a preventative measure, more than 40 per cent of the time they were used for more than 24 hours.

Were antibiotic resistance to continue and preventative antibiotics become unusable, certain surgeries, like heart surgery and joint replacements, would no longer be safe to do.

Meeting expectations

Research from 2014 by NPS MedicineWise found 57 per cent of GPs would prescribe antibiotics for upper respiratory tract infections to meet patient expectation.

Among patients, the research found 13 per cent of people would ask for antibiotics to treat a cold or a flu and 28 per cent believed it would help them get better, even though this was not the case as flus and colds are caused by viruses, not bacteria.

Associate Professor Buising, who is also the deputy director of National Centre for Antimicrobial Stewardship (NCAS) at the Doherty Institute, said it was frustrating to see patients with infections that were increasingly difficult to treat.

Resistant bacteria meant patients who would once have able to visit a general practitioner and get a prescription for oral antibiotics now had to spend time in hospital getting intravenous treatment, she said.

“We used to be mainly worried about golden staff, but more recently we’re seeing multi-drug resistant infections that mainly cause urinary tract infections and abdominal infections,” she said.

“We often say about 80 per cent of antibiotics used in Australia are probably used in animals, and of those used in humans, 80 per cent come from the community, from GPs.”

Professor Chris Del Mar, an academic GP at Bond University, said antibiotics were most commonly prescribed for respiratory infections and middle ear infection.

But he said by the time the drugs started to work they were unlikely to have much of an effect on the patient’s comfort level or illness, which would often eventually go away on its own.

“There may be 12 hours less pain if you use an antibiotic,” Professor Del Mar told SBS News.

“You may be a little bit better, but we have to talk about how much better.”

He said strategies to reduce antibiotic prescription had focused on encouraging GPs to test and assess whether the patient’s symptoms could be attributed to a virus.

“It turns out to be nearly impossible to tell which is bacterial and which is viral and when it comes down to it, we [GPs] were not certain ever.

However, this approach was problematic, Professor Del Mar said.

“It turns out to be nearly impossible to tell which is bacterial and which is viral and when it comes down to it, we [GPs] were not certain ever.

“I say to people, ‘even if it is a bacterial infection, antibiotics will make almost no difference, it’s going to get better by itself anyway’.

“We’re starting off with an established practise and that’s very difficult for GPs who think if it ain’t broke, why fix it.”

GPs needed to discuss the realities of antibiotic treatments and “hand over some of the decision to patients”, he said.

'Nature’s fighting back'

Sydney-based GP, and chair of the Australian Medical Association’s Council of General Practitioners, Dr Brian Morton, told SBS News it was time for Australians to reduce their antibiotic use.

“We’ve had too much of a good thing,” he said.

“We’ve relied on [antibiotics] and now nature’s fighting back.

“When someone says they’ve got the flu or a bad cold they’ve got a virus, and antibiotics don’t kill viruses.

“It’s an inappropriate use of antibiotics and it can lead to resistant strains [of bacteria] developing.”

He agreed with Professor Del Mar in that it was important to discuss the appropriate use of antibiotics with patients.

Dr Morton said the use of antibiotics of vet procedures and animal husbandry could also contribute to the rise of resistance in the community.

Professor Turnidge said it would take years to change the attitude and mindset around antibiotic use and may even require a “generational shift to make a benchmark change”.

“We know from experience in some countries where they’ve had effective campaigns…it has brought that resistance down,” he said.

“It never goes away completely – once resistance emerges it always stays around.”

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